Measuring Psychological Distress:

A Preventive Approach towards Evaluating Mental Wellness

Susan Harrill

Independent Research Proposal

Abstract:
Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

This paper advocates for research investigating the relationship between the experience

of implicit perceptions of satisfaction with protective factors and risk factors thought to be

correlated to the emergence of mental health difficulties. It details a novel screening measure to

be used to evaluate this relationship. It is hoped that through evaluation of changes in risk

factors and protective factors, prevention and promotion strategies can be put into place to

reduce the impact and prevalence of mental health disorders as susceptibility changes. The

proposed research is longitudinal.

If the proposed measure is supported by data it might support suicide prevention. It

might also have significant implications for policymakers who evaluate mental health

management systems.

Table of Contents

I. Introduction with Literature review

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

II. Research Method

A. Participants

B. Measures

C. Formulas and Expected trends

D. Data Analysis

III. Conclusions

IV. Appendix A—Definition of terms

V. Working Citations

Introduction with Literature Review

One recommendation to reduce the incidence of mental health disorders has been the

completion of annual mental health checkups as a way to screen for undiagnosed disorders and

initiate primary prevention (Naubert, R; Contrera, J; Moffic, S). Despite there being many

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

screening tools available, there has been no consensus as to the implementation of these tools for

various reasons. Research is needed to further develop screening measures favoring positive

approaches to the evaluation of mental health situations across the lifespan so that more

screening options are available for implementing annual mental health checkups to support

prevention efforts.

The purpose of this proposed study is to generate data through the use of a novel

screening measure evaluating the correlation between reports of satisfaction with protective

factors and risk factors and the onset of mental health dysfunctions. This project is important

because, with the development of an effective and comprehensive health monitoring measure,

there might be more data to address mental health problems proactively—at the onset of

psychological distress—rather than when full criteria for mental disorders are met.

The first topic to be addressed by this study relates to increased understanding of how

individuals transverse between states of mental wellness and illness as well as an understanding

of what constitutes mental “health”. Too often the term “healthy” can be misleading when

applied to mental health because in the same manner that no individual is completely physically

healthy or without risk, no individual is completely mentally healthy or without risk.

Approximately 26% of Americans suffer from mental illness in any year. One might assume this

means the remaining 74% are mentally healthy, however, this is not the case. Only 17% of

Americans were found to be “flourishing” or “completely mentally healthy” (Keyes, 2003).

Sub-threshold mental disorders, which account for those not “completely flourishing”, affect a

large proportion of the population (World Health Organization and Calouste Gulbenkian

Foundation).

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

At this time clinicians generally see only a proportion of the individuals within the 26%

of those who experience clinically significant difficulties meaning little is known about the

mental health of the remaining populations. Through the proposed longitudinal study,

researchers might have a better understanding of the health of those individuals who are not

experiencing mental health difficulties but might be at-risk or who identify as “mentally healthy”

but might not be “completely” mentally healthy.

Next, the proposed research would advance our understanding of the relationship

between precipitating events and the interplay between protective factors, risk factors, and the

development of later mental health difficulties. Oftentimes, mental health is focused on mental

ill-health, rather than on wellness. In turn, there is little data available relating to precipitating

factors that appear to play a role in the development of dysfunctions. This suggests research

should focus on individuals before they report symptoms of psychological dysfunction rather

than provide focus after symptoms of dysfunction are present.

Many tests and screening measures are currently reflective of a categorical model rather

than a dimensional diagnostic model (McCord, 2019). It is reported, prevention research,

especially as related to assessments, is lacking (World Psychiatry, 2006). The National Institute

of Mental Health attributes the lack of progress in this field as being related to the underlying

diagnostic model (NIMH). One of the problems with a categorical model is that it “diminishes

the ability for treatment to target the specific symptoms a patient is experiencing and instead

focuses only on treating specific constructs” of disorders (Hannah G Mitchell, Dan Frayne,

Brandon Wyatt, Haley Goller & David M. McCord, 2019). What is needed is systematic

evidence-based prevention and promotion-based research to combat this problem.

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

To date, no other studies have attempted to evaluate the correlation between change over

time in implicit perceptions of satisfaction with risk factors and protective factors and links to the

development of disorders, in line with prevention and early intervention aims.

Mental illnesses have a huge impact on whole populations. The World Health

Organization reports that four-hundred-fifty million people worldwide suffer from mental and

behavioral disorders (WHO, 2004). One in four people is expected to develop one or more

disorders throughout their lifespan (WHO, 2001B). Of those who develop a disorder, 45% meet

the criteria for two or more other mental disorders (McCord, 2019). Additionally, “50% of

chronic mental health conditions begin by age fourteen and 75% of individuals will experience

early onset of disorders before age twenty-five essentially making mental health a life long

struggle” (Insel, T).

The proposed research could be useful because mental disorders present immediate

concerns in the lives of those affected and in those around them. They also have effects on

physical health, social health, and impacts on future endeavors (WHO). Consequences of failing

to address mental health needs proactively, include increased rates of incarceration,

homelessness, school drop-out, and job loss. These are difficulties that may begin early in life

and carry over into adulthood suggesting the need for research involving youth and young adults

to address issues before they impede on functioning in multiple settings.

Finally, in addition to brain disorders presenting concerns in the lives of those affected,

the increased prevalence of mental illness is a societal concern in that it contributes to

nationwide and worldwide financial burdens. In 1989, the U.S. alone spent approximately $147

Billion in annual costs related to mental health treatment (Institute of Medicine, 1989; WHO).

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

That number has been steadily increasing. A report completed by the World Health

Organization estimates “the global cost of mental illness at $2.5 Trillion (two-thirds of that in

indirect costs)” (WHO). By 2030, the worldwide costs associated with mental health treatment

are expected to reach $6 Trillion (ning.nih.gov). Research is necessary to address challenges

with reactive rather than a proactive assessment of mental health needs to potentially reduce

these trends.

Hypotheses are multifaceted; first, it is hypothesized that perception of life satisfaction is

a relatively stable trait in the absence of trauma or major life stressors. If perception of

satisfaction is a trait, then a normative screening measure might be appropriate to evaluate

changes in perception of satisfaction-- thought to be correlated to the increased susceptibility of

brain disorders. This leads to the second hypothesis that there is a correlation between the

experience of mental distress and changes in perception of satisfaction with protective factors

and risk factors. The third hypothesis states that over time, a significant decrease in the implicit

perception of satisfaction with protective factors and subsequent increase in risk factors is

correlated with an increased likelihood for the development of brain disorders. The fourth

hypothesis states that over time, an increase in perception of satisfaction with protective factors

and a subsequent decrease in risk factors positively correlates to wellness. If the first hypotheses

are supported, then it is predicted that there is an identifiable threshold at which symptoms

crossover from psychological distress to diagnosable mental illnesses or brain disorders that

could be differentiated upon to initiate early intervention.

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

Prior research suggests that people of all ranges of satisfaction are at risk of developing

mental illnesses. It is predicted however that it is when there is a significant change between

scores on yearly administrations of the proposed measure that people’s susceptibility for

developing a brain disorder is either increased or decreased based on self-reported perceptions of

satisfaction with protective factors and risk factors (in which the presence of satisfaction

indicates a protective factor and absence of satisfaction a risk factor). While there will be

considerable variability between respondents, if the first hypothesis holds and perception of

satisfaction is a trait, these variables will be controlled for within personal response patterns.

Again, to date, no other studies have attempted to evaluate the correlation between

change over time in implicit perceptions of satisfaction with risk factors and protective factors

and links to the development of disorders, in line with prevention and early intervention aims.

Promotion strategies relating to monitoring mental health have included "collecting data on

existing information systems and indicators” and efforts to harmonize existing definitions of

mental health indicators, with many indicators being partial measures of complex problems

(Europa.eu).

In 1999 a two-year plan, the European Community Health Indicator (ECHI), was enacted

to measure the mental health of European communities. The most important aspects to be

measured by this monitoring was transference between states of mental health, vulnerability or

psychological distress, and mental ill-health or disorder. The main indicators evaluated by the

ECHI were demographics and socio-economic factors, health status, determinants of health, and

health systems as it is reported that “many common mental disorders are shaped to a great extent

by social, economic, and environmental factors'' (World Health Organization and Calouste

Gulbenkian Foundation). In the ECHI study, thirty-six testing measures were used to evaluate

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

overall health. While all tests were valid and reliable, some tests were determined as needing

development. These in need of areas included predisposing factors, precipitating factors, social

interactions, individual resources, and individual experience. Data relating to risk factors and

protective factors were also in need of development (Europa.eu). While this research was useful

it was also somewhat problematic in that it required thirty-six individual measures, scoring could

be complicated, and it relied upon tests developed for reasons other than mental health

monitoring suggesting the need for the development of a comprehensive mental health

monitoring tool.

Research completed in the 1990s and 2000s suggests a relationship between risk factors,

protective factors, and links to developing mental disorders (e.g. Cole et al 1993, Ingram and

Price, 2000; Coie JD, Watt NF, West SG, et al, 1993; Ingram RE, Price JM, editors, 2000). It is

reported that it is “mainly the cumulative effect of the presence of multiple risk factors, the lack

of protective factors, and the interplay of risk and protective factors that predispose individuals

to move from a mentally healthy condition to increased vulnerability, then to a mental problem,

and finally to a full-blown disorder” (WHO). Increased vulnerability, which is somewhat vague,

may be better construed as psychological distress. The cognitive dissonance resulting from

changes in satisfaction between administrations of the proposed measure is thought to be

reflective of psychological distress. The proposed research measure attempts to measure this

distress to determine:

1. How much dissonance the average person experiences in a year and

2. If there is a rating of dissonance or change in perception of satisfaction

with protective factors and risk factors that correlates to mental health dysfunction

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

Finally, assessments are one of the primary tools used to evaluate mental-ill health.

While many professionals use templates or questionnaires to complete interviews (one part of

assessments) this is one of the only non-standardized components of a psychological assessment.

The proposed research measure (see below) is roughly based on prompts contained in an

interview. Overall there is much information to be gained from interviews; data obtained through

the interview often inform recommendations made by psychologists or other professionals.

While non-standardized interviews are useful, there is also information to be gained from the

standardization of interview-type questions as this provides a concrete way of monitoring

changes in perception thought to be correlated to mental dysfunction.

One of the limitations of comprehensive psychological assessments is the time required

to administer the full battery of tests. Through the use of the proposed screening measure, it is

thought that assessment processes might be streamlined in that professionals will more

conclusively know who might benefit most from further comprehensive assessment following

administration and scoring of the proposed measure.

In summary, while a decrease in protective factors, an increase of risk factors, and the

interplay between variables is reported to be correlated with mental-ill health, there is still little

data available regarding cognitive dissonance occurring from change in factors over time or how

that impacts self-efficacy and overall mental health or wellness.

Many times, the chemistry of the brain changes even before the onset of the earliest

behavioral detection. Figure 1 depicts changes that are detectable in the brain functioning of

schizophrenic patients using neuro-imaging. While change is clear with brain imaging, this

patient did not present behavioral symptoms or meet the criteria for diagnosis until much later

despite most likely experiencing psychological distress much earlier than at the time they met the

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

criteria for diagnosis. If other mental illnesses affect the brain similarly, promotion strategies

(such as the monitoring tool suggested), are critical to improving outlook for affected

individuals. Perhaps-- had this individual been involved in regular screening-- distress might

have been recognized sooner resulting in indeterminate diagnosis but also resulting in utilitarios

treatment options.

[Figure 1]—Changes in Brain Chemistry of a Schizophrenic patient. (Ted Talk- Thomas Insel)

II. Research Method

The present study is a longitudinal study that assesses implicit self-perceptions of life

satisfaction with protective factors and risk factors at yearly intervals to examine correlations

between brain disorders and perception of satisfaction based on scores from results of functional

analyses.
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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

Initially, the proposed measure would be administered along with a mental health test

such as the MMPI-A in order to screen for preexisting conditions. Of most interest are

individuals who endorse no significant elevations on the MMPI-A but then endorse upon their

next annual visit, subthreshold elevations in some areas. These are the individuals who are

proposed to have “developed” mental illnesses or be showing signs of increased susceptibility.

For research purposes derived scores from these individuals would be compared to see if there

were any similarities in patterns of responding on the proposed measure. It is theorized that

individuals who report elevations on the MMPI-A will also report significant change between

administrations of the proposed measure suggesting a correlation between mental health

dysfunctions and perception of satisfaction.

A trauma survey would be administered along with the proposed measure and mental

health survey to test the predicating hypothesis-- that in the absence of trauma or stressors,

perception of satisfaction is a relatively stable trait. Individuals of most interest are those who

report no trauma or stressors within a one-year period. Scores from these individuals would be

compared to evaluate how much change on the proposed measure was reported. It is

hypothesized they would show little change in derived scores suggesting that perception of

satisfaction is a relatively stable trait. It is predicted that even individuals who experience

trauma, not all will develop mental health difficulties because it is supposed that some people

have greater resiliency. It is proposed that those people who do not experience an increase in

perception of satisfaction following trauma or stressors are most at risk of developing mental

dysfunctions.

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

Protective factors and risk factors, malleable determinants of mental health, useful for

this reason for promotion purposes, are the proposed dependent variables in the current study.

Age would be considered an independent variable.

Participants

While this measure could be administered to any age group, for research purposes,

ideally individuals aged 14 to 25 would participate in the initial research. These ages were

selected because when and how mental health is evaluated is important (as mental difficulties

usually develop early in life); these years were selected because they are the years when many

youth and young adults begin to experience mental health difficulties.

Participants might be selected from a high school or from a university willing to

participate in research. Another way to accomplish this research would be to screen individuals,

of appropriate ages, in conjunction with visits to their primary care providers resulting in an

integrated research approach.

Measures

Primary measure:

The proposed measure would contain questions similar to questions posed by a clinical

interview. Each question would require a judgment by the respondent. While questions are not

designed to address why respondents make specific endorsements, endorsements are thought to

be revealing when measuring change over time. Questions might be purposefully vague in order

to achieve cultural sensitivity as well as to address a variety of protective and risk factors in one

standardized format.

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

All questions might be given equal value by the evaluator with the respondent assigning

importance to each item based on their own unique cultural or personal values. While the

perception of satisfaction will vary depending on socioeconomic factors, resources, and cultural

norms, these differences should remain person-specific and can be factored out by completing

this study longitudinally because these are factors that are proposed to be relatively resistant to

short-term change.

While response patterns will vary from person to person it is predicted they will be

reflective of inner causation and should remain person specific over time. It is predicted

responses will be reflective of people’s current experience. Because people will respond based

on their unique experience this measure should be the same for all individuals regardless of age

so that items are diverse and sensitive to the overall range of experiences throughout the lifespan.

B. Proposed Research Measure

Instructions:

On the following pages are prompts that relate to common experiences. These

experiences are related to protective factors and risk factors. The following questions apply to

diverse populations so not all questions may be relevant to you. Please read each prompt,

evaluate your response, and mark your response using the rating scale provided. The rating scale

ranges from 0-10 with 1 being “least”, 5 being average, 10 being “most”, and 0 being not

applicable. Please do your best to mark every item. If you are unsure of your response give it

your best estimate.

Identifying Information for Measure:

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

Name: _______________ Patient ID_____________ Age__________________

Gender__________________ Ethnicity_______________________

In the past year have mental health issues impacted your daily functioning? Yes or No

If yes, rate the degree to which mental health impacted your daily living with 1 being least

substantially and 10 being most substantially: 1-10 scale

In the past year have you experienced suicidal thoughts or intentions? Yes or No

Questionnaire:

Evaluate your perception of satisfaction with the following items:

1. Perception of satisfaction with your current living situation:

2. Perception of satisfaction with your relationship with your mother:

3. Perception of satisfaction with your relationship with your father:

5. Perception of satisfaction with your relationship with your siblings:

6. Perception of satisfaction with your relationship with your significant other:

7. Perception of satisfaction with access to social supports:

8. Perception of satisfaction with the physical health of family members:

9. Perception of satisfaction with the mental health of family members:

10. Perception of satisfaction with your physical health:

11. Perception of satisfaction with your mental health: (Critical item)

12. Perception of satisfaction with your eating habits:

13. Perception of satisfaction with your level of physical activity:

14. Perception of satisfaction with your maintenance of personal hygiene:

15. Perception of satisfaction with your level of stress:

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

16. Perception of satisfaction with your ability to adapt to change:

17. Perception of satisfaction with access to treatment options to address physical health needs:

18. Perception of satisfaction with access to treatment options to address mental health needs:

19. Perception of satisfaction with your use of drugs, alcohol, or controlled substances:

20. Perception of satisfaction with family members use of drugs, alcohol, or controlled

substances:

21. Perception of satisfaction with your social skills:

22. Perception of satisfaction with involvement in completing routine household chores:

23. Perception of satisfaction with involvement in leisure activities:

24. Perception of satisfaction with involvement in groups or group activities:

25. Perception of satisfaction with educational opportunities:

26. Perception of satisfaction with occupational opportunities:

27. Perception of satisfaction with your current financial situation:

28. Perception of satisfaction with the ability to maintain a balance between family, work, and

other obligations:

29. Perception of satisfaction with time management ability:

30. Perception of satisfaction with involvement in religious/ spiritual affiliations:

31. Perception of satisfaction with the outlook for the future:

32. Perception of satisfaction with sleep habits:

Formulas and Expected Trends

Formula:

l(yr 1 satisfaction -yr 2 satisfaction)l x difference from mean for age range

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

Sample of expected trends:

Individuals are all 18 years old during yr 1. The mean perception of satisfaction for an

18-year-old is 105. Individuals are 19 years old during yr. 2. The mean perception of

satisfaction for a 19-year-old is 100.

Avery Evan Ryan Carmen Taylor Riley

Yr. 1 score= Yr. 1 score= Yr. 1 score= Yr. 1 score= Yr. 1 score Yr 1 score =

82 115 115 72 =105 90

Yr. 2 score Yr. 2 score = Yr. 2 score =90 yr. 2 score= Yr. 2 score = Yr. 2

=72 105 82 115 score=115

l(yr1-yr2)l x l(yr1-yr2)l x l(yr1-yr2)l x l(yr1-yr2)l x l(yr1-yr2)l x l(yr1-yr2)l x

diff. from diff. from diff. from diff. from diff. from diff. from

mean mean mean mean mean mean

l(82-72)l x - l(115-105)lx l(115-90)l x - l(72-82)l x -18 l(105-115)lx l(90-115)l x15

24 5 10 15

10 x -24= - 10 x 5 = 50 25 x -10= -250 10 x-18= -180 10 x 15= 150 25 x 15= 375

240

Explanation of hypothetical samples:

Avery, Evan, and Ryan all report a decline in the perception of satisfaction with

protective factors and an increase in risk factors. Avery and Evan both report a 10 point drop in

satisfaction between year one and year two. Despite similarities in responding Avery is more at

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

risk to experience mental health difficulties than Evan because her initial report of satisfaction

was lower. Despite experiencing a downward trend Evan is most likely not at risk at this time of

developing a mental illness. Despite Evans' positive score, she may require more follow-up than

individuals who report an increase in perception of satisfaction.

Evan and Ryan both initially report satisfaction at 115 however based on Ryan’s

substantial decline he is more likely to develop difficulties than Evan. Finally, Avery and Ryan

despite responding differently, are at similar risk for developing difficulties based on overall

scores of -240 and -250. It is hypothesized that individuals with the lowest scores may be more at

risk of committing suicide than individuals with higher scores. This is something that should be

monitored closely and would require further research.

Carmen, Taylor and Riley all report an increase in perception of satisfaction from the

previous years report. Despite experiencing an increase in perception of satisfaction Carmen is

most likely still at higher risk of experiencing mental health difficulties because her initial report

of satisfaction was lower than Taylor and Riley. She may however not be as high at risk as

Avery and Ryan for developing a new disorder.

Taylor and Riley both earned high positive scores. Taylor and Riley may both currently

be in “good” mental health. Riley’s score may be somewhat unusual in that it is expected that

positive perceptual change, much like behavior modification, is hard to achieve and maintain

within a relatively short time period without conscious effort.

Data Analysis

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

If derivatives of perception of satisfaction are plotted onto a chart, it is hypothesized that

there is a threshold at which people stop reporting “good” mental health and start reporting poor

mental health. This threshold may be noticeable before individuals meet the criteria for mental

dysfunction.

VI. Conclusion

The World Health Organization cites prevention as being crucial to address the mental

health crisis. Preventive strategies “have been found to reduce risk factors, strengthen protective

factors, decrease psychiatric symptoms and the onset of some mental disorders; they also

contribute to better mental and physical health benefits and generate social and economic

benefits” (World Psychiatry).

While prevention and early intervention endeavors are effective (WHO), preventive

and early intervention aims are “only implemented in pockets throughout the country”

(Mentalhealthamerica.net). This trend may exist because at the time that our healthcare system

was structured not much research existed regarding prevention and early intervention

(Mentalhealthamerica.net). While there is now data supporting benefits of prevention and early

intervention, there is still largely a lack of implementation of these practices in part due to initial

startup costs, but also because there is still a lack of concrete evidence supporting effectiveness

of prevention and early intervention versus treatment.

Despite some lack of implementation, the World Health Organization reports that through

prevention the risk of mental disorders can be reduced (WHO). Moving forwards they stress the

need for evidence-based measures that are culturally sensitive and applicable in diverse contexts

to be used to inform integrated public policy (WHO). It is reported that policies need to:

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

1. “Be based on the systematic assessment of public mental health needs

2. Address evidence-based biological, psychological, and social risk and protective

factors and their interactions over the lifespan and

3. Have the capacity to have a large reach on the mental health of whole

populations” (WHO)

If this studies research results are supported, the current proposal satisfies the

recommendations made by the World Health Organization and it could be suggested that testing

should be completed annually for all individuals to evaluate the risk for developing brain

disorders in order to initiate primary prevention and screen for undiagnosed psychological

distress.

While there are arguments to be made that prevention and early intervention efforts are

too expensive, it can be argued that it is too costly not to implement preventive and early

intervention strategies especially when disability-adjusted life years (DALY’s) are taken into

consideration. Additionally, many preventions and early intervention strategies are compatible

with human rights issues and should be the focus of everyone. Finally, many preventions and

early intervention strategies are things that individuals most likely report an interest in doing

anyway--such as eating better, increasing physical activity, being more socially involved,

enjoying leisure time, and getting plenty of sleep.

In some cases, at the core of the problem relating to mental health is:

• Lack of routine person inclusive information collection and exchange

• Lack of early detection measures sensitive to change over time regarding

protective and risk factors and

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

• Lack of early solution-based interventions tailored to individual needs based on

screening measures

This research attempts to address these concerns.

Lastly, currently in non-emergent situations, areas of mental health concern might first be

identified using an assessment or screening tool. In emergent mental health situations, providers

sometimes face challenges because of a lack of patient data before the implementation of more

aggressive behavior modification strategies. If mental health providers had access to routinely

maintained mental health data, (similar to how healthcare professionals have access to yearly

physical information), “diagnosis” might be more accurate (even if they were more generalized

rather than disease-specific), treatment might be more helpful in ameliorating symptoms, and

recommendations might be more reflective of hope.

Intervention is necessary when people move from vulnerable status to dysfunction; it is at

this time that disease-specific intervention and specific diagnoses become more imperative

however much can potentially be done before this point. Not to discount the need for diagnosis,

however many times if difficulties are caught early they could be classified as adjustment

disorders or be classified by deferred diagnoses which might be more easily treated. While some

mental health difficulties may be chronic they are not necessarily pervasive and may only be as

invasive as allowed.

In the future, if steps are taken to address the knowledge gap, screening measures could

be used in many contexts to support mental wellness. People might be helped before the onset of

obvious distress. Standardized screenings could lead to early interventions which in turn might

have an impact on functioning across various settings.

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

Because there is overlap between platforms it becomes less complicated to determine

who should implement proposed standards of care, because solutions can be multidimensional

when brainstorming problem solving strategies. What is proposed is a life course approach that

suggests action be taken to improve the conditions in which people are born, grow, live, work,

and age to reduce inequality as:

“Certain subgroups are at higher risk of mental disorders because of greater exposure and

vulnerability to unfavorable social, economic, and environmental circumstances,

interrelated with gender. Disadvantage starts early in life and accumulates throughout”

(World Health Organization and Calouste Gulbenkian Foundation).

It is recommended that “promotion and prevention should be integrated within a public

policy approach that encompasses horizontal action through different public sectors such as the

environment, housing, social welfare, labor and employment, education, criminal justice, and

human rights”. This would be reported to ”create win-win situations across sectors, including a

wide range of health, social, and economic benefits” (World Psychiatry). Policies should follow

principles of proportionate universalism meaning “policies should be universal yet proportionate

in need” as “Focusing solely on the most disadvantaged of people will fail to achieve the

required reduction in health inequalities necessary to reduce the steepness of the social gradient

in health” (World Health Organization and Calouste Gulbenkian Foundation). In the long run,

this research could go a long way to assisting people with various mental health difficulties and

sub-threshold mental health difficulties especially if implemented within an integrated universal

health care approach.

Future research might focus on other upward and downward “perceptual self

comparisons” that people make about their current self to past perceptions of themselves. Social

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

media trends such as “Throwback Thursday” and accessibility of “Facebook memories” may

contribute to such comparisons. Research would be useful to evaluate this complex relationship.

Appendix A- Definition of Terms

Health is defined as a “state of complete physical, mental, and social well-being and not

merely the absence of dysfunction (WHO, 2001A p1). Mental health, a subcategory of health is

defined as “the state of well-being in which every individual realizes his or her potential, can

cope with the normal stresses of life, can work productively or fruitfully, and can contribute to

her or his community (WHO). Mental health can be thought of as being two-dimensional.

Positive mental health is defined as “the ability to cope with adversity and avoid breakdown or

diverse health problems when confronted with adverse experience” or “the state in which life is

experienced as meaningful and manageable” (Europa.eu). Negative mental health, the second

dimension of mental health, is defined as “aspects of health concerned with mental disorders,

symptoms and problems'' (Europa.eu). While these two concepts are divided, it is reported that

“mental disorders and positive mental health cannot be described as two different ends on a

linear scale but rather as two overlapping and interrelated components of a single concept of

mental health” (Detels R, McEwan J, Beaglehole, editors,2002).

Mental ill-health is defined as “mental health problems, symptoms, and disorders

including mental health strain, and symptoms related to temporary or significant distress (WHO).

Mental disorders, (also called mental illnesses, behavioral disorders, or brain disorders) usually

indicate significant distress and are “defined by the existence of symptoms” influencing multiple

areas of functioning such as how a person behaves, feels, perceives, or thinks (Europa.eu). The

full list of identified disorders can be found in the DSM-V (DSM-V). Sub-threshold mental

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

disorders mean “poor mental health that does not reach the threshold for diagnosis as a mental

disorder”.

Psychological distress is defined as a “non-specific dimension of psychology that

indicates that there is something wrong but does not meet specific diagnostic criteria”

(Europe.eu). Psychological distress may include symptoms of “anxiety, depression, cognitive

problems, irritability, anger, and obsessive-compulsive thoughts” (Europa.eu).

Neuroplasticity refers to “the inherently dynamic biological capacity of the central

nervous system to undergo maturation, change structurally and functionally in response to

experience and to adapt following injury” (Cerebral plasticity: Windows of opportunity for the

developing brain Ismail FY 2017).

Mental health monitoring refers to “systematic, repeated measures of matters related to

mental health of populations through data collection, follow-up of measures, and interpretation

of the evolution of mental health situations” (Europa.eu). Indicators are often used to monitor

mental health. A mental health indicator “measures the state of mental health or is the variable

that is related to mental health and indicates a priority or a problem” (Europa.eu).

Risk factors, one type of indicator, are defined as “factors that are associated with an

increased probability of onset, greater severity, and longer duration of mental health problems”

(WHO). Risk factors often indicate the absence of protective factors. Some examples of risk

factors include insecure attachment, drug use, school failure, and family history of disability

(DSS). On the flip side, a protective factor is defined as “conditions that improve people’s

resistance to risk factors and disorders or, factors that ameliorate or alter a person’s response to

some environmental hazard that predisposes to a maladaptive outcome” (WHO). A protective

factor can also be defined as the “presence of a characteristic at the biological, psychological, or

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

community level that is associated with lower likelihood for problem outcomes” (Ritter M.,

1985). Some protective factors include social involvement, positive norms, family support, and

secure attachments (DSS). Some protective factors and risk factors are “generic” meaning they

are “factors common to several mental health problems and disorders”. Other protective factors

and risk factors are “disease-specific” meaning they are “mainly related to the development of

specific disorders” (WHO).

Mental Health promotion is defined as the “creation of individual, social, and

environmental conditions that enable optimal psychological and psychophysiological

development (WHO). Promotion initiatives “involve individuals in the process of achieving

positive mental health, enhancing the quality of life, and narrowing the gap between countries

and groups” (WHO). Mental health promotion “aims to have impacts on determinants of mental

health such as to increase positive mental health, reduce inequality, to build social capital, to

create health gains, and to narrow the gap in health expectancies” (WHO, 1997). Wellness, one

of the goals of promotion, is defined as “the approach to healthcare that emphasizes preventing

illness and prolonging life as opposed to emphasizing treating disorders” (WHO).

Mental health prevention relies on the use of mental health promotion strategies (WHO).

Prevention, another goal of promotion, is defined (as related to public health) as “structures

aimed at reducing the incidence, prevalence, recurrence of disorders, the time spent with

symptoms or risk conditions for a mental illness, preventing or delaying recurrences, and also

decreasing the impact of mental illness in the affected person, their families, and society”

(Mrazek and Haggerty, 1994). Primary preventions “aim to reduce incidence”, secondary

preventions “aim to decrease prevalence through early detection and treatment of diagnosable

conditions”, and tertiary preventions “aim to reduce disability, enhance rehabilitation, and

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

prevent relapse” (WHO). Of the primary preventions, there are three classifications of primary

preventions—universal, selective, and indicated. Universal prevention is defined as

“interventions that are targeted at the general public or to whole populations that have not been

identified based on increased risk”. Selective prevention is defined as “interventions targeted to

individuals or subgroups of the population whose risk of developing a mental disorder is

significantly higher than average as evidenced by biological, psychological, or social risk

factors”. Lastly, indicated preventions “target high-risk people who are identified as having

minimal but detectable markers indicating predisposition for mental disorders at that time”

(Mrazek and Haggerty, 1994, pp 22-24).

Evidence-based prevention and promotion are defined as the “conscientious, explicit,

and judicious use of current best evidence in making decisions about interventions for

individuals, communities, and populations to facilitate the currently best possible outcomes in

reducing the incidence of diseases and in enabling people to increase control over and improve

their health” (Sackett DL, Rosenberg WM, Gray JA, et al., 1996). Next, a psychological

assessment is defined as “the gathering and integration of psychology-related data for the

purpose of making a psychological evaluation accomplished through the use of tools such as

tests, interviews, case studies, behavioral observations, and specifically designed apparatuses and

measurement procedures (Assessment textbook)”.

Perception, defined as “conscious sensory experience”, is determined by perceptual

process (Sensation and Perception textbook). The perceptual process is different for different

people depending on what is being selectively attended to. Perceptual process is “a sequence of

events leading from the environment to perception of the stimulus, recognition of the stimulus,

and action with regard to the stimulus (Sensation and Perception textbook). The perceptual

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Measuring Psychological DIstress- A Preventive Approach towards Evaluating Mental Wellness

process influences consciousness; in this manner, perception follows behavioral principles

explained by the Stimulus Organism Response Consequence (SORC) model which relates to the

chain of events between the initial stimuli and future consequence with the consequence being

increased likelihood of mental illness when downwards trends are reported in the perception of

satisfaction (Behaviorism textbook). Implicit perception relates to when people have no

awareness of a stimuli but it still has an effect on behavior.

Lastly, life satisfaction is defined as an “overall assessment of feelings and attitudes

about one's life at a particular point in time ranging from negative to positive” (Diener, Ed 1984).

Life satisfaction is characterized as an individual's cognitive judgement about comparisons based

on the comparability of their own living conditions with the standards' “ (Diener, Emmons,

Larsen, and Griffen 1985).

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