Abstract

Mental health conceptualizes the state of well-being in which the individual realizes the ability to
cope with normal stress and can work productively. Mental disorders are highly prevalent all
over the world that contribute to premature mortality, disability, and morbidity. Mental health is
always stigmatised by discrimination and social exclusion. Mental health disorders increase the
risk for other diseases that leads to intentional and unintentional injury. Mental and physical
health are equally important components that are interlinked with each other as depression
increases the risks of health illnesses such as diabetes, stroke, and chronic heart diseases. Mental
illness like depression makes a person fatigued. This study aims at the effects of mental illness
on physical and mental health, mental health awareness, aspects, and the risk associated with
mental illness.

Introduction

Mental health not only refers to the absence of mental disorders but integral component of well-
being that provides the ability to make decisions. Mental health exists in a complex continuum
that varies from person to person with the degree of difficulty and distress. It also contributes to
different clinical and social outcomes. The determinants of mental health include individuals'
psychological and biological factors that include genetics, emotional stress, and other
environmental circumstances that include environmental deprivation, violence, inequality, and
poverty that increase people’s risk of experiencing mental illness. mental condition disturbs
because of a number of reasons. The most common factor that disturbs mental health is
depression, Alzheimer’s disease, dementia and anxiety which contributes significantly to the
non-communicable disease burden. Mental health is categorised in a non-communicable disease
that is considered as a non-fatal condition or rare cause of death. The disturbance in mental
health includes severe long-term stress or any long-term physical health condition, and social
disadvantages such as poverty and debt also result in disturbed mental health. Other factors
include childhood abuse trauma, neglect, social isolation or loneliness. Mental health also gets
disturbed by lifestyle factors that include diet, insomnia, and drugs. The human brain is a
complex structure. The evidence from research suggests that mental health problems might be
linked to certain changes in the brain chemicals that include serotonin and dopamine. Serotonin
is the neurotransmitter that is linked with individuals' happiness and calmness. Dopamine is
associated with pleasure, satisfaction, and motivation but there are no strong pieces of evidence
about the chemical imbalances or chemistry of the brain. some evidence of research shows that
low dopamine levels are associated with symptoms alike depression. High or low dopamine and
serotonin production leads to the development of physical and mental conditions due to impaired
communication between the neurons. Mental conditions lead many people to experience suicidal
and frightening thoughts. Research shows global suicide mortality rates due to psychiatric
disorders such as depression. In children, the most common mental issues include anxiety,
depression, behaviour problems that lead to disruption of the abilities of the children to perform
well at home as well as at school. Exposure to stressful events such as divorce and
unemployment increases the risk of psychological disorders in children.
Statements of the primary review questions

1. What are the impacts of Covid-19 on mental health?

Inclusion Criteria includes

1. All the research papers that are published after 2019.

Methods

Mental health and covid-19

The covid-19 pandemic is one of the biggest outbreaks that cause far-reaching consequences on
health systems, societies, and economies throughout the world. countless people lost their
livelihoods and have died. Children, young and adults have missed out socialising. Many people
become anxious and psychologically affected by stress due to a lack of socialisation and being
isolated at home.

Mental health interlinked with physical health

Poor mental health is the major factor that leads to long-term chronic physical health conditions.
Social determinants such as unhealthy lifestyles, lack of physical activity, exposure to violence,
and poor housing quality lead to mental illness. Excessive stress elevates the heart rate because
of high levels of stress hormones. Research shows that medications such as antipsychotics lead
to abnormal heart rhythms.

Population affected by mental illness

Research shows from one in every 8 people is mentally ill. About 970 million people around the
world are struggling with mental disorders. The most common mental disorders include anxiety
and depression. In 2020, research shows a rise in cases of mental illness. About 26 to 28 %
increase in cases of major depressive disorders and anxiety have been reported. People with
mental disorders do not have access to effective mental care. Recent researches show about 280
million people including children and adolescents are living with anxiety disorders. Research
shows that People living with depression are at higher risk of suicide.

Data collection

The internet spokesperson of the mature people of Denmark was conducted through the study
firm “YouGov” which was used to implement this study. This study was administered for two
random samples: the first sample in August 2019 was finished by 1,508 respondents; the second
round was administered in November 2021 and finished by 1,507 participants. Although the
samples that were taken have been characteristic of the overall Denmark people that also sees off
in the variables taken (age of the person, location of the person, the place where the person is
located) before the study so to elevate the specimen.

Questionnaire items relating to direct and indirect campaign reach

Participants had been inquired an amount of inquiries to analyse the limit of the ABCs of Mental
Health drive and various other drives in Denmark. Direct drive influence (i.e. ease with the drive
name) was calculated by inquiring:

Q1. What are the companies or entities which are coordinating with mental health which you
currently know of?

Q2. What are the ensuing drives/movements coordinating with cognitive health and wellbeing
are you known with or have came to know?

And every choice had an obvious reason pertaining the participant’s willingness including “The
ABCs of Mental Health”. Some other query evaluates the limit (in this scenario ease as in ABC
messages): Q3. Have you seen or listened to any of the subsequent catchphrase? Therefore there
are a lot of choices that encompasses the ABC’s: “Accomplish your objectives; Accomplish your
objectives; Accomplish your objectives as it becomes worthwhile. Responses were evaluated by
inquiring with the same query: Q4. Have you come to know any of the subsequent catchphrases?
Feedback which were not direct, encompassing the subsequent catchphrase, that is implemented
in the drive: “Accomplish and help others” and “Greetings! Be physically prepared as that
improves your cognitive well-being”. Answering positively to any of these would deem as if the
required group has been approached. In order to maintain the number, every positive answer has
been tallied one time, this means that responders were not tallied over again, e.g. the drive name
and the drive catchphrase. Query form relatables regarding the effect of the ABCs of Cognitive
Wellbeing drive Participants telling any understanding with the ABCs of Cognitive Wellbeing
drive had four objects regarding the effect of the drive on their approach towards cognitive well
being. Firstly, they had to answer if the drive actually make them realize about their own
cognitive well being (“Did you realize about thinking of your own cognitive well being after
listening about the drive’s catchphrase?”), participants options giving: no, not at all; yes, to a
very little amount; yes, to some degree; yes, to a large degree; yes, to a very large degree.
Participants saying “to some degree” or more were known as having been impacted by the drive
in the way of realizing about their own cognitive well being. Afterwards, participants were
queried about the communication that occured between their relatives or about mental health
after having heard about the campaign (‘‘Did you speak to friends or private members of their
social circle regarding cognitive well being due to hearing about the cognitive well being drive
note/catchphrase?’’), participants options: yes; no. Afterwards Participants were queried if the
drive was crucial in providing them another perspective regarding cognitive wellbeing (“Did the
drive provided you with a fresh perspective regarding the steps you can take relating to your own
cognitive wellbeing?”), participants providing with choices: no, not at all; yes, to a very little
degree; yes, to some degree; yes, to a big degree; yes, to a very big degree. Participants
providing “to some degree” or more had been well thought out with it having effected by the
drive with regards to new perspective regarding cognitive well being. Finally, participants had
been queried whether they had taken actions to boost their cognitive wellbeing subsequently
coming to know about the drive previously (‘‘Have you taken any steps in regards to boost your
cognitive well being subsequently coming to know about the drive?’’), participants having the
choices: yes; no. With the two objects on ‘thinking about cognitive wellbeing’ and ‘perspective
regarding cognitive wellbeing’, it had been thought to eliminate whereas the drive had a very
little effect (“to a very little amount”), and hence selected “to some degree” or a little more as
suggestive of drive effect.
Items on the questionnaire that asked about attitudes and behaviours relating to improving
mental health

Inorder to research through the key part of cognitive well being inducing thoughts subsequent
queries had been put infront of all particpants irrespective of their understanding with the
cognitive wellbeing drive. Initially, participants had been queried “To what degree are you
certain of the fact you can implement an action to remain cognitively strong?”, participants
having the choices: not at all; to a very little degree; to some degree; to a big degree; to a very
large degree. Participants replying “yes, to a large degree” or “yes, to a very large degree” were
thought of as certain of that one can implement something to be cognitively strong. Immediately
after the participants were inquired: Q5. How can you keep yourself cognitively strong?
Afterwards, participants were inquired with regards to the steps taken to improve cognitive
strength: Q6. How much of an active effort have you made to improve your mental health in the
past two weeks? with the same choices for responses: not in any way shape or form; to a very
small degree; in some degree; generally; to a very high degree. Those who answered "yes, to a
very large extent" or "yes, to a large extent" were deemed to have actively improved their mental
health. To ensure that the answers to the two questions about attitudes and behaviours that
support mental health were unambiguously positive, we only included the last two "yes"
response categories.

The state of my mind Warwick-Edinburgh Short A recognised tool for tracking mental health in
the general population is the Mental Well-being Scale (SWEMWBS). It is predicated on the
notion that mental health entails both feeling good and doing effectively.The scale has been
verified to be correct in Denmark. (Koushede et al., 2019). SWEMWBS consists of seven upbeat
inquiries about mental well-being experienced over the last 14 days: 1. I've been looking forward
to the future with optimism. 2. Recently, I've felt useful. 3. Lately, I've been more at peace. 4.
I've solved issues successfully. 5. I have been thinking clearly. 6. I've been experiencing a sense
of community. 7. I've had the freedom to decide for myself. The response possibilities were:
never (score 1), infrequently (score 2), frequently (score 3), often times (score 4) and always
(score 5). The sum of the item scores yields a score between 7 and 35. Higher scores are an
indication of better mental health. The final scores were then modified to enhance the scaling
features (available online). (Stewart-Brown, 2015). A category for low mental well-being, a
category for excellent mental well-being, and a category for moderate mental well-being have all
been suggested as scale cut points for the general population. Due to this previous classification,
the following fixed cut-points for scale (based on the converted metric score) are used in the
current study: Scores between 7.01 and 19.98 indicate poor mental health, 19.99–29.30 indicate
intermediate mental health, and 29.3–35.00 indicate good mental health These cut-points
significantly predict differential risk for common mental diseases, according to recent research
(Santini et al.). 2020a).

Covariates Subsequent were the covariates: gender: woman; male), age range of 18 to 29 30–39;
40–49; 50–59; 60), marital status (not married, not in a registered partnership, and not living
together; married, living together, or in a registered partnership), Danish region (Capital City
Region; Region of Zealand; District of Southern Denmark; Region of Mid-Jutland; North Jutland
Region), education (primary, secondary, tertiary), occupation (not currently employed, such as
retired or unemployed; student; employed; other). The following question was used to evaluate
physical health maintenance: Q7. In what ways have you actively taken care of your physical
health over the past two weeks? With the choices for responses: in no way; to a very small
degree; in some degree; most of the time; to a very high degree. Those who responded "yes, to a
very large degree" or "yes, to a large degree" were deemed to be actively maintaining their
physical health. Last but not least, we were also interested in determining how people with and
without mental health issues responded to particular questions. Participants were asked, "In the
past 12 months, have you been in contact with a medical doctor, psychiatrist, psychologist, or
other health professional regarding a cognitive wellbeing trouble or cognitive disorder?" in order
to assess the presence of a current mental health problem or illness (self-reported). with the
choices for responses: yes; no.

Analyses using statistics and the arts in order for the wholly seeing ratios over the 2019–2021
interval, several sources corroborate the statistics over 2019 - 2021 were combined till a single
statistics series (N = 3,015). Every statistics, seeing the effect and range—2019 and 2021—have
been largely same and not overly distinct, p > 0.1. The wholly sway and effect seeing ABCs of
Cognitive Wellbeing Drive were evaluated using weighted proportions. Regression analysis and
margin estimates were used to find the adjusted mean differences in mental health between the
various groups. Using multinomial strategic relapse, we also discovered relationships between
mental well-being (result) at high, low, and moderate levels and beliefs and behaviours related to
promoting psychological wellbeing. We divided the groups into those who had mental health
issues and those who did not in our multinomial regression models. All models contained data on
age group, area, gender, education level, occupation, maintenance of physical health., As were
the crucial elements. (ideas and events linked to increasing cognitive wellbeing). Every single
quantifiable test was run using STATA version 13. The open-ended question's qualitative
investigation was conducted using NVivo Enterprise Pro 2020. The answers to the open-ended
questions were grouped using inductive reasoning. We created groups that were "true" to the
participants' initial responses. Authors 2 and 3 worked together on the coding to make sure there
was uniformity in the defined categories. Some responders gave several statements in response to
the question, while others just said one. Regardless of the content of their comments, every
participant who gave a response fits into at least one group.Results: Groups in the sample were
relatively evenly distributed in terms of gender, age, and geography. Table 1 displays the
sample's characteristics. Of the 3,015 participants, 224 (7.5%) were familiar with the ABC label
or messages, and 350 (11.9%) were also aware of the campaign slogans as of the end of the
drive. More specifically, only direct reach (knowledge of the target name/ABC postings, but not
trademarks) attracted 151 (5.0%); 126 (4.3%) were familiar with the term just, but not the
mission name or ABC messages; and 73 (2.6%) were in contact with both direct and indirect
sources. The percentages of the campaign's reach by slogan, which may overlap, are not depicted
in Table 2: 127 (4.4%); Whether alone or with a companion, do something. Hello from the club!
Your mental health can be enhanced by engaging in group activities 87 (3.2%); Perform a deed
of kindness for others; How you choose The percentage of participants who had been directly or
indirectly reached by the ABCs of cognitive health drive (acquaintance with the drive label or
catchphrase) was 237 (10.4%) among those who did not have a cognitive health problem,
compared to 97 (16.9%) among those who did. (Proportions may overlap.) Participants learnt
about the ABCs of cognitive health drive from the following sources. (not shown in Table 2).
coverage in the media, such as on radio, television, and in newspapers; Social networking
platforms like Facebook, Instagram, and LinkedIn are used by 26.0% of newsletters, 13.5% of
family, friends, or coworkers, 12.8% of people for work, 32.1% of people for personal reasons,
14.2% of workouts, and 4.7% of people from other places.
Impacts of the ABCs Cognitive Wellbeing Drive

Figure 1 demonstrates the drive’s effect midst participants who told if there is acquaintance from
the cognitive wellbeing drive. Among them, 74.2% told that the drive had made to feel them
critically analyse one’s cognitive well being, and 35.5% told how they spoke to their close
relatives and acquaintances about in regards to cognitive well being that they talked to family
and friends about mental health later listening to the organization’s well being heard about the
organization. About 78.4% reported that the campaign gave them new knowledge about what
they themselves can do to enhance their own mental health, while 16.2% said that they did
something actively to enhance their mental health as a result of hearing about the ABCs of
Mental Health. Figure 2 shows the weighted proportions of campaign impact stratified by groups
with and without a mental health problem or illness. The proportions among respondent with a
mental health problem were generally greater in each category, with the exception of reporting
that the said organization had provided them new knowledge about what they themselves can do
to enhance their cognitive wellbeing, in the said instance the in this case the ratio decreased as
compared to the people not having a cognitive issue.
Cognitive wellbeing inducing views Mental health-promoting, activities and connotations with
and decent cognitive wellbeing

The rest of the research has been done throughout the whole benchmark. Both variables
(thoughts relating improved cognitive well being; activities relating to improved cognitive well
being) were +vely linked amongst themselves, r = 0.35, p < 0.05. Figure 3 demonstrates the
edited average marks of cognitive well being (constant gauge) graded by sets irrespective of
cognitive issue. For each group variances, every edited averages have been very distinct amongst
themselves (p < 0.001). Unswervingly, people who accepted and thought that they are able to
apply a significant factor in their lives to stay cognitively sharp got more average marks of
cognitive health as compared to the people who didn’t think likewise and people who applied the
principles in their lives to improve their cognitive health had got better average marks than the
people who did not took action to change their cognitive well being. As previously mentioned
the following was the incident without taking into effect the notion that if they were facing any
cognitive well being issue. Among 3,015 participants, significantly 87,8% replied this interesting
question:
Q8. What steps will be taken in order to keep one cognitively good?

When we take into account the participants replies, very significantly 92 classes were created.
Appendage 1 shows 92 classes also as it became evident on the specification of the kinds of
sentences the classes have been reflected upon. It is shown in Table that the classes that were
provided from minimum 1% from participants. Replies like for example using one alphabet or
sign have been classified as “Unanswered” (12.2 perecent). Ambiguous sentences have been
classified over a broad spectrum 4 classifications: other (8.1%), no knowledge (6%), indecisive
(1.8%) and nothing/limited/little (1.1%) (look over Appendage 1 in order to see a better specified
detail of the categories). Comparatively huge number of classifications give the hint that the
group refer to several objects when replying to the query. This is significant as there are a lot of
different factors when taking this into consideration. Although when looking into the
classifications there is a hint that many persons may look at distinct objects wile replying to the
query. Therefore, based on the classifications, 5 different can be extracted as clear, the paths:
social people relations, health inclusive behaviour, practice of relaxation, deep positive mindset
and finally activity of the brain. Table 3 demonstrates several larger categories that relates to the
theme social people relations, such as: social life and relations (13%), speaking with others
(5.5%) and Relatives (4.9%). The significance of bodily well being and vigor characteristic in
order for cognitive well being is a clear mental health is also a clear tune among the participants,
as shown by the categories such as: exercise and training (12.8%), eat healthy (7.2%) and healthy
lifestyle and bodily well being (2.4%). The table also shows a theme regarding relaxation
showcased with classifications such as: sleep (6.5%), reduce stress/avoid stress (6%) and
relaxation and rest (4.1%), and a theme concerning having a positive mentality exemplified with
the categories: Optimistic approach and hopefulness (8.9%) and reflection and carefulness
(5.7%). Likewise, the categories brain activity games (3.4%), brain exercise and challenge the
mind (3.1%) taking mind action and keep the mind occupied (2.8%) point to that using the brain
also is a central theme when asked about what can be done to keep mentally healthy. In addition
to the five themes, the two classifications read (7.3%) and gait (4.1%) are remarkable as these
categories appear as segregated from the rest of the categories, but at the same time, constitute
relatively large categories. Lastly, deep research (graded by groups with and without a mental
health problem or illness, see Table 4) show that believing that one can do something to keep
cognitively good was associated with significantly lower odds for low mental well-being and
significantly higher odds of improved cognitive well-being. In the same way, constantly
remaining active benefits cognitive processes and is linked with exceptionally few chances of
was associated with significantly lower odds of little cognitive health and exceptionally higher
chances of increased cognitive health. Now this has to be said irrespective of any recurring
cognitive well being issue.

Although believing that one can do something to keep mentally healthy did not reach
statistical significance in the case of high mental well-being as the outcome. However, the
pattern of associations remained the same and the lack of significance may be attributed to
lacking statistical power for this group (there were only 26 individuals with a mental health
problem or illness in the high mental well-being group). Overall, the strength of the associations
was generally stronger for “actions in regard to enhancing mental health” as compared to “beliefs
in regard to enhancing mental health”. Discussion Overall, in a representative sample of the
Danish population, 7.6% report awareness or familiarity with the ABCs of Mental Health
campaign – or 11.9% when also counting familiarity with campaign slogans – over the period
2019–2021. A major objective of the ABCs of Mental Health is to frame mental health positively
and as something that matters to everyone. Further, an objective is to reduce stigma about mental
health problems (by framing mental health positively) and to create a new mindset about mental
health, namely: that mental health is much more than simply the absence of mental illness and
symptoms of psychopathology, but also very much a matter of what it means to be ‘mentally
healthy’ (which is relevant for everyone); and that mental health is dynamic and people
themselves can do something to influence their mental health (Lyubomirski et al., 2005;
Koushede and Donovan, 2022). According to our results, among the respondents who had been
reached by the ABCs of Mental Health campaign, respondents predominantly (74%) reported
that the campaign had made them reflect on their own mental health and one-third (36%) spoke
to family and friends about mental health after having heard about the campaign. Thus, our
results suggest that the campaign has been successful – at least to some extent – in reaching this
objective, which would also appear to be supported further by the remaining impact indicators
we included in the study. Specifically, respondents predominantly (78.4%) reported that the
campaign had given them new knowledge about what they can do to enhance their mental health,
while some (16.2%) also reported having acted upon the campaign messages, i.e. they did
something actively to enhance their mental health as a result of having heard about the campaign
and the ABC messages. Regarding the latter finding, it may be noted that facilitating behaviour
change is difficult across all disciplines (Kelly and Barker, 2016; Bauman et al., 2006), which
may explain the lower proportion of affirmative responses relative to the other campaign impact
indicators. Other factors influencing behaviour change may be found in the literature on health
literacy. For example, Baker (2006) proposes several aspects such as the individuals/recipient’s
prior knowledge, the complexity and difficulty of the messaging and contextual factors that all
influence the process of forming new knowledge and personal attitudes that can lead to
behaviour change. Regarding the contextual factors, prior research (Wakefield et al., 2010)
suggests that the likelihood of achieving behaviour change through campaigns is substantially
increased by the application of multiple interventions, such as campaigns combined with
community-based initiatives and policies that support the desired behaviour change. Another
thing to consider is that many people may also already be engaging in various activities that are
promoting and sustaining good mental health. Thus, the objective of the ABCs of Mental Health
campaign is not necessarily to encourage that people engage in more activities, but rather to
increase awareness that the ABC activities that people already engage in are important for mental
health and to encourage them to continue to prioritise those activities. Our results also showed
that substantial proportions of both those with and without a mental health problem are reached
and have been impacted by the ABCs of Mental Health campaign. This is in line with Act-
Belong-Commit impact evaluations from Australia, also suggesting that the campaign reaches
both people with and without mental health problems in a population (Anwar-McHenry et al.,
2012; Donovan et al., 2016). The reach proportion was slightly greater for those with a mental
health problem as compared to those without a mental health problem, in line with results from
Australia showing that the campaign appears to attract relatively more attention and involvement
from groups with diagnosed mental illness than from those without (Anwar-McHenry et al.,
2012; Donovan et al., 2016), and that the campaign also stimulates information-seeking and
help-seeking among people experiencing mental health problems (Drane et al., 2022). The
results from Australia have further shown that people with a mental health problem or a
diagnosed mental illness find the campaign empowering by 1) providing a simple and practical
ABC for enhancing mental health, which may also be used as a tool for recovery similar to other
applied frameworks (Piat et al., 2017; Dell et al., 2021), and 2) destigmatising, exactly because
the ABCs of Mental Health campaign is a universal approach that targets whole populations (i.e.
the campaign is “for everyone”, and hence, their involvement is not defined by their mental
illness). As stated earlier, a major objective of the ABCs of Mental Health campaign is to
promote mental health universally irrespective of (mental) health status and our results indicate
that the campaign holds the potential to do so. We also investigated how mental health
promoting beliefs and actions were associated with different levels of mental well-being. We
found that individuals who believe that they themselves can do something to keep mentally
healthy score higher on mental well-being than individuals who do not, and individuals who do
something actively to enhance their mental health score higher on mental well-being than
individuals who do not. In terms of “beliefs in regard to enhancing mental health”, it may be
noted that the means were adjusted for sociodemographics as well as “actions in regard to
enhancing mental health” (which was also the case in our multinomial logistic regression
discussed below). In other words, believing that one can do something to enhance mental health
is independently associated with a higher level of mental well-being, regardless of whether one
actually does something actively to enhance it. An explanation for this might be that simply
having a belief that one can do something to enhance mental health may influence one’s outlook,
behaviour, lifestyle etc., which in turn associates with a higher level of mental well-being, even
if the person is not consciously doing something specific to enhance mental health. A person’s
“belief in regard to enhancing mental health” may be considered a mental health-specific variant
of locus of control, similar to a recently validated Well-being Locus of Control Scale (WB-
LOC12) (Farnier et al., 2021). An internal well-being locus of control implies the capacity to
recognise the potential to which an individual can influence her or his own mental health, while
an external locus of control implies an attitude that mental health and well-being is mainly or
solely influenced by external forces, e.g. influenced by others or by chance. It is of interest that
the validation study of the WB-LOC12 scale included a separate measure of positive activities
(practicing a sport; having a good time with friends; having a good time by oneself; working on
personal projects meaningful to oneself; practising meditation; practising yoga, relaxation or
other physical well-being activities; or doing personal development practices or exercises), and
these activities would appear to be consistent with the ABC messages. According to their results
(Farnier et al., 2021), an internal well-being locus of control correlated positively with positive
activities, while an external well-being locus of control correlated negatively with positive
activities. In other words, individuals that engage in activities consistent with the ABC messages
tend to have an internal well-being locus of control, and vice-versa. In our study, we also found a
similar correlation between beliefs in regard to enhancing mental health and actions in regard to
enhancing mental health. Further, according to the WB-LOC12 validation study (Farnier et al.,
2021), an internal wellbeing locus of control correlated positively with mental well-being and
subjective happiness, as well as negatively with depression, anxiety and stress, while the
opposite was the case for an external locus of control. This pattern aligns with our results
showing associations with low and high mental well-being. In terms of our qualitative analysis,
with 92 identified categories based on the responses to the open-ended question ‘‘What can you
do to keep mentally healthy’’, responses illustrate the vast variety of possible actions that people
point to as a means to keeping mentally healthy. Five themes in particular stand out as being
reported frequently: social relations, health behaviour, relaxation, positive mindset and use of the
brain. In addition to the five themes, the two categories read and walk also appear as some
relatively large categories, but at the same time, stand as thematically separated from the
remaining categories. Although it could be argued that the categories could be included in some
of the mentioned themes, e.g. health behaviour or use of the brain, we believe they stand out
because they are based on the specific (often singular) statement to perform the action “read” or
“walk”. While the majority of the sample responded to the question with some suggestion for
action, about 50% reported that they had done so only to some extent or less within the past two
weeks (Table 1). There may be various reasons for not engaging in mentally healthy behaviours,
and we can only speculate as to what they may be. One reason may be that although most people
intuitively know what they can do to enhance their mental health, they often forget to prioritise it
in their daily lives (Nielsen et al., 2017; Donovan et al., 2007). An alternative possibility may be
that they wanted to prioritise it, but they did not manage to find the opportunity for it. One group
(about 7%) did not know what could be done or thought that nothing or very little could be done
to enhance mental health. Our findings show that there is a need to both increase awareness
about what can be done to enhance mental health and to encourage and provide opportunities for
people to actually do so. This is a core component of the ABCs of Mental Health campaign. Our
results generally support the argument that it is important to have mental health campaigns –
such as the ABCs of Mental Health campaign and partnership – that promote an internal
wellbeing locus of control, i.e. that increase awareness that individuals can do something to
enhance their own mental health; encourage them to prioritise and engage in activities that they
intuitively know are important for keeping mentally healthy; and provide them with suggestions
and opportunities to actually engage in mentally healthy behaviours and lifestyles, all of which
are associated with better mental health. Lastly, our multinomial logistic regression models
showed that having a belief that one can do something to keep mentally healthy (as compared to
not having this belief) was associated with lower odds of low mental well-being and higher odds
of high mental wellbeing. Similarly, doing something actively to enhance mental health (as
compared to not doing something) was associated with lower odds of low mental well-being and
higher odds of high mental well-being. In other words, our results indicate that beliefs and
actions towards enhancing mental health may both prevent poor mental health (low levels of
mental well-being), as well as promote good mental health (high levels of mental well-being).
With recent research demonstrating that higher levels of mental well-being are inversely
associated with risk for developing a common mental disorder at a future time point (Santini et
al., 2022a) as well as future health and social care costs (Santini et al., 2021b), our findings could
have major implications for public mental health and mental illness disease burden. However,
longitudinal and intervention research is needed to establish this. Both in terms of adjusted
means and our multinomial logistic regression analyses, our results suggest that the associations
of “actions in regard to enhancing mental health” with mental well-being are stronger than those
of “beliefs in regard to enhancing mental wellbeing”. Thus, our results indicate the greatest
benefit to mental health would occur when individuals both believe that they can do something
to enhance their mental health, as well as taking action to do so. Overall, our results add to the
evidence base (Donovan et al., 2021; Hinrichsen et al., 2020; Jalleh et al., 2013; Koushede and
Donovan, 2022) regarding the potential of the ABCs of PAGE 284 j MENTAL HEALTH AND
SOCIAL INCLUSION j VOL. 26 NO. 3 2022 Mental Health campaign to promote such beliefs
and actions universally throughout the population.