Positive mental health softens detrimental effect of psychiatric disorders

Mental disorders appear to worsen overall health and quality of life, according to a recent Singapore study. Positive mental health (PMH) may work to oppose this effect.

“Knowledge about the state, correlates and role of PMH is important for informing mental health promotion and intervention programmes,” the researchers said. “This study estimated the level of PMH in a large general population sample comprising people with and without mental disorders.”

Of 2,270 Singaporeans (mean age, 42.1 years; 52.1 percent female), 14.8 percent had a lifetime prevalence of any mental disorder. The total PMH score, measured by the 47-item PMH Instrument, was 4.46±0.48. Those of Chinese ethnicity dominated the sample (77.5 percent). [Health Qual Life Outcomes 2020;18:55]

Those with a history of any mental disorder had significantly lower total PMH scores (4.23±0.66 vs 4.50±0.67; β, –0.233, 95 percent confidence interval [CI], –0.337 to –0.129; p<0.001). This was consistent across almost all different types of mental issues: major depressive disorder (p=0.002), bipolar disorder (p=0.017), generalized anxiety disorder (p=0.008) and obsessive-compulsive disorder (p<0.001).

Moreover, mental health problems also impaired overall health. Self-measured scores for overall health were significantly lower for those with a history of any mental disorder (3.24±0.52 vs 3.51±0.51; β, –0.352; 95 percent CI, –0.491 to –0.213; p<0.001).

Quality of life was similarly impaired, both in terms of the mental (51.5±5.12 vs 56.3±6.37; β, –4.485; 95 percent CI, –5.78 to –3.191; p<0.001) and physical (54.1±5.97 vs 54.4±5.23; β, –1.019; 95 percent CI, –1.947 to –0.091; p=0.031) component summary scores.

Notably, researchers found that PMH exerted a mediating effect on the relationship between mental and overall health. The resulting indirect effect (IE) size was –0.1318. A similar trend was reported for both mental (IE size, –0.8059) and physical (IE size, –0.3216) component summary scores.

“This shows that higher levels of total PMH in individuals with mental disorders reduced the effect sizes of the associations between mental disorders and health outcomes,” researchers explained. “This being the first study to assess mediation by PMH in mental disorders, it is difficult to draw direct comparisons with previous research on its mechanisms.”

One potential mechanism involves emotional support, one of the six dimensions of the PMH Instrument and is known to have a positive effect on quality of life. Better general coping, on the other hand, can lead to better problem-solving efficacy and lower stress. [Schizophr Res 2016;172:23-28; J Pers Soc Psychol 1987;53:337-348)

“Further research on the independent contribution of these dimensions could fully explain mediation by PMH,” the researchers noted.

“[These] results support the notion that clinical interventions should incorporate approaches to improve PMH in routine practice,” they said. “Although mental health promotion is largely devoted to prevention and treatment of mental illness, continued efforts are essential to improve PMH in people with mental disorders and monitor the relationship between these disorders and important health outcomes.”