A recent study published in Nature Mental Health identifies a core set of elements that make up positive mental health, offering a standardized framework to define what it means to truly be well. By consulting experts across multiple disciplines, the research outlines nineteen specific dimensions, ranging from life satisfaction to social connection. The findings provide a foundation for creating more consistent strategies to support and measure psychological well-being in communities and workplaces.
Positive mental health encompasses more than just the absence of mental illness. It includes aspects of functioning effectively, feeling good, and connecting with others. High levels of mental well-being are associated with better recovery from stressful events, lower risks of chronic disease, and widespread benefits for society.
Despite its broad relevance, the exact definition of positive mental health varies widely depending on the field of study. Psychologists, public health officials, economists, and sociologists often use different terms and models to describe similar ideas, such as flourishing, thriving, or coping.
This lack of a shared vocabulary causes fragmentation in research and policy. When different organizations use completely different standards to define well-being, comparing research data or evaluating the success of public policies becomes incredibly difficult.
“Put very simply, there is very little agreement on what we mean when we say mental wellbeing, flourishing, positive mental health, or related terms,” said Matthew Iasiello, head of data and research translation at Be Well Co and postdoctoral research fellow at Adelaide University’s School of Biomedical Science. “These terms can all be used interchangeably, and each discipline defines them slightly differently, meaning that measures often focus on different things and evidence is hard to synthesize. This leads to confusion in the academic world, which also trickles into the ‘real world’ with governments and funders guessing about what to measure and where to invest.”
To address this inconsistency, researchers set out to establish a unified list of components that constitute positive mental health. Building a shared framework helps ensure that professionals across all sectors are aiming for the same targets when designing mental health interventions.
The researchers used a technique known as the Delphi method, which involves surveying a group of experts over multiple rounds to reach a consensus on a specific topic. The study recruited 122 prominent academics from 26 countries, representing 11 different disciplines. These fields included clinical psychology, psychiatry, public health, philosophy, nursing, and economics.
The experts had an average age of about 53 years and an average of nearly twenty years of experience in their respective fields. About 84 percent of the participants identified as Caucasian or European, and a majority resided in Western nations such as the United States, the United Kingdom, and Australia. The response rate for the survey was approximately 10 percent of the invited academics, though the participating experts were highly cited in their disciplines.
In the first round of the survey, participants evaluated 26 potential dimensions of positive mental health drawn from previous scientific reviews. The experts rated each dimension on a four-point scale from irrelevant to essential. To be included in the final framework, a dimension needed to reach at least 75 percent agreement among the experts. Participants also had the opportunity to suggest additional components in open-text boxes.
In the second round, the experts reviewed the newly suggested dimensions and re-evaluated the items that had not yet reached a consensus. In the third and final round, the participants rated the approved dimensions to determine if they were primarily drivers that cause positive mental health or outcomes that result from it. They used a visual scale from zero to 100, where zero indicated a driver and 100 indicated an outcome.
The panel reached a consensus on nineteen distinct dimensions that constitute positive mental health. Six of these components achieved greater than 90 percent agreement for inclusion. These highest-rated components included meaning and purpose, life satisfaction, self-acceptance, connection with others, autonomy, and happiness.
Iasiello noted that the average person should understand “that positive mental health is broad. It’s more than feeling happy and more than simply not being unwell.” He added, “When we asked a large, cross-disciplinary panel of experts to agree, six dimensions stood out as near-universal: meaning and purpose, life satisfaction, self-acceptance, connection, autonomy and happiness. So if you want a fuller picture of how someone is doing, those are good places to look.”
Other dimensions that made the final list of nineteen included optimism, competence, engagement, calmness, vitality, and a sense of belonging. Rounding out the accepted framework were acceptance, achievement, activities and functioning, development, fun, self-congruence, and a sense of safety. The panel also agreed to exclude certain concepts altogether. For instance, avoidance coping, which involves attempting to ignore stressors, achieved only about 20 percent agreement and was excluded.
The experts debated the boundary between psychological and physical elements of well-being. Factors like physical health achieved only 62.8 percent agreement, and personal circumstances achieved only 62.5 percent agreement, meaning both failed to reach the 75 percent threshold for inclusion. This indicates a tendency among the experts to classify these physical and environmental factors as outside influences rather than core parts of mental well-being itself.
When categorizing the finalized components on the zero to 100 scale, the panel rated happiness and life satisfaction primarily as outcomes of positive mental health, with scores averaging near 74 and 72, respectively. On the other hand, elements like autonomy and a sense of safety were considered primarily as drivers that help produce well-being, scoring around 29 and 32 on the scale.
Differentiating these variables proved to be a challenging task. “Probably how difficult it was for our panel to separate ‘outcomes’ or ‘drivers’ of positive mental health,” Iasiello told PsyPost, regarding what surprised the research team. “The surprising finding was that most of the 19 included dimensions could be seen as both an outcome or a driver, depending on the research question or population. This points to the complexity of the topic!”
The feedback from the participants helped shape a new working definition of positive mental health. The updated definition emphasizes that positive mental health is a subjective experience of functioning well and feeling content. It also specifically notes that a person can experience positive mental health and take action to improve it even while managing a mental health condition.
This proposed taxonomy represents a starting point for standardizing the field, but it possesses built-in limitations. “The main misinterpretation is thinking that this work is a finished product,” Iasiello said. “This shared taxonomy aims to be a starting point towards reaching greater consistency in the field. Our panel was highly expert but heavily Western and English-speaking, so the taxonomy almost certainly carries a Western view of well-being, and concepts like the Japanese idea of ikigai may not sit neatly inside it.”
Concepts like ikigai, which broadly translates to a reason for being or a sense of purpose in everyday living, highlight how different cultures prioritize unique psychological traits. A panel consisting predominantly of academics from industrialized, English-speaking nations might overlook elements of well-being that emphasize communal harmony or spiritual connection.
The boundaries between the causes of mental health and the outcomes of mental health also remain highly complex. A factor like social connection can serve as a driver of well-being on one day and an outcome of a positive mood on the next. The dynamic interactions between these variables suggest that any standardized list will struggle to capture the fluid nature of human psychology in everyday life.
To address these gaps, the researchers have several goals for subsequent studies. “First, test the taxonomy well beyond a Western panel, and deliberately include non-Western concepts and the lived experience of groups often left out, such as people managing chronic illness,” Iasiello said. “Second, work out the structure, which dimensions act as drivers, which are outcomes, and how they nest together, rather than leaving them as a flat list.”
“Third, map positive mental health against mental illness, since the two aren’t just opposite ends of one line,” Iasiello continued. He also emphasized a desire for practical applications moving forward. “Alongside that, we want the science to reach real communities through partnerships between universities, councils, businesses, NGOs, and practitioners, so it gets tested where people actually live and work.”
The study, “A Delphi consensus study on the dimensions of positive mental health,” was authored by M. Iasiello, J. van Agteren, K. Ali, E. Kolovos, P. J. Batterham, F. Goodman, A. Jarden, T. B. Kashdan, M. Kyrios, L. G. Oades, D. Weziak-Bialowolska, and D. B. Fassnacht.
Below is the complete list of the components and their meanings as outlined in the study:
The Top Six Dimensions (Greater than 90% Agreement)
The Remaining 13 Dimensions
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