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Psychological Well-Being Revisited: Advances in Science and Practice
Carol d. ryff.
University of Wisconsin-Madison
This article reviews the research and interventions that have grown up around a model of psychological well-being (Ryff, 1989) generated more than two decades ago to address neglected aspects of positive functioning, such as purposeful engagement in life, realization of personal talents and capacities, and enlightened self-knowledge. The conceptual origins of this formulation are revisited and scientific products emerging from six thematic areas are examined: (1) how well-being changes across adult development and later life, (2) what are the personality correlates of well-being, (3) how well-being is linked with experiences in family life, (4) how well-being relates to work and other community activities, (5) what are the connections between well-being and health, including biological risk factors, (6) and via clinical and intervention studies, how psychological well-being can be promoted for ever greater segments of society. Together, these topics illustrate flourishing interest across diverse scientific disciplines in understanding adults as striving, meaning-making, proactive organisms who are actively negotiating the challenges of life. A take-home message is that increasing evidence supports the health protective features of psychological well-being in reducing risk for disease and promoting length of life. A recurrent and increasingly important theme is resilience – the capacity to maintain or regain well-being in the face of adversity. Implications for future research and practice are considered.
Introduction
Nearly 25 years ago a model of psychological well-being [ 1 ] was put forth to address omissions in formulations of positive human functioning that prevailed in the 1980s. Implications of the formulation for psychotherapy and psychosomatics were subsequently considered [ 2 ]. This article examines what has been learned from the extensive research that proliferated around this model of well-being, particularly as it relates to health (mental and physical) and interventions intended to improve the human condition. Before reviewing scientific advances, the philosophical and theoretical foundations of the formulation are revisited to underscore its distinctiveness vis-à-vis alternative approaches to assessing well-being. Issues of measurement are also considered in this opening section.
Conceptual Foundations and Empirical Indicators
Although considerable empirical research in the 1980s was concerned with well-being, as studied in national surveys [ 3 , 4 ] and segments of psychology [ 5 , 6 ], such endeavors focused largely on reports happiness, life satisfaction, and positive affect. Minimal attention was given to the deeper question: namely, what constitutes essential features of well-being? The neglect was puzzling, given the deep philosophical roots of happiness, dating back to the ancient Greeks, along with pervasive interest shown in humanistic, existential, developmental, and clinical psychology in distilling positive human functioning [ 7 – 14 ]. These differing conceptions revealed overlapping themes in articulating what it means to be self-actualized, individuated, fully functioning, or optimally developed. Such points of convergence became the basis for distilling six key components of well-being (see Figure 1 ). Following the construct-oriented approach to personality assessment [ 15 ], definitions of high and low scorers were then generated for each dimension, and self-report items were written to operationalize the definitions.
Core Dimensions of Psychological Well-Being and Their Theoretical Foundations.
The new measures probed the extent to which respondents felt their lives had meaning, purpose, and direction ( purpose in life ); whether they viewed themselves to be living in accord with their own personal convictions ( autonomy ); the extent to which they were making use of their personal talents and potential ( personal growth ); how well they were managing their life situations ( environmental mastery ); the depth of connection they had in ties with significant others ( positive relationships ); and the knowledge and acceptance they had of themselves, including awareness of personal limitations ( self-acceptance ). Detailed definitions are provided in Table 1 . Taken together, these dimensions offered a notable contrast to extant indicators focused on feeling good, happy, positive, or satisfied with life. A decade later these contrasting approaches were framed as fundamental distinctions in scientific research on well-being [ 16 ] – that is, while early studies reflected a largely hedonic approach, the above indicators were consistent with a eudiamonic perspective. Both terms were traceable to the ancient Greeks.
Definitions of theory-guided dimensions of well-being
High scorer | Is self-determining and independent; able to resist social pressures to think and act in certain ways; regulates behavior from within; evaluates self by personal standards |
Low scorer | Is concerned about the expectations and evaluations of others; relies on judgments of others to make important decisions; conforms to social pressures to think and act in certain ways |
High scorer | Has a sense of mastery and competence in managing the environment; controls complex array of external activities; makes effective use of surrounding opportunities; able to choose or create contexts suitable to personal needs and values |
Low scorer | Has difficulty managing everyday affairs; feels unable to change or improve surrounding context; is unaware of surrounding opportunities; lacks sense of control over external world |
High scorer | Has a feeling of continued development; sees self as growing and expanding; is open to new experiences; has sense of realizing his or her potential; sees improvement in self and behavior over time; is changing in ways that reflect more self-knowledge and effectiveness |
Low scorer | Has a sense of personal stagnation; lacks sense of improvement or expansion over time; feels bored and uninterested with life; feels unable to develop new attitudes or behaviors |
High scorer | Has warm, satisfying, trusting relationships with others; is concerned about the welfare of others; capable of strong empathy, affection, and intimacy; understands give and take of human relationships |
Low scorer | Has few close, trusting relationships with others; finds it difficult to be warm, open, concerned about others; is isolated and frustrated in interpersonal relationships; not willing to make compromises to sustain important ties with others |
High scorer | Has goals in life and a sense of directedness; feels there is meaning to present and past life; holds beliefs that give life purpose; has aims and objectives for living |
Low scorer | Lacks a sense of meaning in life; has few goals or aims, lacks sense of direction; does not see purpose in past life; has no outlooks or beliefs that give life meaning |
High scorer | Possesses a positive attitude toward the self; acknowledges and accepts multiple aspects of self including good and bad qualities; feels positive about past life |
Low scorer | Feels dissatisfied with self; is disappointed with what has occurred in past life; is troubled about certain personal qualities; wishes to be different than what he or she is |
Indeed, the deeper philosophical roots of the new model of well-being resided in Aristotle’s formulation of the highest human good, which in his Nichomachean Ethics [ 17 ] he termed eudaimonia. His writings sharpened the significance of this alternative approach to well-being [ 18 ] via the claim that the highest of all human goods is not happiness, feeling good, or satisfying appetites. Instead, it is about activities of the soul that are in accord with virtue, which Aristotle elaborated to mean striving to achieve the best that is within us. Eudaimonia thus captured the essence of the two great Greek imperatives: first, to know yourself, and second, to become what you are. The latter requires discerning one’s unique talents (the daimon that resides in us all), and then working to bring them to reality. Two centuries later, these ideas flowed naturally into humanistic and developmental conceptions of self-realization. Existential thinking, in turn, emphasized the importance of finding meaning in adversity or an absurd world. From the scientific perspective, the larger point was that research on well-being, if it is to do justice to the topic, needs to encompass the meaning-making, self-realizing, striving aspects of being human.
Philosophical gravitas counts for little, however, if key constructs are not quantified. The development of assessment tools, essential for empirical research, shifted the focus to questions of psychometric properties. To date, more than 25 publications have evaluated the foundational evidence of scale reliability and validity [ 1 ] with a primary focus on whether the empirical facts supports a six-factor model. Numerous studies in different cultural contexts suggest it does [ 18 – 27 ]. Contrary evidence has also been provided [ 28 – 30 ], with accompanying critiques that the six dimensions are insufficiently distinct after adjusting for measurement error, and that the items are insufficiently discriminating at high levels of well-being. Others have challenged these same critiques, showing that inconsistent findings on the latent structure are likely due to the use of overly short scales rather than problems with the theoretical model itself [ 21 ]. Longitudinal analyses have added to the evidence of distinctiveness among dimensions by showing differential profiles of change with age [ 31 ].
The issue of scale length has been of interest. The initial measurement scales [ 1 ] were based on 20 items for each of the six dimensions (120 items total). Such length was needed to follow good scale construction guidelines (e.g., incorporate both positively and negatively phrased items) as well as to capture the multiple components of scale definitions, derived from the conceptual sources described above. These parent scales were subsequently reduced to 14-item scales (84 items total) to reduce respondent burden in completing the inventory [ 32 , 33 ]. A more extreme reduction in length (3-items per scale, 21 items total) was implemented to bring the measures into a national survey study [ 23 ]. That extremely pared down version supported the six-factor model of well-being in a large national sample, but psychometric problems with the individual scales (low alpha coefficients) made clear the reduction had been excessive. That was because items for the ultra-short version were not selected to maximize internal consistency, but rather to cover the underlying components of each scale, thereby maintaining fidelity with the conceptual foundation of each scale, which in turn, compromised internal consistency coefficients. What was learned in this process is the need to achieve balance between concerns about scale length (i.e., respondent burden) with the goals of adequate depth of measurement to insure credible assessment of the six well-being constructs. Most recently, a 7-item version (42 items total) employed in longitudinal follow-up of the U.S. national sample, seems to achieve such balance [ 34 ].
Taking all of the above into account, the six scales of well-being from the original model [ 1 ] have withstood extensive psychometric scrutiny. While debates about factorial structure may continue, such concerns have not hindered use of the scales by the larger scientific community, where still further evidence (see below) has been amassed regarding the distinctiveness across the measures (as outcomes, as antecedent influences, and as moderating variables). Issues of scale length have received extensive scrutiny, with growing evidence supporting the use of 14-item, or at minimum 7-item, scales to insure quality assessment of the constructs. It is also worth noting that clinimetric criteria have been advanced to evaluate the sensitivity of the scales in revealing psychological change following clinical treatments [ 35 – 37 ]. In such intervention contexts (detailed below), an interview-based version of the well-being model is also available [ 38 ]. Finally, as efforts to adjudicate the measurement or clinical effectiveness of the scales have proceeded, the instruments have been translated to more than 30 different languages, thus, underscoring their growing presence in science and practice around the world.
Scientific Advances on Psychological Well-Being
To date, over 350 publications using the eudaimonic scales of well-being have appeared in more than 150 scientific journals. The usage covers diverse topics extending across multiple scientific disciplines. It is beyond the scope of this article to examine the products in comprehensive detail, although illustrative categories of findings can be distilled. What follows organizes the scientific output according to six thematic areas: (1) development and aging, (2) personality correlates, (3) family experiences, (4) work and other life engagements, (5) health and biological research, and (6) clinical and intervention studies. Well-being is often investigated as outcome or dependent variable in these studies, but occasionally it is studied as an antecedent or predictor variable. Increasingly, it is also considered as a moderating influence (protective factor). These diverse applications underscore the broad utility of well-being constructs in contemporary scientific research. Although the last two thematic areas are of primary interest, the first four provide important evidence as to why eudiamonic well-being may be consequential for health and well-being – namely, because it is fundamentally anchored in how individuals negotiate their way through the challenges of life. This recognition further explicates why eudaimonic well-being is a worthy and essential target in intervention studies.
Development and Aging
Many researchers have used the scales to investigate adult development and psychological aging. Multiple studies have linked Erikson’s [ 9 ] stages of identity formation [ 39 ], generativity [ 40 – 42 ], and ego integrity [ 43 , 44 ] to psychological well-being. Across these endeavors, those reporting higher levels of ego development tend to show higher well-being. There are exceptions: identifying oneself as lesbian, gay, or bisexual has been associated with lower eudaimonic well-being [ 45 ], with such patterns linked to experiences of discrimination. Having a more developed feminist identity, however, has been linked with higher well-being [ 46 ].
Other work has focused on themes of personal growth, extracted from autobiographical memories [ 47 ], stories of life transitions [ 48 ], and narratives of major life goals [ 49 ]. All such aspects of growth have been linked with higher well-being. Two dimensions, environmental mastery and personal growth, were used to identify three specific paths of adult development in women, defined as conservers, seekers, and achievers [ 50 ]. Developmental changes in goal orientations from early to late adulthood have been studied, with higher well-being linked to maintenance of goals and loss prevention [ 51 ], while interference among goals predicted lower well-being [ 52 ].
Whether eudiamonic well-being improves or declines with aging has been a key focus. Initial cross-sectional studies revealed vulnerabilities in existential aspects of well-being, especially purpose in life and personal growth, among older compared to young or midlife adults [ 1 , 23 , 53 ]. These patterns have been validated with longitudinal evidence from multiple large samples, including national surveys [ 31 ]. Age and well-being varies by cultural context, however, as illustrated by Japanese and U.S. comparisons [ 54 ]. Later life well-being is known to be influenced by socioeconomic standing as well [ 53 , 55 ].
Related inquiries have examined subjective aging – how adults perceive themselves to be changing as they grow older. Younger and middle aged adults saw themselves as improving over time, whereas older adults anticipated decline in their well-being in the years ahead [ 56 ]. Distinctions have been made between how old people feel versus how old they would ideally like to be, with results showing that higher well-being is predicted by feeling younger, but not wanting to be younger [ 57 ]. A related study found that adults who perceive that they are younger than they actually are tend to have higher well-being [ 58 ]. Subjective aging has been compared with their actual aging, which allows for assessment of realism or illusion in self-evaluation. This work has shown that at all ages, greater realism and less illusion predict better functioning, including higher well-being [ 59 ].
How individuals negotiate the transitions of adult life has been linked to well-being. One common transition for older adults is relocation, typically involving a move from one’s longstanding home to an apartment or retirement community. Older women going through relocation were found to have higher well-being if they engaged in adaptive interpretative processes, such as comparing themselves favorably to others in the new setting and showing flexible self-concepts [ 60 – 62 ]. Those with higher environmental mastery, autonomy, and personal growth before the move also showed better emotional reactions after the move, particularly if the transition was difficult [ 63 ]. Chronic challenges, such as caring for an adult child with mental retardation, have been studied. Analyses from two longitudinal studies, one focused on caregiving and the other on relocation, found more positive cross-time changes in well-being among the women who were relocating compared to those providing care to an adult child [ 64 ]. However, coping strategies more strongly predicted the well-being of caregiving mothers, thus underscoring possible gains in expertise that accompany challenges of lengthy duration. Other work has linked the well-being of older adults in residential care facilities, particularly positive relations with others and self-acceptance, to coping strategies (active, passive, meaning-based) as well [ 65 ].
In sum, progressing through the developmental tasks of adult life has been linked with higher well-being, although aging itself has been accompanied by declines in purpose in life and personal growth. Those who feel younger than they are, but not who wish to be younger, report higher well-being, although realism rather than illusion in self-evaluation predicts higher well-being. Well-being changes as individuals negotiate the events of challenges of adult life, with improvements tied to various psychological processes (social comparisons, flexible self-perceptions, coping strategies).
Personality Correlates
Psychologists have given considerable attention to how well-being relates to other “individual difference” variables, such as personality traits [ 66 ]. An early investigation used the big five model of traits and found that openness to experience was linked with personal growth, agreeableness was linked with positive relations with others, and extraversion, conscientiousness and neuroticism were all linked with environmental mastery, purpose in life, and self-acceptance [ 32 ]. Many similar patterns were evident in an Iranian sample [ 67 ]. Comparative data from U.S. and German samples showed that personality traits rather than self-regulatory characteristics were strong predictors of well-being in both countries [ 68 ].
Longitudinal inquiries have addressed links between early personality profiles (age 16) and midlife well-being, finding that teenage females who were more outgoing (extraverted) had higher well-being (all dimensions) in midlife [ 69 ]. Teenage neuroticism, in contrast, predicted lower well-being on all dimensions, with the effects mediated through emotional adjustment. Interactions among traits were used to predict changes in well-being over the course of community relocation [ 70 ]. Openness to experience, for example, was found to amplify extraversion in predicting higher well-being, but it also amplified neuroticism in predicting greater distress.
A variety of other psychological variables have been linked with well-being. Optimism, for example, predicts higher well-being, with the effects mediated by sense of control [ 71 ]. Stable self-esteem predicts higher scores on autonomy, environmental mastery, and purpose in life than unstable self-esteem [ 72 ]. Emotion regulation strategies predict well-being: reappraisal is a positive predictor, whereas suppression is a negative predictor [ 73 ]. Life longings, defined as intense desire for alternative states and life realizations, predict lower well-being [ 74 ], but not if life longings are perceived as controllable. Life management strategies (selection, optimization, compensation) have been positively linked with well-being (after controlling for personality and motivational constructs) [ 75 ]. The satisfaction of psychological needs contributes to higher well-being [ 76 ]. Intentional activity changes predict gains in psychological well-being [ 77 ], while those who revealed shifts from extrinsic to intrinsic values over the college career had greater increases in psychological well-being [ 78 ].
Interpersonal well-being (positive relations with others) has been linked with self-reported empathy [ 79 ] as well as emotional intelligence [ 80 ], after controlling for personality traits and verbal intelligence. Cross-cultural research has shown that high independence (personal control) predicted higher well-being in the U.S., whereas high interdependence (relational harmony, measured as the absence of relational strain) predicted higher well-being in Japan [ 81 ].
In sum, researchers have studied how personality traits, often construed as heritable characteristics, predict reported levels of well-being using both cross-sectional and longitudinal designs. Numerous other individual difference variables, such as optimism, life management strategies, intentional activities, empathy, emotional intelligence, and independence and interdependence have been investigated as factors to account for reported differences in well-being.
Family Experiences
Scientists from subfields of sociology as well as family studies have linked diverse family roles, family transitions and unanticipated (nonnormative) family events to psychological well-being. Many adults occupy multiple family roles (parent, child, sibling, spouse). How these statuses are linked with diverse aspects of well-being has been examined in national U.S. surveys [ 82 ]. Findings are complex, depending on respondents’ age and gender, but they highlight that parenting children is more challenging to the well-being of women than men, that the well-being benefits of marriage are fairly similar for men and women, and that having unhealthy aging parents undermines the well-being of young and midlife women. Whether having multiple roles enhances or undermines well-being has been examined [ 83 ], with findings supporting the idea that greater role involvement enhances well-being. Well-educated women in multiple roles showed higher levels of autonomy, with perceived control moderating some links between multiple roles and well-being.
Other studies have investigated what people do in their adult roles. Helping those in one’s family has been linked with higher levels of purpose, self-acceptance, and positive relations in men, whereas general helping of others was linked with higher purpose and self-acceptance in women [ 84 ]. In dealing with the functional decline that accompanies aging, the sense of obligation that people feel to help others protected against declining levels of personal growth and self-acceptance [ 85 ]. Family connections and family rituals have been linked to well-being, both in adolescence and midlife [ 86 , 87 ].
Marital status, per se, has been of considerable interest. The consistently married compared to the divorced, widowed, or never married had higher purpose in life, with such differences partly explained by socioeconomic resources [ 88 ]. Similarly, being divorced and never married was negatively associated with total well-being (all six scales combined), although widowed and never married women reported significantly higher total well-being than men in the same marital groups [ 89 ]. In contrast, single women fared better than married women in reported levels of autonomy and personal growth [ 90 ]. The transition to divorce or widowhood has been associated with well-being decline, particularly for women [ 90 ], although post-divorce well-being was influenced by finding meaning in one’s activities [ 91 ]. Underscoring well-being as a protective resource, individuals with higher environmental mastery, self-esteem, and optimism were better able to adapt to conjugal loss [ 92 ].
The parental experience has been extensively linked to adult well-being. Parents reporting positive experiences with their adult children had higher well-being, with such effects linked to midlife generativity [ 93 ]; another investigation found differences between parents and childless adults [ 94 ]. Childless middle-aged women had higher well-being if they felt they had control over this life longing [ 95 ]. How adults themselves were parented also seems to matter – adults who recalled having authoritative rather than authoritarian or uninvolved parents reported greater psychological well-being in midlife, especially men [ 96 ]. Those who perceived their parents to be permissive showed lower well-being [ 97 ]. How children were doing in life was also linked with parents’ well-being. Those whose children had more problems reported compromised well-being [ 98 ]. Alternatively, parents who perceived that their children were well adjusted reported higher well-being [ 33 ], although children’s attainment (e.g., educational standing) was less strongly linked with their parental well-being. Interestingly, parents who viewed their children as better adjusted than themselves had lower well-being. The success of sons was more strongly predictive of parents’ well-being than the success of daughters [ 99 ], although personal comparisons with daughters more strongly predicted parents’ well-being than comparisons with sons.
Nonnormative (unplanned, unexpected) family events have been studied. The trauma of losing a child has been shown to have lasting consequences: nearly 20 years after the death, bereaved parents reported poorer well-being, more depressive symptoms, and more health problems than comparison parents [ 100 ]. However, the same investigation showed that recovery from grief was linked with deepened purpose in life. Other research showed that death of a child had more detrimental effects on the well-being of fathers than mothers [ 101 ], while conversely having an adult child return to the parental home decreased the well-being of mothers, but not fathers. Providing care to an aging parent has been linked with change in depressive symptoms [ 102 ], but such effects were reduced among daughters with higher levels of environmental mastery. Being the sibling of an adult with mental illness has been linked with less well-being and more distress compared than adults with normal siblings [ 103 ].
Multiple investigations have examined how early family experiences influence adult well-being. Losing a parent to death or divorce prior to age 17 was linked with lower self-acceptance, lower environmental mastery, and lower positive relations with others in midlife men [ 104 ], whereas parental death in childhood predicted higher autonomy in adult men, but greater depression in adult women. Lack of parental support during childhood was linked with increased depressive symptoms and chronic conditions in adulthood [ 105 ], with some effects mediated by well-being and self-esteem. Family dynamics (connection and individuation in the family system) during adolescence predicted adult well-being in midlife [ 106 ], while discrepancies between adolescents’ versus parents’ perceptions of family functioning were linked with lower well-being in adolescence. Elderly parents’ well-being was linked to positive relationships with their adult children, with such effects traceable to family systems dynamics when children were adolescents [ 107 ]. Those who reported experiencing psychological and/or physical violence from parents in childhood had less psychological well-being and more negative affect in adulthood [ 108 ].
To summarize, greater role involvement appears to promote higher well-being, although actual activities in family roles matters – helping others seems to enhance purpose and self-acceptance. Those who are consistently married have a well-being advantage compared to the divorced, widowed, or never married, but single women score higher on autonomy and personal growth compared to married women. Parenting seems to enhance adult well-being, particularly if one’s children are doing well. Loss of a child in adulthood predicts impaired well-being decades later, while loss of a parent in childhood predicts lower levels of multiple dimensions of adult well-being. Experiencing psychological or physical violence from parents in childhood compromises adult well-being, as does caring for an aging parent, although less so for daughters with high environmental mastery. Overall, family life shows extensive connections to reports of diverse aspects of eudaimonic well-being in adulthood.
Work and Other Life Engagements
People’s workloads have been studied as factors contributing to depression and physical symptoms, but limited research has examined how work influences positive aspects of human functioning. Links between work and psychological well-being were found to differ depending on whether work is paid or unpaid [ 109 ]. For women, unpaid work was associated with lower levels of self-acceptance and environmental mastery, whereas for men, paid work was associating with increased levels of personal growth. Well-being has been investigated as an influence on vocational identity and career pursuits. Purpose in life and personal growth were found to contribute to career commitments [ 110 ]. Women who saw themselves as falling short of their early career goals had lower levels of purpose in life and higher depressive symptoms, after adjusting for multiple background and health characteristics [ 111 ]. A longitudinal cohort of Swedish women found different psychological outcomes for diverse combinations of education, work and family [ 112 ]; a key finding showed that women in higher socioeconomic strata exhibited better health and well-being than those in lower strata. Focusing on types of work, women teachers were found to have higher well-being compared to women working in banks, who in turn, had higher well-being than women working in industry [ 113 ]. Work and educational experiences were the strongest predictors of well-being among older adults, whereas reports of family and relational experience were strongest predictors of well-being in midlife [ 114 ].
The interface between work and family has been extensively studied. Work-family conflict, particularly as it relates to the demands of caregiving, has been linked with poorer well-being [ 115 ]. Alternatively, positive spillover from work to family and from family to work is associated with better well-being outcomes [ 116 ]. Changing expectations about how to fulfill work and family roles has been linked with cohort differences in how such roles are tied to well-being [ 117 , 118 ]. For example, older women and younger men who adjusted their work schedules to meet family demands had higher self-acceptance, whereas older men and midlife or younger women had lower self-acceptance if they cut back on paid employment to accommodate family demands. Invoking comparisons between Korean and U.S. adults, positive work to family spillover was associated with better adult well-being, but not for Korean women, whereas negative work to family spillover was linked with poorer well-being, especially among U.S. women [ 119 ]; negative family to work spillover was also linked with poorer mental health, particularly among Korean men.
Beyond work and family life, reports of well-being have been linked to participation in volunteer work. Longitudinal data showed that volunteer work over time enhanced eudaimonic, but not hedonic well-being [ 120 ], and that people with higher well-being at baseline were more likely to volunteer. A similar study [ 121 ] used longitudinal data to show that a moderate amount of volunteering (up to 10 hours monthly) and donating to charity was linked with increases in well-being over a 9 year period. Formal volunteering was shown to be protective in dealing with later life role loss [ 122 ] – specifically, volunteering moderated the negative effect of role loss on older adults’ purpose in life.
Religious participation and religious experience has been linked to well-being. In late adulthood, religiousness was positively associated with interpersonal well-being, whereas spirituality was positively linked with personal growth [ 123 ]. Religious involvement predicted higher levels of multiple dimensions of well-being among elderly African Americans [ 124 ]. Formal religious participation was associated with higher purpose in life and personal growth, but lower autonomy, whereas higher spirituality was associated with higher levels of all aspects of eudaimonic well-being [ 125 ].
In sum, well-being appears to contribute to, and be influenced by, career pursuits with findings varying depending on the types of work pursued. How work and family life come together has been extensively linked to well-being, with evidence showing that conflict between the two realms undermines well-being, while positive spillover from one to the other predicts better well-being. Social change is unfolding in how younger cohorts of men and women manage work/family roles, with related differences for reported well-being. Cultural differences how work and family influence well-being are also evident. Volunteering, especially in later life, is linked with higher well-being, while religious participation has been tied to higher levels of levels of purpose and growth, but lower levels of autonomy.
Health and Biological Research
Arguably, the most novel advances in the science of eudaimonia have occurred in building bridges to physical health, including underlying biological regulation. Such work signals important strides for research on human well-being, by showing its relevance for multiple aspects of physical functioning, as well as for health research, by demonstrating the importance of attending to people’s phenomenological outlooks about how they are dealing with the existential challenges of life. As illustrated below, numerous topics have connected eudaimonia and health.
Regarding self-reported health, the prior section on aging showed that later life physical health predicts psychological well-being via social comparison processes [ 126 , 127 ]. Longitudinal analyses further demonstrated that women in the poorest health at baseline who engaged in positive social comparisons showed more positive relations with others and less depression and anxiety at follow-up [ 128 ]. In addition, later life stress has been shown to affect health via beliefs about self-efficacy and environmental mastery [ 129 ]. On the positive side, mentally healthy adults (those with high levels of multiple aspects of well-being and limited psychological distress) at all ages had fewer chronic conditions compared to adults lacking well-being [ 130 ]; they also showed greater productivity and lower health care use [ 131 ].
Frailty in old age has been associated with diminished well-being, which in turn, was linked with 5-year mortality, independent of numerous factors [ 132 ]. Among frail older adults, however, spirituality emerged as a resource for maintaining psychological well-being [ 133 ]. How older adults manage daily life (e.g., environmental mastery) in the face of sensory loss (visual, hearing) has been linked to cognitive resources [ 134 ]. Hearing disability has been shown to compromise well-being among older adults [ 135 ], those experiencing late onset deafness showing significantly lower well-being [ 136 ]. How older adults manage end-of-life medical decision making has been linked to their personal and affiliative beliefs, rather than to a lack of autonomy [ 137 ].
Women with fibromyalgia reported lower overall well-being than women with rheumatoid arthritis or healthy controls, although those with greater well-being showed less disability and fatigue [ 138 ]. Well-being also mediated the relationship between social network size and disability. In patients with rheumatoid arthritis, low environmental mastery has emerged as a useful screen for identifying those vulnerable to developing depression [ 139 ]. Research on patients with Parkinson’s disease showed compromised levels of sense of coherence and well-being compared to a control group [ 140 ]. Psychological factors, including well-being, have been linked to adjustment in patients suffering from hypertension [ 141 ] as well as congestive heart failure [ 142 ], thereby underscoring the importance of well-being in understanding the course of illness.
Psychosocial impairment has been studied in the context of pituitary disease. Such work employed a brief instrument (Psychosocial Index, PI) designed for use in clinical practice [ 143 ]. A subset of well-being items were included, along with reduced assessments from other established measures. Findings revealed that patients with endocrine disease, whether pituitary or not, reported more psychological distress and less well-being than controls [ 144 ]. A further study used the PI to document that patients with primary aldosteronism had higher levels of psychological distress and lower levels of well-being than controls [ 145 ].
Family members and friends of adults with aphasia were found to be reliable informants of their partner’s well-being and daily activities, but not of their health-related quality of life [ 146 ]. Visually impaired young adults participating in a game designed for them (torball) showed significantly higher levels of well-being on 5 of 6 scales compared to nonplayers [ 147 ]. Multiple factors (sociodemographic characteristics, psychosocial adaptation to pregnancy, well-being) were investigated as influences on preterm uterine contractions [ 148 ]. Women at risk for preterm labor were shown to have lower environmental mastery, lower positive relations with others (especially husband), and lower acceptance of pregnancy compared to gestationally and parity-matched controls. Well-being, along with other demographic, behavioral and medical variables, predicts those likely to use hormone therapy [ 149 ].
Several studies have investigated well-being among cancer survivors. Perceived social support and approach oriented coping strategies predict higher eudaimonic well-being among women diagnosed with stage I or II breast cancer [ 150 ]. Personal narratives among breast cancer survivors were used to identify those in the positive self-transformation group (compared to the minimal transformation or feeling stuck subgroups) [ 151 ]. Such individuals showed higher self-esteem and well-being than the other two groups. Breast-cancer survivors, compared to matched controls, showed greater posttraumatic growth, particularly in relating to others and appreciating life [ 152 ]. Benefit finding among patients with thyroid cancer, after controlling for demographics and cancer stress, was associated with greater positive affect, wisdom, and spiritual well-being, but not greater purpose in life or self-acceptance [ 153 ]. A national longitudinal study found impairment in mental health, mood, and some aspects of well-being in cancer survivors compared to sociodemographically matched non-cancer comparison group, although some areas of vulnerability were evident prior to cancer diagnosis [ 154 ]. However, cancer survivors in the same study exhibited resilience in social well-being, spirituality and personal growth. Although personal growth tends to decline with age, cancer status was found to slow the decline in personal growth among younger adults, while it accelerated the decline among older cohorts [ 155 ].
Health behaviors have been linked to well-being. Those who engage in diverse types of exercise show higher psychological well-being and self-esteem compared to non-exercising respondents [ 156 ], with additional analyses showing that regular physical activity predicts higher levels on all aspects of psychological well-being compared to non-exercisers [ 157 ]. An ecological model of exercise in adulthood showed that levels of exercise were linked with educational status, age, and race as well as with functional health problems and perceptions of living in a less safe neighborhood [ 158 ]. In addition, good mental health, defined with multiple composites including well-being, was greatest among those who exercised, did not smoke, attended church regularly, and had frequent contact with friends [ 159 ].
A further behavior of interest has been sleep. After adjusting for demographic characteristics and mental and physical health conditions, insomnia significantly predicted both hedonic and eudaimonic well-being, although insomnia symptoms were more strongly related to compromised enjoyment of life than to lowered meaning in life [ 160 ]. A further study showed that after adjusting for numerous factors, optimal sleepers reported higher levels of environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance as well as reduced symptoms of depression and anxiety, thus underscoring sleep as a resource related to stress management and self regulation [ 161 ]. Longitudinal findings over a 10-year period showed that recurrent insomnia is particularly detrimental to both types of well-being [ 162 ]. A separate longitudinal sample of aging women, showed that sleep declined over time, but not for all respondents [ 163 ]; those with higher well-being (all dimensions except autonomy) and lower depression at baseline showed reduced odds of being in the sleep disrupted group over time.
Weight and body consciousness have been linked with well-being. Those who are overweight or obese showed lower well-being compared to normal weight groups, particularly among women [ 164 ]. In addition, obese respondents (body mass index of 35 or higher) were more likely to report employment discrimination and interpersonal mistreatment and lower levels of self-acceptance, with the latter effect mediated by the perception that they had been discriminated against on the basis of appearance. A sample of college students and their middle-aged mothers showed that body consciousness (e.g., feeling one does not meet cultural standards) was linked to lower well-being in both groups, with body esteem tied more strongly to daughters’ well-being than mothers’ [ 165 ]. Alternatively, overweight women showed that those who endorsed the need for social change in attitudes toward overweight people had higher body self-esteem and self-acceptance and lower body shame than those who endorsed only personal acceptance of body size [ 166 ]. Age-related changes and cohort differences in models of body experience were studied in a 10-year longitudinal investigation [ 167 ] with results showing that young women’s body surveillance and body shame decreased over time, while body esteem increased.
Innovative research has linked eudaimonic well-being to biological measures to investigate whether subjective indicators of meaning, purpose, and growth are accompanied by better regulation of physiological systems. Initial work, based on a sample of older women, [ 168 ] showed that those with higher levels of eudaimonic well-being had lower levels of daily salivary cortisol, lower pro-inflammatory cytokines, lower cardiovascular risk, and longer duration REM sleep compared to those with lower well-being [ 168 ]. Hedonic well-being, in contrast, showed minimal linkage to the biomarker assessments. The same aging sample showed that, after adjusting for covariates, women with higher scores on positive relations with others had lower levels of plasma IL-6, whereas those reporting higher scores on purpose in life had lower levels of the soluble IL-6 receptor (sIL-6R) [ 169 ]. Another study showed lower cortisol output among individuals with high psychological well-being [ 170 ]. Lower cortisol levels were found among individuals showing self-enhancing cognitions, with such effects mediated by psychological resources, including well-being [ 171 ]. Links between well-being and immune function were investigated via cytokine responses to influenza or hepatitis A immunization; significant positive correlations were found between well-being and production of IFN-γ and IL-10 [ 172 ].
The interplay between positive relationships with others, sleep quality, and plasma IL-6 has been investigated [ 173 ] with findings showing that higher levels of this marker, implicated in cardiovascular and rheumatological disease as well as osteoporosis and Alzheimer’s disease, were evident among women with poor sleep efficiency and poor social relationships. There was also evidence of compensatory effects: women with poor sleep efficiency but good relationships, as well as women with poor relationships but good sleep, had levels of IL-6 comparable to those with the protective influence of both factors. Extending the inquiry to a national sample, social engagement was found to moderate the association of sleep complaints on both IL-6 and the soluble adhesion molecule E-selectin in men, but not women [ 174 ]; similarly, social engagement moderated the link between actigraphy measured sleep efficiency and IL-6, but again only for men.
Psychological well-being is increasingly investigated as a moderator of links between inequality and biological risk factors. Adults with lower educational attainment were found to have higher levels of IL-6, after adjusting for numerous factors [ 34 ], but educational status interacted with psychological well-being in predicting levels of IL-6: among those with a high school education or less, higher eudaimonic well-being (multiple dimensions) and higher positive affect was associated with lower levels of IL-6. The results thus revealed protective effects of well-being in the face of educational disadvantage. Socioeconomic status and well-being were used to predict cross-time changes in glycosylated hemoglobin (HbAlc), a marker of glycemic control, among nondiabetic older women [ 175 ]. Higher income predicted lower cross-time profiles of HbAlc, but measures of well-being (purpose in life, personal growth, positive affect) moderated the relationship between income and HbAlc. Shifting to challenges of aging, psychological well-being has been found to moderate relationships between later life co-morbidity and inflammation [ 176 ]. That is, many older adults live with multiple chronic conditions, known to fuel further inflammatory processes that can contribute to subsequent functional decline. Although IL-6 and CRP levels were shown to be higher among those with increased numbers of chronic conditions, such effects were buffered by respondents’ levels of well-being: older adults with higher levels of purpose in life and positive relationships with others had levels of inflammation comparable to those with fewer chronic conditions.
Shifting to integrative measures of biological risk, individuals with higher levels of both eudaimonic and hedonic well-being were at reduced risk of metabolic syndrome, after adjusting for confounds [ 177 ], with such effects robust across demographic subgroups (age, gender, educational status, race). A study of personality change over ten years found that those who became less conscientious and more neurotic over time had both lower well-being and worse metabolic profiles [ 178 ]. Another study examined multiple topics in a healthy population (sources or distress, psychiatric and psychosomatic symptoms, well-being and social and occupational functioning) and found that those meeting multiple criteria of distress had lower levels of serum proteins, erythrocytes, and immune differential count compared to non-distressed counterparts [ 179 ].
Particular interest has been shown in purpose in life, a key existential dimension of eudaimonic well-being, and its links to disease outcomes as well as mortality. A longitudinal epidemiological study of aging showed that those with higher levels of purpose in life at baseline were at reduced risk for incident Alzheimer’s disease and mild cognitive impairment compared to those with lower purpose in life, after adjusting for confounds [ 180 ]. High purpose in life also predicted reduced rates of mortality seven years later [ 181 ]. In the same study, post mortem examination of organic pathology in the brain showed that links between multiple indicators of pathology and cognitive impairment differed depending on levels of purpose in life [ 182 ]. Specifically, respondents with higher purpose in life exhibited better cognitive function, despite the increased burden of disease. Such effects persisted after controlling for numerous confounds. Other recent work, based on a large national longitudinal study of aging, has shown that purpose in life is linked with reduced risk of stroke [ 183 ] and reduced risk of myocardial infarction among those with coronary heart disease [ 184 ], after adjusting for numerous covariates.
The neural correlates of well-being are receiving increased attention. Using electrophysiological indicators, an initial study showed that adults reporting higher levels of eudaimonic and hedonic well-being showed greater left than right superior frontal activation in response to emotional stimuli [ 185 ]; further, the eudaimonic effects were maintained after adjusting for the hedonic indicators, but the reverse was not true (brain-based links to hedonic well-being were no longer significant after controlling for eudaimonic well-being). Another study used functional magnetic resonance imaging to investigate differences in amygdala activation in response to negative relative to neutral stimuli [ 186 ]. Findings showed that those who were faster to evaluate negative information showed increased left and right amygdala activation, but these effects varied depending on overall profiles of psychological well-being. Individuals with high well-being were slower to evaluate such information, showed reduced amygdala activation, and increased ventral anterior cingulated cortex activation. Another recent study has documented that those showing sustained activity in the ventral striatum and dorsolateral prefrontal cortex while viewing positive stimuli reported higher eudaimonic well-being as well as lower cortisol output [ 187 ]. These results suggest that sustained engagement of reward circuitry when encountering positive events may underlie the phenomenology of well-being as well as related regulation of the hypothalamic pituitary adrenal axis. Finally, eudaimonic well-being has been linked with insular cortex volume, which is involved with a variety of higher-order functions. Results showed positive links between personal growth, positive relations and purpose in life with right insular cortex grey matter volume [ 188 ]. The positive relations scale was also significantly associated with left insula volume.
To summarize, growing evidence indicates that well-being is compromised in those with diverse physical illnesses and disabilities, although its presence has been implicated in the course of illness, with some individuals showing gains or maintenance of well-being in the aftermath of disease. Importantly, epidemiological studies document the protective influence of purpose in life vis-à-vis risk for cognitive impairment and Alzheimer’s disease, even in the presence of organic pathology in the brain. Purpose in life is also linked with reduced risk for stroke and myocardial infarction. Other inquiries have linked aspects of eudaimonic well-being to health behaviors (exercise, sleep, weight). Numerous studies show higher well-being predicts better biological regulation, measured in terms of stress hormones, such as cortisol, as well as inflammatory markers and cardiovascular risk factors. These benefits were evident in contexts of risk, such socioeconomic disadvantage and increased chronic conditions in later life. The neuroscience of eudaimonia is emerging, with initial evidence showing that those with higher well-being have differential brain responses to negative stimuli (less amygdala activation, more engagement of higher order cortical structures) and positive stimuli (sustained activation of reward circuitry), with the latter effect accompanied by reduced cortisol output. Those with higher well-being also show greater insular cortex volume. Eudaimonia is thus increasingly implicated in health and biological regulation as well as in brain-based processes, with an overarching message that it appears to serve adaptive, protective functions.
Clinical and Intervention Studies
How well-being intersects with mental illness has received considerable attention. A national sample of U.S. adults found that risk of a major depressive episode was substantially higher among individuals who lacked multiple aspects of well-being [ 189 ]. Measurement work further clarified that emotional, psychological, and social well-being constitute separate unipolar dimensions relative to measures of major depressive episodes, generalized anxiety, panic disorder, and alcohol dependence [ 190 ]. When combined, only a small proportion of the population (16.6%) showed complete mental health (presence of the positive, absence of the negative), although such individuals had fewest limitations in activities of daily living and fewest missed days at work compared to other mental health categories. Longitudinal data showed that cross-time gains in mental health (defined in terms of well-being) predicted cross-time declines in mental illness, thus underscoring the need for greater public health attention on the promotion of positive mental health [ 191 ].
Other investigators have probed linkages between specific mental disorders and well-being. One study examined how well-being moderates insight in patients with schizophrenia or psychotic disorders who had paranoid symptoms [ 192 ]. The paranoid group with low insight showed higher self-acceptance, autonomy, and personal growth, compared to the paranoid group with low insight. Additional work examined implicit and explicit self-esteem (assessed in part with the self-acceptance scale) in patients with persecutory delusions [ 193 ]. Depressed patients showed lower explicit self-esteem than did paranoid and healthy control participants, but those with persecutory delusions had significantly lower implicit self-esteem than healthy controls. The findings were interpreted with a focus on defense mechanisms in the paranoid group.
Individuals in the chronic phase of schizophrenia reported significantly lower levels on all six dimensions of well-being relative to controls. Further, negative symptoms and depression predicted these aspects of well-being in the schizophrenic sample [ 194 ]. Among residents in aged care settings, psychological well-being (environmental mastery, purpose in life, autonomy) was found to be more important in understanding depression than traditional risk factors such as medical illness or disability [ 195 ]. Post-traumatic stress disorder in Pakistani earthquake survivors was linked with protective psychosocial factors [ 196 ], with findings showing that among those who met PTSD criteria, symptoms were lower if they had higher levels of purpose in life.
Psychiatric paradigms often define recovery as reduction in symptoms or the absence of psychological distress. Moving beyond this formulation, studies in remitted patients with mood and anxiety disorders [ 197 ] as well as panic disorder and agoraphobia [ 198 ] revealed significantly lower levels on multiple aspects of psychological well-being. Such findings clarify that complete recovery involves more than reduction of distress; it must also include improvements in well-being, which in turn, underscore the need for sequential therapeutic strategies.
A prominent example is “well-being therapy” developed by Fava and colleagues [ 199 , 200 ], which make explicit use of the eudaimonic approach to psychological well-being. Conceived as an addition to cognitive behavioral therapy in treating the residual phase of major depression, the goal is to promote patients’ experiences of the positive as a way of preventing relapse. The intervention requires keeping daily diaries of positive experiences, which then become the focus in therapy wherein patients learn how to prevent premature curtailment of positive experiences as well as how to enrich and extend them. For example, if a diary entry pertains to a good social interaction experience, the clinician expands on the meaning of positive relationships with others to broaden the patient’s thinking about what good interpersonal relations might entail. Initial findings with such treatment revealed significant improvements after discontinuation of drug therapy, compared to no significant change in the clinical management group. A follow-up study showed that benefits in the prevention of relapse of major depression persisted over a six-year period [ 201 ]. Subsequent work extended the approach to treating generalized anxiety disorder [ 202 , 203 ], thereby underscoring the benefits of sequential treatment strategies (i.e., cognitive behavioral therapy, CBT, followed by well-being therapy, WBT) in achieving sustained recovery. The combination of cognitive behavioral treatment with well-being therapy was also employed in a randomized clinical trial to treat cyclothymic disorder [ 204 , 205 ]. Findings on all outcomes showed greater improvement in the CBT/WBT group compared to clinical management group. Taken together, these initiatives speak to the utility of well-being therapy in preventing relapse of mood, anxiety, and cyclothymic disorders as well as treating patients who fail to respond to standard pharmacological or psychotherapeutic treatments or have body image disturbances [ 206 ]. Throughout, these approaches have underscored the need for a more expansive concept of recovery – no longer is reduction in number and severity of symptoms sufficient, new criteria call for patients to experience well-being that is known to reduce future risk for relapse [ 207 ].
Other types of psychiatric interventions have utilized assessments of well-being to evaluate the efficacy of treatment. For example, reports of psychological well-being were used to document the effectiveness of a cognitive behavioral therapy, known as Graduated Recovery Intervention Program (GRIP), designed for those experiencing an episode of psychosis [ 208 ]. Gains in four of six dimensions of well-being were used to demonstrate the efficacy of strategies to treat depression among individuals suffering from multiple sclerosis [ 209 ]. A community-based intervention program for people with aphasia and their families showed gains over a six month period in five of six dimensions of well-being among clients and family members [ 210 ]. Patients with rheumatoid arthritis participating in a mindfulness-based stress reduction program showed significant improvement in psychological well-being after an 8-week course and a 4-month maintenance program [ 211 ]. A loving-kindness meditation conducted with patients with schizophrenia-spectrum disorders produced gains in well-being and reductions in negative symptoms [ 212 ].
Interventions have been conducted with nonclinical samples as well, thus revealing shifts toward prevention of mental or physical health disorders. For example, Ruini and colleagues adapted well-being therapy to school settings [ 213 ] in an effort to prevent psychological disorders such as depression during adolescence. Comparison of students receiving the intervention with an attention-placebo group revealed significant improvements in personal growth along with reductions in multiple indicators of distress [ 214 ]. A mental health program designed to promote adult resilience in the workplace used interpersonal and cognitive behavioral therapy over an 11-week intervention; findings showed significant improvements in mental health and well-being [ 215 ]. Similar effects were obtained with a second, shorter (7-week) intervention [ 216 ]. The emotional disclosure of trauma has been shown to improve sense of mastery, personal growth, and self-acceptance, while decreasing depressive symptoms, anxiety and somatization [ 217 ]. Gains in all aspects of well-being resulted from a retrospective life review program conducted with community-dwelling older women [ 218 ].
Finally, meditation interventions have utilized assessments of well-being. One study involved a three month intensive meditation program designed to improve self-regulation strategies [ 219 ]. Findings revealed improvement in response inhibition in the treatment compared to the control group as well as accompanying gains in adaptive functions, including a composite of measure of well-being. Effects were sustained five months post-training. Another study examined the effect of a 3-month meditation retreat on telomerase activity as well as mindfulness and purpose in life [ 220 ]. Compared to the wait-list control group, those receiving intensive meditation training showed significantly greater telomerase activity and increases in both psychological outcomes, with the latter effects mediated by increases in perceived control and decreases in neuroticism.
To recapitulate, it is now well established that eudaimonic well-being is not simply the flipside of psychological distress. Both are important indicators of overall mental health, and population studies reveal diverse combinations of how the two domains come together. Increasingly, well-being is considered in research on specific mental disorders (schizophrenia, depression, panic disorder, cyclothymia, agoraphobia, post-traumatic stress disorder) that have been shown to compromise the individual’s sense of mastery, growth, purpose, and positive self-regard. It is also the case that the presence of well-being is sometimes accompanied by reduced symptoms of these disorders. The greatest advances have occurred in clinical intervention studies where improvements in well-being now constitute innovative new treatment targets needed to prevent relapse. Multiple studies document long-term treatment benefits associated with well-being therapy. Other psychiatric interventions have employed measures of well-being to validate the effectiveness of diverse treatment programs. Interventions have been extrapolated beyond the clinic to school and workplace settings with the goal of enhancing well-being so as to prevent mental illness and promote resilience. Meditation-training programs have been shown to increase eudaimonic aspects of psychological well-being.
Summary Observations and Future Directions
As illustrated above, the eudaimonic approach to psychological well-being has become a flourishing arena of scientific inquiry and clinical practice. Why this has occurred merits reflection. Presumably, it stems from the fact that these phenomenological indicators capture core aspects of what it means to be human: that is, to strive, be proactive, make meaning, and as articulated by Aristotle over 2,000 years ago, to pursue the highest good that is within us. These ideals about human functioning, along with refinements from existential, humanistic, developmental, and clinical psychology, paved the way for new empirical targets in scientific research [ 1 ]. Measures designed to operationalize eudaimonic well-being have now been incorporated into many fields as tools to evaluate people’s negotiations through the challenges and transitions of adulthood and aging as well as their management of work, family and community life. Psychological well-being, it seems, is becoming as foundational to defining who we are as were personality traits some decades ago.
Without question, the most informative advances have come from linking psychological well-being to physical health, biological regulation, and neuroscience. These scientific strides need to be broadened and deepened, but growing evidence shows that qualities such as purposeful engagement, self-realization and growth, and enlightened self-regard are relevant empirical influences on how long and how well people live. Epidemiological studies document that purpose in life predicts reduced risk for numerous diseases (Alzheimer’s, stroke, myocardial infarction), and a proliferation of studies have begun to probe underlying biological mechanisms, measured in terms of neuroendocrine regulation, inflammatory markers, glycemic control, and cardiovascular risk. Multiple studies have linked phenomenological indicators of well-being to reduced amygdala activation in response to negative stimuli, sustained activity in the ventrial striatum and dorsolateral prefrontal cortex when viewing positive stimuli, and increased insular cortex volume. Of importance in the research that lies ahead is the need to build bridges across these different levels of analysis – phenomenology, biology, and neuroscience, all of which play a part in accounting for adaptive human functioning.
Given the prior lines of inquiry reviewed above, it is both sensible and appropriate that interventions are flourishing to enhance and improve individuals’ experiences of well-being, as a route to nurturing sustained recovery from diverse mental health problems, such as major depression, generalized anxiety disorder, cyclothymic disorder, schizophrenia and post-traumatic stress. These advances have been accompanied by preventive interventions outside the clinic, intended, for example, to reduce risk for depression in adolescence and old age. Clearly, the emphasis on psychological well-being has launched important new directions in research translation, application, and education.
The way forward includes rich possibilities. One relevant priority is to nurture greater interplay among the multiple domains summarized in this review. The six thematic areas examined each have their own scientific communities, including their own journals. Enlightened multidisciplinary research is needed to work across these domains. That is, psychological studies of adult development and aging, along with personality research, are enriched by attending to the contexts of people’s lives (work and family experiences), with well-being serving as a vital thread throughout. These same areas of psychosocial and contextual inquiry, in turn, are critically needed in research on health, biological regulation, and neuroscience, which is often disconnected from the substance of people’s lives, and importantly, from their phenomenological outlooks on how things are going.
Weaving these pieces together demands datasets that include in-depth measures across multiple domains as well as longitudinal follow-ups. One such study is MIDUS (Midlife in the U.S., www.midus.wisc.edu ), the data from which are publicly available. MIDUS is thus a major forum for carrying out biopsychosocial investigations that are open to all interested scientists. Thanks to parallel data collected from a large Japanese study, known as MIDJA (Midlife in Japan), the integrative work has also begun to embrace culture influences on what constitutes the highest goods in life and how they matter for health.
A fruitful future direction, given decades of health research on why people become ill (mentally or physically), diseased, disabled, and die, is human resilience – namely, the capacity of some to experience and sustain their well-being, perhaps even deepen it, despite the challenges that life presents to them, be they loss events, social inequalities, unexpected traumas, or living in a sometimes hostile world [ 221 ]. MIDUS, because of its notable depth in assessing well-being, along with all of the thematic domains covered above, is uniquely suited for such research. Indeed, MIDUS has become primary hub for studies of human resilience [ 222 ]. Much future work remains to be done in probing hypotheses about how eudaimonic well-being affords protection under diverse conditions of challenge and the mechanisms through which such effects occur. Nurturing these integrative pursuits and their implications for the world of practice is a worthy goal for the next 25 years.
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Discovering Psychological Well-Being: A Bibliometric Review
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- Published: 16 April 2024
- Volume 25 , article number 43 , ( 2024 )
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- Busra Yiğit ORCID: orcid.org/0000-0002-0096-856X 1 &
- Bünyamin Yasin Çakmak ORCID: orcid.org/0000-0003-2050-0267 1
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Psychological well-being is among the concepts that have attracted significant attention from researchers in the fields of social life, work life, and health in recent years. We conducted bibliometric mapping and content analysis to reveal current trends in the concept and contribute to the literature. Using VOSviewer, Citespace, Bibliometrix and MS Office Excel programs, we analysed 16,885 academic studies published in the Web of Science database between 1980 and 2022. The research results show a continuous increase in publications and citations, with a notable surge observed after 2016. The United States accounts for over a third of the publications. Furthermore, the International Journal of Environment Research and Public Health and Frontiers in Psychology stand out as the most productive journals, whereas Carol D. Ryff is the most prolific and cited author in the field. When the footprints of the keywords over the past 10 years are interpreted, some notable trends are identified. Initially, research themes mainly revolved around children, dementia, and social support. However, with the COVID-19 pandemic emerging as a new thematic focus and the disruption of the person-job and person-environment order due to the repercussions of lockdowns, the emphasis has shifted from the theme of social support to mindfulness, loneliness, and support. Notably, motivation and rehabilitation have emerged as significant focal points, with increased attention on social isolation and healthcare workers in recent publications.
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1 Introduction
Positive psychology (PP) is a vibrant field of research, as the focus in mental health research has shifted from negative psychological problems to positive human behaviours (Seligman & Csikszentmihalyi, 2000 ). In PP, well-being is modelled as holistic (Seligman, 2012 ) or multidimensional (Ryff, 1989 ). With the emergence of PP, interest in the structure and nature of well-being has increased. Due to the broad research field of well-being, different approaches have been developed. The hedonic approach, which is one of the vital and ongoing popular topics in the field, sparked discussions in the 1950s and was considered close to subjective well-being (SWB) since it was subjectively inspired by positive and negative emotions and quality of life (Bradburn, 1969 ; Diener, 1984 ). Meanwhile, the eudaimonic approach started with experimental studies in the 1980s, emphasising the necessity of self-actualisation and thus revealing its potential (Keyes et al., 2002 ; Ryff, 1989 ). This approach more closely resembles the concept of psychological well-being (PWB). In the studies carried out to date, it is seen that SWB and PWB have different structures but contain related factors (Linley et al., 2009 ), with both approaches consisting of human values that are concerned with and increase the human capacity to investigate the necessities of a good life (Keyes et al., 2002 ). The two approaches are not opposites but are complementary to each other (Joshanloo, 2015 ).
In this study, we focus on PWB, which includes a person’s overall assessment of their life and emotional state and is considered a fundamental aspect of the psychological health of individuals and groups (Stone et al., 2010 ). The concept of PWB, which focuses on the individual’s optimal functioning (Huppert, 2009 ), expresses positive functions rather than psychological distress, depression, and dysfunction and draws attention to high levels of flexibility, positivity, and strong social bonds (Trpcevska, 2017 ). Synthesising past research findings is one of the most important tasks to advance a particular research area (Zupic & Čater, 2015 , Introduction). To achieve this, we prefer the scientific mapping method, which is based on a quantitative approach and is increasingly used to show the evolution of study areas.
Bibliometric analysis is a helpful method for examining the development of fields of study that are integral to evaluating academic production (Ambhore & Ofori, 2023 ). These analyses are widely used in examining new, ambiguous, or complex research areas since they can provide an objective view of a particular research area without including the subjective interpretations of researchers (Liu et al., 2015 ; Yan et al., 2015 ). Bibliometric studies usually reveal the intellectual structure of the field by identifying trends in a particular research field by year, country, institution, citations, or theoretical approach (Donthu et al., 2021 ; Paul & Criado, 2020 ). Before presenting a detailed review of the PWB field and positioning research, examining the bibliometric mappings that present the research points and trends of the PP and SWB fields with which the concept is closely related is helpful.
When examining bibliometric studies in the field, we identified that there are bibliometric mappings on PP (Schui & Krampen, 2010 ; Wang et al., 2023 ) and SWB (Dominko & Verbič, 2019a ; Huang et al., 2022 ). Despite being one of the popular research topics in PP, PWB has been analysed in only two studies and has a limited framework with the bibliometric analysis method. In the first of these, Kúld et al. ( 2021 ) examined studies focusing only on the PWB of visually impaired children with bibliometric analysis, whereas Ambhore and Ofori ( 2023 ) examined PWB studies in the fields of economics, econometrics, finance, business, management, and accounting. The researchers agree that the research area of the concept has expanded, but there is yet to be a bibliometric study that comprehensively covers the footprints of PWB’s trending workspaces, leading authors, journals, and studies. Therefore, in this study, we aim to contribute to future research by presenting a detailed picture of the distribution of publications and citations in the field by years, countries, institutions, journals, authors, and the most commonly used keywords as well as to examine the publications in all research categories in the Web of Science Core Collection.
Our primary research is built on two keywords: ‘psychological well-being’ and ‘psychological well being’. In addition, we conducted three separate searches from the Web of Science Core Collection database to examine previous bibliometric studies in the field. The first search syntax was ‘psychological well-being’ or ‘psychological well being’ and ‘bibliometric’. The second search syntax was ‘subjective well-being’ or ‘subjective well being’ and ‘bibliometric’. The third search syntax was ‘positive psychology’ and ‘bibliometric’. In basic research published between 1980 and 2022, we identified 16,885 publications. Considering these publications, we sought answers to the following research questions:
Which science categories have nourished the field of PWB, and to what extent has this field grown?
Which countries, sources, and authors have contributed the most to the PWB field?
What are the most influential sources and publications in the field of PWB?
What themes and keywords have been prominent in the field of PWB in recent years?
The research is structured as follows: In Sect. 2 , we explain the study’s background, including a literature review on PWB. In Sect. 3 , we include bibliometric studies related to PWB that we analyse using content analysis techniques. Section 4 covers data and analysis methods, while Sect. 5 details the findings. In Sect. 6 , we offer the discussion and conclusion. Subsequently, we provide suggestions for future studies in Sect. 7 and outline the research limitations in Sect. 8 .
2 The Concept of PWB
PWB is defined as striving for perfection and revealing one’s true potential for self-realisation (Ryan & Deci, 2001 ; Ryff, 2014 ). This concept has been notable in social and working life for an average of 40 years. In essence, PWB is a state of well-being in which each individual copes with the daily stresses of life, works productively and efficiently, and contributes to society (WHO, 2014 ). PWB is a multifaceted structure encompassing the individual’s general happiness, life satisfaction, purpose in life, and mental and emotional health (Dhanabhakyam & Sarath, 2022 ). According to some researchers, it is also expressed as having positive emotions and high life satisfaction (Diener et al., 2010 ; Gyu Park et al., 2017 ). For PWB, an environment where the individual can realise their potential and strengths and is able to develop accordingly is necessary (Ryan & Deci, 2001 ). Individuals with a high level of well-being seek purpose and meaning in their lives and establish positive relationships with other people. In addition, these individuals would think that they can make the right decisions in line with the goals they want to achieve because they feel self-confident and independent (Ryff & Keyes, 1995 ).
Differences in the definition of PWB stem from researchers’ considerations of the different dimensions associated with this concept. Ryff ( 1989 ) discussed PWB’s dimensions of self-acceptance, positive relationships, autonomy, environmental mastery, life purpose, and personal growth. Seligman ( 2002 ) stated that PWB brings together positive emotions and activities. Some researchers think that having a high level of life satisfaction and experiencing positive emotions while having low levels of negative emotions indicates well-being (Diener et al., 2010 ). In contrast, Ryan and Deci ( 2001 ) discussed this concept within the framework of self-determination theory, focusing on three human needs: competence, belongingness, and autonomy.
Various scales (Diener et al., 2010 ; Hills & Argyle, 2002 ; Ryff, 1989 ; Warr, 1990 ; WHO, 1998 ) have been developed and used in empirical studies to determine the PWB levels of individuals. In addition to comprehensive PWB scales, researchers in the literature examine the PWB of specific groups. In these studies, scales were developed to determine the PWB levels of women living in Indonesia (Eggleston et al., 2001 ), working individuals (Dagenais-Desmarais & Savoie, 2012 ), and children (Liddle & Carter, 2015 ).
There are many studies in the literature related to PWB and its sub-dimensions: productivity-related personal goals (McAdams & St. Aubin, 1992 ), altruism and helping behaviour (Batson & Powell, 2003 ), autonomy (Sheldon & Niemiec, 2006 ), self-compassion (Neff et al., 2007 ; Zessin et al., 2015 ), job demand control (Häusser et al., 2010 ), social support (Walen & Lachman, 2000 ), transformational leadership (Arnold et al., 2007 ), extraversion and neuroticism (DeNeve & Cooper, 1998 ; Ruini et al., 2003 ; Vitterso & Nilsen, 2002 ), age (Blanchflower & Oswald, 2008 ; Clark & Oswald, 1994 ; Stone et al., 2010 ), work and family variables (Parasuraman et al., 1996 ), physical activity during COVID-19 (Maugeri et al., 2020 ), physical exercise (Carek et al., 2011 ; Hassmen et al., 2000 ; Scully et al., 1998 ), work-family conflict (Parasuraman & Simmers, 2001 ), obesity (Wardle & Cooke, 2005 ), life satisfaction (Markowitz, 1998 ), gender and ethnicity (Crosnoe et al., 2023 ), and effects of the COVID-19 pandemic (De Kock et al., 2021 ; Heshmati et al., 2022 ; Ropret et al., 2023 ; Wolf & Schmitz, 2023 ) are considered together with PWB.
Synthesising past research findings is one of the most important tasks to advance a particular research area (Zupic & Čater, 2015 , Introduction). The scientific mapping approach, based on quantitative research methods in addition to traditional qualitative and quantitative approaches, helps researchers understand the scope of a subject, its emerging trends, and its evolution over time (Singh et al., 2020 ). The bibliometric analysis “is a great way to get a reliable, clear, and unbiased quantitative estimate of the rise in scientific publications” (Kumar et al., 2023 :277).
While examining the bibliometric studies in the field, it is important to consider the mapping studies written, such as those on PP and SWB, to determine how the mapping approach, which is the subject of this article, will be positioned. The following section examines previous PP, SWB, and PWB bibliometric studies. We used the bibliometric mapping approach to overcome the limitations of previous studies and to specifically understand the PWB field.
3 Bibliometric Studies in PP, SWB, and PWB
The motivation for this topic is to identify the location and contribution of PWB mapping. Examining the publications produced in these fields is important in determining how to contribute to the literature. Therefore, to observe the current state of the PP research field, we deemed it appropriate to examine the bibliometric studies written on PP and SWB before the bibliometric studies on PWB. We examined the bibliometric studies determined by three different search syntaxes from the Web of Science Core Collection database on August 8, 2023, and these are indicated in Table 1 .
Search syntax: TITLE-ABS-KEY = (‘Psychological Well-Being’) OR (‘Psychological Well Being’) AND TITLE-ABS-KEY = (‘Bibliometric’)
Search syntax: TITLE-ABS-KEY = (‘Positive Psychology’) AND TITLE-ABS-KEY = (‘Bibliometric’)
Search syntax: TITLE-ABS-KEY = (‘Subjective Well-Being’) OR (‘Subjective Well Being’) AND TITLE-ABS-KEY = (‘Bibliometric’)
The inclusion criteria for bibliometric studies in this study are as follows: written in English, identified as a review article, and included one of the aforementioned search syntaxes in the database search.
When examining bibliometric studies on PP, we found that Rusk and Waters ( 2013 ) analysed studies in the PsycINFO database between 1992 and 2011 by identifying the indexes scanned in the Web of Science database. In the study, the authors stated that the concept of PP has developed rapidly since its inception and has become conceptually remarkable. They also emphasised the interest in the field from many different disciplines. Schui and Krampen ( 2010 ) reviewed articles, books, and dissertations in the PsycINFO database between 1999 and 2010. The researchers examined the frequency of publications on PP, types of publications and media, and effects of index terms on the semantic network and psychological sub-disciplines. Wang et al. ( 2023 ) evaluated the current situation and trends in PP research between 1999 and 2021 in their study. The authors provided a scientific mapping with the most productive country, organisation, journal, and author analysis, noting steady growth in PP studies.
When we examined bibliometric studies on SWB, Huang et al. ( 2022 ) reviewed studies on older adults between 2002 and 2021. In this context, they highlighted the most influential journals and disciplines; top contributing institutions, authors and countries; and the main research topics and trends in the field. Dominko and Verbič ( 2019a ) followed the development of SWB research in the field of economics between 1915 and 2006. Another study by Dominko and Verbič ( 2019b ) provided a bibliometric analysis of the field by examining SWB studies for the elderly between 1961 and 2016. In both studies, the most important articles, authors, journals, organisations and countries in this field were analysed. Xu et al. ( 2022 ) also presented a bibliometric map by examining studies on the effects of urban green spaces on SWB of older adults between 2015 and 2022. They examined the keywords ‘partner country networks’ and ‘co-author network relations’ in the study.
Moreover, when we examined bibliometric studies in the field of PWB, we observed that only two studies have the keywords ‘psychological well-being’ in their research strategies. From these studies, Kúld et al. ( 2021 ) mapped the studies published in the Web of Science database in 2000–2017, which only include PWBs of visually impaired children, with bibliometric analysis. Ambhore and Ofori ( 2023 ) analysed studies published in the Scopus database between 1978 and 2022 on economics, econometrics, finance, business, management, and accounting to examine the impact of PWB on the economy and businesses.
In the examination of general bibliometric studies in the field, studies on PP (Rusk & Waters, 2013 ; Schui & Krampen, 2010 ; Wang et al., 2023 ) provide a comprehensive concept review, examining the effects of bibliometric studies on SWB, such as on older adults (Huang et al., 2022 ), the elderly (Dominko & Verbic, 2019b ), and older people (Xu et al., 2022 ). Also, a bibliometric study examines studies in the field of economics (Dominko & Verbic, 2019a ).
Studies on PWB are focused on specific samples, such as children with visual impairments (Kúld et al., 2021 ) and are mapped by research area limitations such as economics and business (Ambhore & Ofori, 2023 ). To fill this gap, we believe that a comprehensive bibliometric study examining all academic publications on ‘psychological well-being’ or ‘psychological well being’ in the Web of Science Core Collection database will provide stronger evidence to examine the research field of the concept.
4 Data and Bibliometric Analysis Methodology
We used a boolean logic model in the Web of Science Core Collection advanced search menu (TS = ‘Psychological Well-Being’ OR ‘Psychological Well Being’). We utilized the ‘TOPIC’ option in the advanced search screen. We did not restrict any Web of Science Core Collection research categories because including all research categories would be more appropriate for creating a holistic picture.
Bibliometric analyses summarise the intellectual structure and current trends of the research field in studies with an extensive research area or dataset that cannot be examined manually (Donthu et al., 2021 ). Bibliometric mapping is particularly suitable for areas where there are numerous studies or where the field is unclear. These mappings are widely used to examine new, ambiguous, or complex research areas because they provide an objective view of a particular research area without including the subjective interpretations of researchers (Liu et al., 2015 ; Yan et al., 2015 ).
We used three programs, MS Office Excel, VOSviewer ver.1.6.18 (van Eck & Waltman, 2010 ), Bibliometrix (Aria & Cuccurullo, 2017 ) and Citespace ver.6.2.R4 (Chen et al., 2010 ), to define and analyse the dataset. We employed the MS Office Excel program to prepare tables such as document types, citations, and documents by year. We conducted document analysis of the most popular institutions and journals and co-citation analysis of authors with the VOSviewer program. We also used Citespace and Bibliometrix (R-tool) to visualise the trends and keyword changes over the years. To utilize VOSviewer and Citespace programs, we saved the Web of Science Core Collection data in plain text format with all records and references.
4.1 Inclusion Criteria
The document types included were articles, review articles, proceedings papers, early access, book chapters, editorial materials, data papers, books, and retracted publications. We excluded non-English publications from 2023. Our reason for excluding 2023 was that the year still needed to be completed and could potentially affect annual averages adversely. Since 1980 was the date of the first study to include the concept of PWB in at least one of the titles, abstracts, or keywords in the Web of Science Core Collection database, the research covers the publications between 1980 and 2022. At the end of all processes, we included 16,885 documents in the research (as of August 8, 2023). Figure 1 shows the search strategy. We stored the data acquired in the search strategy in the appropriate folder by selecting the plain text format and marking the custom full edit from the record content section.
Search strategy
4.2 Identification of Dataset
Table 2 provides an overview of the literature collected from the Web of Science Core Collection. Web of Science is acknowledged to cover journal citations more comprehensively than Scopus and Google Scholar (Adriaanse & Rensleigh, 2013 ). Due to its reliability, it is widely used as a primary data source, particularly in bibliometric studies (Zhang & Liang, 2020 ).
Table 2 shows the document types of the studies examined in the field. More than 90% of the publications are articles. The proportion of books, editorial materials, data papers, and book chapters is below 1% (0.8%) in the studies examined.
4.3 Data Standardisation
Data standardisation is needed to obtain consolidated information, even when using a single database in bibliometric studies. In addition, the data used for bibliometric analyses may contain misspellings or inaccuracies that require editing (Cobo et al., 2011 ). We followed two steps to address this issue.
First, we removed duplicate and misspelled items. Sometimes, data may contain items representing the same person, concept, or object with different spellings. To prevent this, we reviewed the data in plain text format and made corrections, especially for author names. For example, ‘Ryff CD’ can also be spelled as ‘Ryff Carol D.’ Similarly, ‘Deci EL’ might be spelled as ‘Deci Edward L.’ We identified and fixed a similar problem in keywords ‘positive psychology’ or ‘PP’. Moreover, to analyse PWB under a single keyword, we consistently used the term ‘well-being’ (as opposed to ‘well being’).
Second, we sought to overcome data visualisation constraints. This was particularly relevant for category, source, journal, and author reviews. Images representing all institutions or individuals would often be overwhelming for the reader. Therefore, we limited the table to the top 20 strongest. In keyword analysis, it is impractical to include all publications between 1980 and 2022 in a single table. Instead, we found that examining the past 10 years provides more recent insights into trends. Even then, the merged network between keywords in the past 10 years consists of 200 keywords with 2,001 keyword associations and at least one link.
5.1 Citation and Publication Counts
Figure 2 shows the number of citations and publications related to PWB. The number of citations and publications offers insight into the field’s popularity. Increasing the number of studies in the field contributes to the growth of both theoretical and practical knowledge.
Source Web of Science Core Collection, Authors’ own work
Citations and publications by years.
According to the Web of Science database, the first publication in the field was made in 1980, marking the initial interest in this field. Since 1994, over 100 publications have been produced annually, indicating a growing research interest. This trend accelerated significantly after 2005, with over 200 publications annually, and surpassed 500 publications annually by 2010. A notable surge in publications occurred in 2016. After 2016, it has been observed that the publications on the subject have gained popularity and increased by an average of 20% each year compared to the previous year. Although this growth plateaued in 2022, citation rates have continued to increase compared to the previous year since the first publication. When examining the citations after 2016, we observed that the publications in the field receive an average of 17% (17.3%) more citations each year compared to the previous year.
5.2 Research Areas (Web of Science Database)
Table 3 shows the category distribution of publications in the PWB search. These categories give an idea of the current trends and workload of the field.
When examining the studies, psychology, multidisciplinary, public environment, occupational health, and psychiatry emerge as the most widely published categories. We observed that these three categories contain more than one third (34%) of the total publications. The distribution is generally more homogeneous in other areas. Education, environmental sciences, social work, and sociology each represent more than 2% of publications, particularly in health and medicine-intensive research fields. Notably, each of the top 20 disciplines in the field has over 450 publications. In addition, the density of social sciences among the top 20 disciplines is relatively lower compared to health sciences.
5.3 Global Publishing Trends
Figure 3 presents a colour-coded world map illustrating the geographical distribution of publications between 1980 and 2022. We examined the top 20 publishing countries in the field and assigned five colour codes based on the number of publications.
Global geographical distribution and trend of publications.
A total of 150 countries or regions contributed to 16,885 publications. The colour indicators for the categories based on the number of publications are as follows: dark green for the first category (10% and above), light blue for the second category (6%–8%), green for the third category (4%–6%), turquoise for the fourth category (2%–4%), and yellow for the last category of countries (1%–2%). The United States hosted 33.9% of all publications, followed by the United Kingdom (11.3%), and Australia (7.0%). It is seen that each of the 20 most productive countries contributed to the field with at least 223 studies.
5.4 Most Prolific Sources
Figure 4 displays the bibliometric map of the sources with the highest number of publications in PWB. All publications related to the field were produced by 4,101 sources.
Source Web of Science Core Collection, Authors’ own work. The higher-resolution image can be explored at: https://tinyurl.com/yus4s2ne
Most prolific sources.
The most prolific sources are represented in five clusters. Journals in the same colour set often show that they publish articles with similar content and are closely related to each other. The size of each circle reflects the total number of journal publications. We also reviewed publications and citations for the 20 most productive sources. The International Journal of Environmental Research and Public Health (355 publications) and Frontiers in Psychology (322 publications) were the two most prolific sources. After these two journals, we observed that the article productivity rate in the top 20 is below 1%. In addition, we found that the top 10 most productive journals out of 4101 different sources published 9.4% of the total research in the field of PWB. This indicates that many sources produce few articles in the field. Additionally, Fig. 4 shows the 20 most prominent sources in the field, which had more than 64 documents and 440 citations.
5.5 Most Influential Sources Based on Citations
Citation rates of sources, documents, or authors provide information about their impact on the field (Zupic & Cater, 2015 ). Citation analysis is a basic science mapping technique that reflects the intellectual connections between publications (Appio et al., 2014 ). In bibliometric studies, VOSviewer provides clear visuals to highlight the values (such as keywords, resources, and loyalties) that are the subject of the analysis and to reveal the networks of relationships among them. Figure 5 presents a network visualisation among the top 100 most popular sources based on citation counts.
Source Web of Science Core Collection, Authors’ own work. The higher-resolution image can be explored at: https://tinyurl.com/yp42y28n
Most influential sources by citation.
The size of the circle area represents the number of most cited sources, whereas the width of the connecting lines between sources indicates collaboration effectiveness. The results show many cross-citation links, especially among journals with large circle area sizes. The Journal of Personality and Social Psychology (24,698 citations) is the most cited journal, followed by Social Sciences and Medicine (7191 citations), Personality and Individual Differences (6628 citations), and the Journal of Health and Social Behavior (6551 citations). Another important finding is that the first four of these journals received an average of 11.9% (45,068 out of 539,278) of the total citations. It is apparent that the top 100 related journals in the field have at least 26 publications and 250 citations. Figure 5 shows the top 20 sources with the highest citation rates in the field.
5.6 The Most Influential Documents
Table 4 shows the 20 most influential publications according to the number of citations. The impact of a study is directly related to the citations it receives (Liu et al., 2015 ).
We analysed the 20 most cited documents in the field using the content analysis technique. Brown and Ryan ( 2003 ), in the most cited publication (6410 citations), examined the role of mindfulness in PWB, both theoretically and empirically. They also developed the Attention Awareness Scale to evaluate the role of mindfulness. Similarly, Ryff and Keyes ( 1995 ) and Diener et al. ( 2010 ) conducted scale development studies to evaluate PWB, development, and positive–negative emotions.
Ryff ( 1989 ), who discussed the definition of PWB through theoretical studies, criticisms of its definition, its dimensions, meaning, the conditions that gave birth to it, and the differences according to place and time, received 5647 citations. Ryan and Deci ( 2001 ) received 5008 citations. In the studies examined, PWB and its sub-dimensions—social bonding and social support (Thoits, 2011 ), chronic illness (Lorig et al., 1999 ), subjective vitality (Ryan & Frederick, 1997 ), awareness (Baer et al., 2008 ; Brown & Ryan, 2003 ), urban green areas (Wolch et al., 2014 ), SWB (Keyes et al., 2002 )—have been discussed theoretically and empirically. In addition, researchers have examined the relationship between mental health, which is a frequently encountered topic in the PWB literature, and aspects such as social capital (Kawachi & Berkman, 2001 ) and COVID-19 (Vindegaard & Benros, 2020 ). Also, Topp et al. ( 2015 ) systematically examined 213 articles using the well-being index created by the World Health Organization.
5.7 Most Notable Authors
Here, we discuss the authors with the most publications in the field of PWB. Table 5 shows the number of publications the authors have contributed to the PWB field. The 20 most notable authors named in the table have at least 20 studies in the field.
University of Wisconsin-Madison psychology professor Carol Diane Ryff is noted as the most prolific author with 51 publications, followed by Kim (44 publications), Fava (43 publications), Burke (37 publications), and Ruini (36 publications). When we examined the citations of the authors in Table 5 , Ryff was at the top of the list with 18,459 citations, followed by Fava (2367), Kubzansky (1554), and Ruini (1539) as the most influential writers.
5.8 Analysis of Keywords
We planned keyword analysis in three stages. The first one (Fig. 6 ) allows us to visualize the 40-year thematic evolution of the PWB field with the most frequently preferred keywords. The second one (Fig. 7 ) was prepared to examine these keywords in more detail for the last 10 years. The third table (Table 6 ) allows us to see in which years the most frequently preferred keywords in the last 10 years had a citation burst. The connection of themes occurs from the algorithm of the program and calculates from the frequency with which concepts co-occur. The thematic evolution discussed herein does not prove the transformation between concepts, but it facilitates the tracking of themes debated in the field.
Thematic evolution of PWB field
Analysis of keyword footprints
When the thematic evolution of PWB is examined, the most prominent themes until the early 2000s were pain, disability, and stress, while women and adolescence constituted the most frequently researched examples (Christopher, 1999 ; Norris et al., 1992 ; Sumi, 1997 ). However, from the early 2000s onward, discussions expanded to encompass topics rooted in assessing psychological well-being through positive functionality, such as life satisfaction and quality of life (Keyes et al., 2002 ; Seligman & Csikszentmihalyi, 2000 ).
During the third phase of thematic evolution (2011–2021), the global impact of the COVID-19 pandemic profoundly influenced the trajectory of studies in the field. At the onset of this period, strong research themes revolved around children, dementia, and social support, with the pandemic emerging as a new thematic focus. Over time, COVID-19 became an increasingly prevalent subject of investigation. In recent years, due to the repercussions of lockdowns and disruptions in the person-job and person-environment order, the emphasis has shifted from the theme of social support to mindfulness, loneliness, and support. Notably, motivation and rehabilitation have emerged as significant focal points in recent years.
Figure 7 shows the most frequently used keywords and clusters in the past 10 years. Reviewing keywords allows for highlighting critical topics that are new or outdated, often in demand over the years.
The keywords analysis first provided insights into the research keywords with which PWB was examined together due to their close association with one another in 2012, such as ‘quality of life’, ‘older adults’, ‘life satisfaction’, ‘mental health’, ‘social support’, ‘SWB’, and ‘emotion regulation’. These keywords are frequently examined together. For PWB, studies dealing with social media and ethnic identity were more widely published between 2012 and 2018. In 2019, the COVID-19 pandemic stood out as a new phenomenon. The most common keywords associated with COVID-19 in post-2019 publications are ‘health care workers’, ‘social distancing’, ‘university students’, ‘social isolation’, ‘caregiver burden’, and ‘psychological impact’. It is not surprising that these words came to prominence. With the pandemic, online education and university students (Agrawal & Krishna, 2021 ; Aw et al., 2023 ; Li et al., 2021 ) have become research areas that have garnered great interest. In addition, researchers have focused on social distancing (Jakhar & Kharya, 2021 ; Silva et al., 2021 ), social isolation (Birditt et al., 2021 ; De la Rosa, 2022 ), and effects on public health in different sample groups during the curfews.
As seen in Table 6 , keywords such as ‘quality of life’, ‘mental health’, ‘life satisfaction’, ‘COVID-19 pandemic’, ‘emotional intelligence’, and ‘physical activity’ come to the forefront in studies related to PWB that have been conducted in the last 10 years. Especially in the post-2015 period, it would be helpful to divide it into pre-COVID-19 (2015–2018) and the COVID-19 period (2019–2022). Before COVID-19, ‘job satisfaction’, ‘public health’, ‘social well-being’, ‘perceived stress’, and ‘ethnic identity’ were frequently preferred keywords in the PWB field. After the emergence of COVID-19, keywords such as ‘COVID-19 pandemic’, ‘social isolation’, ‘social distance’, ‘health workers’, and ‘higher education’ were discussed together with PWB. We found that they had strong citations bursts as they were frequently used.
6 Discussion and Conclusion
In this study, we performed bibliometric mapping of the publications in the field of PWB between 1980 and 2022. Unlike previous bibliometric studies in the PWB field, which were constrained by sample (Kúld et al., 2021 ) and domain (Ambhore & Ofori, 2023 ) limitations, we attempted to shed more light on the academic publications produced in this field. We used this mapping to examine document types, Web of Science categories, countries, source titles, links, authors, and keywords.
Findings revealed that the field has been gradually developing every year since 1980. When we examined the citations, we observed that the citation rates of the publications have increased every year since the first publication. After 2016, the publications in the field received 17% (17.3%) more citations each year compared to the previous year. Authors of recent PWB studies in business and economics also draw attention to increased publications in the past 10 years (Ambhore & Ofori, 2023 ). Despite producing publications for the past 40 years, the field of PWB has not lost its relevance and continues to grow. That growth appears to be much faster (10.28% by year) than the general growth of science (4.10% by year, according to Bornmann et al., 2021 ).
The fields of public environment, occupational health, and psychiatry, especially psychology multidisciplinary, emerge as the categories with the most publications. These three categories cover more than one third (34%) of the total publications. It is stated in the SWB bibliometric study of Huang et al. ( 2022 ) that most publications are in psychology and medicine. When we analysed the global publication production, we observed that the United States (33.9%) produces more than one third of the publications, followed by the United Kingdom (11.25%), Australia (7.01%), China (6.81%), and Canada (6.64%). Given that publications covering the field were produced from a total of 150 countries, the fact that these five countries alone account for almost two thirds (65.74%) of the total publications is remarkable. Similar trends can also be seen in the SWB research. Although developed European countries and the United States dominate the research field, it should be noted that China, Japan, South Korea, and Australia have limited influence (Huang et al., 2022 ). Dominko and Verbič ( 2019a ) reviewed the SWB research in economics and found that the United States is the top country with 1,169 articles and the United Kingdom is the second with 354 articles. Similarly, Dominko and Verbič ( 2019b ) found that the United States is the leading country with 856 articles in SWB.
The top 10 most productive journals out of 4,101 different sources published 9.4% of the total research in the field of PWB. To date, 51,753 authors have contributed to the PWB field. Among these authors, Carol D. Ryff of the University of Wisconsin-Madison is the leading author (51 publications), followed by Jungsik Kim (44 publications), Giovanni A. Fava (43 publications), Ryan J. Burke (37 publications), and Chiara Ruini (36 publications), who stand out as the most prolific authors. Additionally, in terms of the number of citations, Ryff holds the first place with 18,459 citations.
In the keyword review, we identified the trends of the past 10 years in the studies. Before the pandemic, keywords such as ‘job satisfaction’, ‘public health’, ‘social media’, ‘social capital’, ‘perceived stress’, and ‘mental well-being’ were prominent. However, with the emergence of COVID-19, keywords such as ‘health workers’, ‘higher education’, and ‘social isolation’ came to the forefront. Similarly, in the fields of PP and SWB, COVID-19 emerged as a focal point (Huang et al., 2022 ; Wang et al., 2023 ). Accordingly, COVID-19 acted as a catalyst that changed the direction of PWB, PP, and SWB studies.
As a result, while ‘children’ was a dominant theme during the period when the pandemic was felt all over the world, keywords such as ‘college students’ and ‘higher education’ have emerged as notable citation bursts in recent years in the PWB field. Studies have shifted focus towards support and illness agendas concerning higher education students and the elderly, replacing the emphasis on social support with concepts of rehabilitation and motivation.
Prominent topics such as physical activity and social support, which have been explored in the context of PWB, have relatively diminished in significance. Ostensibly, the extensive literature on how PWB is provided has been reassessed with variables such as loneliness, mindfulness, and discussions of parent and family support in cases like trauma and dementia.
With this bibliometric study, we shed light on the ‘bests’ of the PWB field along with the contributing structures and individuals. Our research revealed the developmental trajectory of the field, the extent of each country’s contribution to the production of publications in the field, popular research categories, journals, publications, and authors. In particular, our findings on trends enabled us to examine the active development of the field since 1980 and its trends in the past 10 years.
The COVID-19 pandemic has affected PWB like many other fields. In addition to pre-pandemic research focuses such as older adults, there has been an increase in studies addressing young individuals, university students, and healthcare workers. PWB has achieved strong acceptance within the PP fields. We anticipate that the importance of PWB will continue to grow, given the ongoing burst of research focusing on social distancing, online education, and social isolation. It will be a substantial area where the effects are examined for new variables in the post-pandemic period.
7 Recommendations for Future Research
This research has illuminated the knowledge and current trends in the field through meticulous examination of the literature on PWB using the bibliometric analysis method. The comprehensive analyses conducted in the study provide guiding outputs for both academics and practitioners.
We have demonstrated that the COVID-19 pandemic has broadened the scope of variables and examples related to PWB discussions. It appears that PWB in children has not been adequately examined in the post-COVID period, indicating a research gap in this area. It is crucial to explore the variables affecting post-pandemic PWB across different age and education groups, including students. There is a need for research on the psychological impact of the pandemic and strategies to address it. We believe that studies aimed at enhancing psychological functionality, which may have declined due to health issues or traumas during the pandemic, will contribute significantly to the field. Given the disruption of the person-work and person-environment dynamics during the pandemic, the discussions on social support were interrupted. We expect that PWB studies will contribute to revitalizing workplace dynamics by fostering new motivation sources and enhancing work-person harmony in Generation Z as a new social support mechanism.
The concept of PWB is not extensively discussed in social sciences compared to other fields. Therefore, there is an opportunity to delve deeper into PWB within this domain. While recent bibliometric studies, such as the one conducted by Wang et al. ( 2023 ) in the field of PP, offer valuable insights, bibliometric mappings in SWB provide additional evidence of the overall picture of the area, particularly among older adults (Huang et al., 2022 ), the elderly (Dominko & Verbic, 2019b ), and older people (Xu et al., 2022 ). Expanding bibliometric mappings to include various age groups or broader research categories related to SWB will enhance our understanding of the similarities and differences between the two fields.
8 Limitations
It is important to acknowledge some limitations of this study. First, there may be existing studies that should have been included but were not due to our reliance on a single database. We incorporated studies that included PWB concepts in at least one of the titles or keywords in the abstract. Researchers may interpret the field differently by employing different date restrictions or a similar search syntax that includes multiple databases. Despite this limitation, we believe that this study will effectively inform and guide future research endeavours.
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Yiğit, B., Çakmak, B.Y. Discovering Psychological Well-Being: A Bibliometric Review. J Happiness Stud 25 , 43 (2024). https://doi.org/10.1007/s10902-024-00754-7
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A systematic review and meta-analysis of psychological interventions to improve mental wellbeing
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Our current understanding of the efficacy of psychological interventions in improving mental states of wellbeing is incomplete. This study aimed to overcome limitations of previous reviews by examining the efficacy of distinct types of psychological interventions, irrespective of their theoretical underpinning, and the impact of various moderators, in a unified systematic review and meta-analysis. Four-hundred-and-nineteen randomized controlled trials from clinical and non-clinical populations ( n = 53,288) were identified for inclusion. Mindfulness-based and multi-component positive psychological interventions demonstrated the greatest efficacy in both clinical and non-clinical populations. Meta-analyses also found that singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based, and reminiscence interventions were impactful. Effect sizes were moderate at best, but differed according to target population and moderator, most notably intervention intensity. The evidence quality was generally low to moderate. While the evidence requires further advancement, the review provides insight into how psychological interventions can be designed to improve mental wellbeing.
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Acknowledgements
The authors thank colleagues at the South Australian Health and Medical Research Institute, Wellbeing and Resilience Centre, for their support during the creation of this review, S. Brown and N. May, for their help in crafting the search strategy. This work was supported by a grant by the James and Diana Ramsay Foundation. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
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Joep van Agteren, Matthew Iasiello, Laura Lo, Jonathan Bartholomaeus, Marissa Carey & Michael Kyrios
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J.v.A.: review methodology, screening of literature, data extraction, risk of bias, meta-analysis and writing. M.I.: review methodology, screening of literature, data extraction, risk of bias and writing. L.L.: screening of literature, data extraction, risk of bias and writing. J.B.: data extraction, risk of bias and writing. Z.K.: risk of bias and writing. M.C.: data extraction and writing. M.K.: input into methodology, focus of review and writing.
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van Agteren, J., Iasiello, M., Lo, L. et al. A systematic review and meta-analysis of psychological interventions to improve mental wellbeing. Nat Hum Behav 5 , 631–652 (2021). https://doi.org/10.1038/s41562-021-01093-w
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Peer-reviewed
Research Article
Can We Increase Psychological Well-Being? The Effects of Interventions on Psychological Well-Being: A Meta-Analysis of Randomized Controlled Trials
* E-mail: [email protected]
Affiliation Centre for eHealth and Well-being Research, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
- Laura A. Weiss,
- Gerben J. Westerhof,
- Ernst T. Bohlmeijer
- Published: June 21, 2016
- https://doi.org/10.1371/journal.pone.0158092
- Reader Comments
There is a rapidly growing interest in psychological well-being (PWB) as outcome of interventions. Ryff developed theory-based indicators of PWB that are consistent with a eudaimonic perspective of happiness. Numerous interventions have been developed with the aim to increase PWB. However, the effects on PWB measured as coherent outcome have not been examined across studies yet. This meta-analysis of randomized controlled trials of behavioral interventions aims to answer the question whether it is possible to enhance PWB.
A systematic literature search was performed in PsycINFO, Cochrane and Web of Science. To be included, studies had to be randomized controlled trials of behavioral interventions with psychological well-being as primary or secondary outcome measure, measured with either Ryff’s Psychological Well-Being Scales or the Mental Health Continuum—Short Form. The meta-analysis was performed using a random effects model. From the 2,298 articles found, 27 met the inclusion criteria. The included studies involved 3,579 participants.
We found a moderate effect (Cohen’s d = 0.44; z = 5.62; p < .001). Heterogeneity between the studies was large (Q (26) = 134.12; p < .001; I 2 = 80.62). At follow-up after two to ten months, a small but still significant effect size of 0.22 was found. There was no clear indication of publication bias. Interventions were more effective in clinical groups and when they were delivered individually. Effects were larger in studies of lower quality.
Conclusions
It appears to be possible to improve PWB with behavioral interventions. The results are promising for the further development and implementation of interventions to promote PWB. Delivering interventions face-to-face seems to be the most promising option. We recommend to keep including clinical groups in the research of psychological well-being. Heterogeneity is a limitation of the study and there is need for more high-quality studies.
Citation: Weiss LA, Westerhof GJ, Bohlmeijer ET (2016) Can We Increase Psychological Well-Being? The Effects of Interventions on Psychological Well-Being: A Meta-Analysis of Randomized Controlled Trials. PLoS ONE 11(6): e0158092. https://doi.org/10.1371/journal.pone.0158092
Editor: James Coyne, University of Pennsylvania, UNITED STATES
Received: September 1, 2015; Accepted: June 12, 2016; Published: June 21, 2016
Copyright: © 2016 Weiss et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper and its Supporting Information files.
Funding: LAW received a fund for her PhD research by the Netherlands Organization for Health Research and Development ( http://www.zonmw.nl/en/ ), the Hague, grant 200210013 (awarded to Eddy Wezenberg, Arcon). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Introduction
In the last years, the focus in mental healthcare and prevention has shifted from solely treating or preventing mental health complaints to enhancing positive aspects of mental health. A new goal in mental healthcare is the promotion of well-being [ 1 – 4 ]. However, there are currently many definitions of well-being [ 5 ]., with the two main concepts being subjective and psychological well-being.
Subjective well-being builds on a hedonic framework in which striving for positive experiences is central. It is usually measured as satisfaction with life in combination with a balance between positive and negative emotions [ 6 ]. The standards that people use to judge their subjective well-being were not theorized in this framework. By contrast, Carol Ryff introduced the concept psychological well-being with the intention to develop theory-based indicators of positive human functioning that were consistent with a eudaimonic perspective of happiness [ 7 ]. Another well-researched theory in the eudaimonic tradition is the self-determination theory that states that the fulfillment of basic psychological needs is essential to well-being and growth [ 8 ].
The variety of concepts and measures makes it difficult to compare studies [ 9 ]. It is therefore important to be precise in one’s definition of well-being. This paper focuses on the concept of psychological well-being according to Ryff’s definition [ 10 ]. Earlier meta-analyses have already examined subjective well-being [ 11 , 12 ]. The latest meta-analysis has also included psychological well-being, but measured it in a very broad way with many different instruments [ 12 ]. We will conduct the first meta-analysis that exclusively examines psychological well-being as defined by Ryff.
Based on an extensive review of the literature of clinical, humanistic and life-span developmental psychology, as well as existential and utilitarian philosophy, Ryff [ 10 ] defined psychological well-being as a process of self-realization, consisting of six dimensions: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life and self-acceptance. There is some discussion on the six-factor structure [ 13 ] and whether psychological and subjective well-being are two separate but related dimensions or one overarching construct [ 14 ].
Recently Ryff [ 15 ], reviewed over 350 empirical studies on psychological well-being that have been conducted in the past decades. Longitudinal studies show that high levels of psychological well-being are a protective factor against mental illnesses and psychopathology [ 16 – 18 ] and that it is also related to biological markers of physical health, reduced risk for various diseases such as Alzheimer’s disease, and a longer life-duration [ 15 ]. This growing evidence of positive outcomes of psychological well-being makes it worthwhile to study whether we can improve it.
However, as existing studies show that psychological well-being is rather stable across time [ 19 ], an important question is whether it can indeed be promoted in interventions. Answering this question will provide more insight into the state or trait discussion whether characteristics of psychological well-being are more trait-like or state-like [ 20 ].
In recent years, there has been a rapid increase of studies on behavioral interventions that included psychological well-being as an outcome measure (e.g. [ 21 , 22 ]). A central aim of interventions such as well-being therapy [ 23 , 24 ], acceptance and commitment therapy [ 25 ], life-review therapy [ 26 ], and positive psychological interventions [ 27 ] is to enhance positive psychological functioning. Meta-analyses have shown that these interventions are successful in enhancing certain aspects of psychological well-being [ 11 , 12 , 28 ], but as mentioned, they measured psychological well-being with many different measurement instruments that do not all fit the definition of Ryff. To which extent interventions have an impact on psychological well-being as a coherent construct of positive psychological functioning is unclear. Also, only positive psychological interventions were included, thereby neglecting the increasing number of interventions that addressed psychological well-being in other disciplines.
Hence, we will take the next step in reviewing the evidence on psychological well-being by conducting a meta-analysis on the effects of different behavioral interventions on psychological well-being as a coherent construct across randomized controlled trials. We want to examine whether well-being can be changed as a function of behavioral interventions.
Eligibility criteria
Study eligibility criteria..
The research question and inclusion criteria were established before the meta-analysis was conducted. Psychological well-being had to be used as primary or secondary outcome measure. To examine it as coherent construct, it had to be measured either with Ryff’s Psychological Well-Being Scales (PWBS) [ 10 ] with all six dimensions of psychological well-being as study endpoints, or with the subscale ‘Psychological Well-Being’ of the Mental Health Continuum—Short Form (MHC-SF) [ 29 , 30 ]. The MHC-SF also assesses psychological well-being with the six dimensions of Ryff’s model. If the MHC-SF was used, the data of the subscale psychological well-being had to be available. Research on the MHC-SF in different cultures has provided support for its psychometric properties and its three dimensional factor structure [ 31 , 32 ]. The reliability and validity of the PWBS has been established in different versions and across various cultures (e.g. [ 33 , 34 ]). Yet it has to be noted that the a priori six-factor structure is debated [ 13 ]. This problem appears to be exacerbated by the existence of multiple forms of the test, ranging from 18 to 120 items. There is also discussion whether the PWBS is able to discriminate between higher levels of well-being [ 35 ].
Only randomized controlled trials (RCTs) of behavioral interventions were included, excluding pharmacological interventions. We focused on all study populations, including both healthy and clinical populations of any age. Waiting list, no treatment, care-as-usual, placebo, or alternative treatment groups were included as comparators.
Report eligibility criteria.
To be included, an article had to be published in English-language peer-reviewed journals, excluding books, dissertations and conference proceedings. No publication date restriction was imposed. Data necessary to calculate the effect size had to be available in the article or upon request.
Search strategy and selection of studies
Information sources..
A systematic literature search was performed in the databases of the Cochrane Library, PsycINFO, and Web of Science. The last search was run on 13 April 2015. The first and second author developed the search with the help of an information specialist. The first author (LAW) and a trained student assistant (PDW) conducted the search. We screened the reference lists of included studies and of the meta-analyses of Sin and Lyubomirsky (11), Bolier et al. [ 12 ] and the review of Ryff [ 15 ] for additional potentially eligible studies. Finally, we invited four experts in the field to suggest additional studies that might meet the inclusion criteria.
Search terms were Ryff* or "mental health continuum" or "psychological well-being" or "psychological wellbeing" in all fields of the database, combined with one of the following terms in the title or abstract: intervention or therapy or treatment or random* or control* or trial or RCT. Search strings were adapted to the according database. No limitations were used.
Study selection.
Two data extractors (LAW and PDW) assessed the eligibility independently in a standardized manner. The retrieved records from the database search were screened by title and abstract. First, the extractors screened the first ten publications in PsycINFO together and discussed the results, and then both screened the next 100 studies in PsycINFO independently. They performed an interrater reliability check where Cohen’s kappa was 0.71, which is considered ‘good’ [ 36 ]. A consensus procedure for disagreement between them was established and disagreements were resolved by consensus. The remainder of the records were screened by the two researchers independently. After the titles and abstracts were screened for possible inclusion, full articles were assessed for eligibility.
Data collection
Data items..
Information was extracted from each included study on (1) study sample; (2) outcome measure (Ryff’s PWBS or MHC-SF) with number of items; (3) type of intervention; (4) number of sessions and treatment duration in weeks; (5) control group; (6) total sample size; (7) mean age of the sample with standard deviation or range; and (8) quality assessment.
Data collection process.
LAW extracted the data from the included studies with a data extraction sheet, PDW checked the extracted data. Disagreements were resolved by discussion. We contacted 14 authors through e-mail for additional data. Seven authors responded and provided the unpublished data. In one case, data was obtained via the author of an earlier meta-analysis where the study was included. One author had lost the data due to a hard drive failure. For the remaining five articles, the authors did not respond. All in all, six studies could not be included due to missing data.
Quality assessment
Quality was assessed with eight criteria, partly based on the criteria of the Cochrane collaboration [ 37 ] tailored for the included studies. (1) Was the randomization adequately described? (2) Were drop-out and reasons for drop-out properly described? (3) In case of drop-out, was an intention-to-treat analysis performed? (4) Were the professionals who delivered the intervention adequately qualified? (5) Was a power analysis carried out or were a total of at least 128 participants included (i.e., could the trial detect a moderate change according to a power analysis with Cohen’s d = .50, alpha = .05, power (1-beta) = .80)? (6) Was the treatment integrity checked? (7) Were the outcome measures at baseline assessed and study groups comparable? In the case of differences between groups, were adjustments made to correct for baseline imbalance? (8) Were inclusion/exclusion criteria described?
Each criterion was scored with 0 or 1. As certain criteria were not applicable to some studies, the percentage of items scored 1 across all applicable criteria was calculated. We classified study quality as lower (<40% quality index), intermediate (41–75%) or higher (>75%). For details, see Table in S1 Table . We included quality as a moderator in the moderator analysis, as we hypothesized that the effect size may differ between studies depending on the quality of the studies.
Data analysis
All analyses were completed with the program Comprehensive Meta-Analysis (CMA, version 2.2.064).
We used the random effects model and a 95% confidence interval with two-tailed tests.
Summary measures.
We expected considerable heterogeneity due to diverse intervention types and populations. Therefore, the meta-analysis was performed using a random effects model. If possible, outcomes from an intention-to-treat analysis were used. Samples for completers only were used when intention-to-treat samples were not provided. The primary outcome statistic was the standardized difference in means. For each study, between-group effect sizes were computed, using Cohen’s d. When Ryff’s PWBS were used, the six dimensions were joined in one outcome measure. Standard deviations were reconstructed from p-values or t- statistics when necessary. Lipsey’s rules for interpretation were used: small effect sizes range from 0 to 0.32, medium effect sizes range from 0.33 to 0.55 and large effect sizes are 0.56 or higher [ 38 ].
Heterogeneity.
To evaluate between-study variability, we tested for heterogeneity with the chi-squared test Cochran’s Q and I 2 statistics, which quantifies the amount of variation in results across studies, beyond the expected chance. The heterogeneity analysis was performed with a random effect model, a 95% confidence interval and a two-tailed test.
Moderators.
Moderator analyses were conducted with the following moderators and categories: (1) target group : clinical (psychopathological or health problems) or non-clinical; (2) age of target group : adolescence/young adulthood (≤ 25 years), adulthood (26–55 years) or later life (≥55); (3) intervention type : self-help, individual face-to-face, or group face-to-face; (2) number of sessions : less (≤ 8 studies) or more (> 8 sessions); (5) instrument : PWBS or MHC-SF; (6) control group : not active (no treatment, waiting list, or care-as-usual) or active (placebo or alternative treatment); (7) quality : lower (<40%), intermediate (41% -75%) or higher quality (≥75%).
Publication bias.
The risk of publication bias was estimated using a funnel plot, the Egger’s test and a trim and fill analysis.
Follow-up assessment.
When available, between-group effect sizes (Cohen’s d) were computed for follow-up differences in psychological well-being.
Study selection
Fig 1 summarizes the database hits, (reasons for) exclusion and final inclusion in a flow diagram. We found 2631 records from Web of Science (1151), the Cochrane Library (1026), and PsycINFO (454), and Reference lists searches added four studies and expert consultation two studies. After adjusting for duplicates, 2298 studies remained and were screened for title and abstract. Of these, 2150 were discarded as the studies did not meet the inclusion criteria. The full texts of the remaining 148 studies were assessed for eligibility. 121 studies did not meet the inclusion criteria. Finally, a total of 27 studies met the inclusion criteria and were included in the meta-analysis.
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Study characteristics
The main characteristics of the studies are presented in Table 1 . All 27 studies were RCTs published in peer-reviewed English journals. The studies were published between 1998 and 2014. The included studies involved 3579 participants. Sample size varied between 20 and 376 participants. Whereas 14 studies were conducted among non-clinical populations (e.g. employees, students), 13 studies used a clinical sample. The vast majority of the clinical samples had psychological disorders, mostly affective disorders. Only two studies used a population with physical complaints (i.e., hearing impairment [ 39 ] and chronic pain [ 40 ]). The mean age varied between 11 and 79 years. While 4 studies used adolescents or young adults, 18 studies examined adults, and 5 studies had a sample of older people. Interventions included well-being therapy, life review, positive psychology interventions, acceptance and commitment therapy, mindfulness interventions and identity interventions. Seven interventions were self-help (web-based or book), 6 were individually administered and 14 group-based. The duration of the interventions varied between 4 and 52 weeks. Whereas 15 studies had between four [ 41 ] and eight sessions, 10 studies had between 8 and 48 sessions [ 42 ]. Sixteen studies used the PWBS as outcome measure, 11 studies the MHC-SF. Six different versions of the PWBS were used, varying between 14 and 84 items. The control conditions included 16 non-active control groups (no intervention, waiting list, care-as-usual) and 13 active control groups (placebos such as relaxation sessions or alternative established interventions such as cognitive behavioral therapy). Nine studies were qualified as having a lower quality, 8 as intermediate and 10 as higher quality studies. Whereas 16 studies declared no conflict of interest [ 21 , 22 , 24 , 39 , 41 – 51 ], the other 11 studies did not mention whether there was a conflict of interest.
https://doi.org/10.1371/journal.pone.0158092.t001
Results data analysis
Post-test effects..
The random effect model showed that the behavioral interventions had a moderate effect on psychological well-being (Cohen’s d = 0.44; z = 5.62; p < .001). The 95% confidence interval was between 0.29 and 0.59, with a standard error of 0.08. The forest plot in Fig 2 displays the post-test effects.
https://doi.org/10.1371/journal.pone.0158092.g002
Effect sizes of studies ranged from 0.05 to 2.11. A heterogeneity analysis revealed significant heterogeneity (Q (26) = 134.12; p < .001). Heterogeneity was high (I 2 = 80.62). Therefore, moderator analyses were performed.
Table 2 presents the findings of the moderator analyses. A systematic finding is that for 15 out of 17 categories, significant effects were found. No significant effects were found for age of target group, number of sessions, measurement instrument and control group. However, the strength of the effects differed for target group, intervention type and study quality. Interventions in clinical groups showed larger effects than those in non-clinical groups. Individual face-to-face interventions had stronger effects than self-help or group interventions. Studies of lower quality had higher effect sizes than studies of intermediate or higher quality. In a post-hoc analysis, we assessed whether the three significant moderating variables were interrelated among each other. There was no relation between target group and intervention type ( χ 2 = 1.1; df = 1; p = 0.587). Target group and study quality were related ( χ 2 = 9.4; df = 2; p = 0.009). Studies with clinical target groups had higher quality. The higher effects for clinical groups can thus not be attributed to a lower quality of studies. There was a significant relation between intervention type and quality of the study ( χ 2 = 14.1; df = 4; p = 0.007). Individual face-to-face interventions were more often assessed in studies with lower quality. Due to this contamination, it remains uncertain whether the intervention type or the quality of the study caused the higher effect sizes.
https://doi.org/10.1371/journal.pone.0158092.t002
There is no clear indication of publication bias. Visual inspection of the funnel plot suggested no evidence of publication bias, as the distribution is symmetrical. Egger’s regression intercept also suggests that there is no publication bias (intercept = 1.53; t = 1.31; df = 25; p = 0.20). Duval and Tweedie’s trim and fill analysis indicated that no studies needed to be filled or trimmed, which suggests that the effect size was not affected by publication bias.
Follow-up effects.
Twelve studies [ 21 , 22 , 40 , 42 , 44 , 45 , 49 – 51 , 55 , 57 , 61 ] examined follow-up effects after at least 2 months up to 10 months. Nine of these 12 studies examined the follow-up at 6 months. The random effect model showed small but significant effects for psychological well-being, compared with a control group (Cohen’s d = 0.22; z = 4,9; p<0.001). The 95% confidence interval was between 0.13 and 0.31, with a standard error of 0.045. Heterogeneity was low (Q (11) = 11.45; p<0.41; I 2 = 3.89).
Discussion and Conclusion
Psychological well-being is increasingly used as an outcome in studies on behavioral interventions, besides measures of psychological complaints and psychopathological symptoms. Several studies reported evidence that psychological well-being can indeed be promoted through behavioral interventions. This is the first meta-analysis to assess their overall effect. A moderate effect size of 0.44 was found across studies for psychological well-being, with no indication for publication bias. Significant effects were found across the categories of the moderator variables, illustrating the systematic nature of the effects. In the follow-up assessment, the effect size was still significant, but small (0.22). This result has to be interpreted with caution as only 12 studies could be included in this analysis. It is important that future studies make use of follow-up measures to gain more insight in the longitudinal development of the effects of interventions on psychological well-being.
This study explicitly focused on psychological well-being as an integrated construct that builds on several psychological theories of the twentieth century. The effect size of psychological well-being is somewhat lower than the standardized mean difference of .61 that was reported in a meta-analysis by Sin and Lyubomirsky (11) and somewhat higher than the effect of .20 for psychological well-being in a meta-analysis by Bolier et al. [ 12 ]. These differences may be related to the fact that the first meta-analyses focused on subjective well-being whereas the second one included 10 different measures of psychological well-being in addition to the PWBS and MHC-SF, for example hope, mastery and purpose in life. This might demonstrate the importance of good definitions of well-being as different results may be obtained with instruments derived from different traditions. Furthermore, both previous meta-analyses focused on specific positive psychological interventions, whereas our study included a number of different therapeutic interventions. Because the interventions varied considerably, a reliable subgroup analysis was not possible. When sufficient studies will be published in the future, later meta-analyses could address differences between interventions, for example comparing positive psychological interventions, well-being therapy, acceptance and commitment therapy, and life review therapy. Despite the relatively high levels of stability of psychological well-being across time [ 19 ], these results show that it is possible to improve psychological well-being. Consequently, it might have more state-like characteristics, as a trait would be very hard to change, especially in a short period of time.
The heterogeneity was large with effects ranging from 0.05 [ 41 ] to 2.11 [ 52 ]. Although the statistical power is sufficient for the study in total, it is low for the moderator analyses [ 63 ]. Therefore, it is even more remarkable that we did find three significant moderators out of seven possible moderators. Effects were larger for clinical groups and in individual interventions. Interestingly, these moderators were also found significant in the meta-analyses of Sin and Lyubomirsky [ 11 ] and Bolier et al. [ 12 ]. The promotion of psychological well-being seem to be best suited for individuals who suffer from psychological or somatic complaints. One possible explanation is that clinical populations have more impaired levels of psychological well-being at the beginning of the intervention, indicating that there is more room for improvement. This finding is relevant because psychological well-being can be seen as an important component of recovery [ 64 ]. Higher levels of psychological well-being are associated with better physical health [ 15 ] and buffer against future disorders [ 16 , 65 ], suggesting that people with higher levels are potentially more resilient [ 66 , 67 ]. Furthermore, a personal approach with face-to-face contact appears to work better compared to self-help and group interventions. Yet interventions targeted at the general population or using self-help or group interventions showed smaller, but still significant effects. When such interventions have a large enough reach, they might also bring substantive public health gains [ 12 ].
For an interpretation of the results, it is important to be aware of possible limitations of the meta-analysis. First, one third of the studies had lower quality, whereas these studies also showed larger effects. However, the quality might have been underestimated, as it was scored conservatively: not reporting on the randomization procedures for example was rated as absence. Lower quality might also be attributed to the fact that new interventions were tested with pilot studies with a small number of participants. The larger effects of studies with lower quality might also contaminated with the finding that individual face-to-face interventions had higher effects. Future research needs RCTs with better quality, such as a larger number of participants based on a priori power analyses and longer follow-ups. Second, there are some limitations due to the search strategy. There was not sufficient data for six studies which met the inclusion criteria, limiting the completeness of the meta-analysis. The search strategy also may have been imperfect, as additional information sources revealed another six studies which were not found with the database search. Still, this possible limitation has been compensated by asking experts in the field and searching through reference lists of relevant articles and meta-analyses. We also excluded grey literature articles that were not peer-reviewed, which might have led to biased results. However, we did not find any indication of a publication bias. Another limitation is that the meta-analysis included highly heterogeneous studies; different outcomes may be due to factors such as different patient populations, protocol characteristics, and enrollment procedures [ 68 , 69 ].
A broader point of discussion concerns the fact that the scales rely on self-reports. Self-reported well-being measures correlate with social desirability [ 70 ]. It would therefore be interesting to find new ways of measurements to assess aspects of psychological functioning in a more objective way, for example using biological markers or automatic behavioral analyses. Until the reliability and validity of such methods have been proven, the possible self-reporting biases should be kept in mind when interpreting results of meta-analyses such as the current one.
Despite the limitations, we conclude that psychological well-being can be significantly improved to a moderate extent. This is important evidence for the development and implementation of interventions and policies in the field of mental health promotion. Improvement of psychological well-being is especially successful in clinical populations. Based on this meta-analysis, individual face-to-face interventions can be considered as valuable option when developing interventions for an improved psychological well-being. There is a need for higher quality studies in this emerging field to be able to further underpin the promising results of this meta-analysis.
Supporting Information
S1 checklist..
https://doi.org/10.1371/journal.pone.0158092.s001
S1 Table. Methodological Quality Assessment Criteria.
https://doi.org/10.1371/journal.pone.0158092.s002
Acknowledgments
We want to thank Sanne Lamers and Linda Bolier for giving us an introduction to the program Central Meta-Analysis. We are grateful to Mirjam Irene Maas who made a start with her thesis and Pauline de With for helping with the data-search and other tasks that came up.
Author Contributions
Conceived and designed the experiments: LAW GJW ETB. Performed the experiments: LAW. Analyzed the data: LAW GJW. Wrote the paper: LAW GJW ETB.
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