Poor Separation of Clinical Symptom Profiles by DSM-5 Disorder Criteria

Assessment of mental illness typically relies on a disorder classification system that is considered to be at odds with the vast disorder comorbidity and symptom heterogeneity that exists within and across patients. Patients with the same disorder diagnosis exhibit diverse symptom profiles and comorbidities creating numerous clinical and research challenges. Here we provide a quantitative analysis of the symptom heterogeneity and disorder comorbidity across a sample of 107,349 adult individuals (aged 18–85 years) from 8 English-speaking countries. Data were acquired using the Mental Health Quotient, an anonymous, online, self-report tool that comprehensively evaluates symptom profiles across 10 common mental health disorders. Dissimilarity of symptom profiles within and between disorders was then computed. We found a continuum of symptom prevalence rather than a clear separation of normal and disordered. While 58.7% of those with 5 or more clinically significant symptoms did not map to the diagnostic criteria of any of the 10 DSM-5 disorders studied, those with symptom profiles that mapped to at least one disorder had, on average, 20 clinically significant symptoms. Within this group, the heterogeneity of symptom profiles was almost as high within a disorder label as between 2 disorder labels and not separable from randomly selected groups of individuals with at least one of any of the 10 disorders. Overall, these results quantify the scale of misalignment between clinical symptom profiles and DSM-5 disorder labels and demonstrate that DSM-5 disorder criteria do not separate individuals from random when the complete mental health symptom profile of an individual is considered. Greater emphasis on empirical, disorder agnostic approaches to symptom profiling would help overcome existing challenges with heterogeneity and comorbidity, aiding clinical and research outcomes.

Salutogenic-Oriented Mental Health Nursing: Strengthening Mental Health Among Adults with Mental Illness

This chapter focuses on mental health promotion with a salutogenic understanding of mental health as an individual’s subjective well-being encompassing both feelings and functioning. Mental health is an ever-present aspect of life, relevant for everybody; thus, to promote mental health is a universal ambition. Our chapter is written with adults with mental illness in need of mental health nursing in mind. To understand the present and make suggestions for the future, knowledge of the past is needed. We elaborate on historical trends of nursing, nursing models, and the hospital setting to support our statement; persons with mental illness need a more complete mental health nursing care, including salutogenic mental health promotion. In the last part of the chapter, we introduce the salutogenic-oriented mental health nursing, and further showing how salutogenesis can be integrated in nursing care for persons with mental illness. As well as elaborating on the features of salutogenic-oriented mental health nursing, and briefly present the Act-Belong-Commit framework for mental health promotion as an example of salutogenesis in nursing practice.

Framing School Mental Health Services Within a Dual-Factor Model of Mental Health

This chapter proposes a reimagined dual-factor, multitiered system of support (MTSS) that targets students’ complete mental health by simultaneously diminishing symptoms of mental disorders and enhancing attributes of well-being. Examples of assessments and interventions are cited to show that our existing knowledge base includes examples of universal screening, progress monitoring, and interventions that address complete mental health. An argument is made for more research to build a broader base of assessments of well-being for progress monitoring and universal screening and to develop and field test decision-making protocols to identify students’ complete mental health needs and align services with these needs. The chapter concludes that important first steps toward dual-factor MTSS have already been taken.

Conceptualizing Youth Mental Health Through a Dual-Factor Model

This chapter summarizes evidence for the dual-factor model of mental health in which youth psychopathology and well-being are related but distinct and the promotion of wellness is equally important as amelioration of emotional and behavioral problems. The dual-factor model identifies 2 groups described in traditional mental health frameworks: youth without psychopathology who report positive emotional well-being (complete mental health) and youth who experience both psychopathology and low emotional well-being (troubled). Additional groups identified in dual-factor models are youth who are languishing emotionally but evidence no psychopathology (vulnerable) and youth who experience psychopathology while also evidencing emotional wellness (symptomatic but content). The use of the dual-factor model in school mental health facilitates identification of students who are vulnerable or symptomatic but content and need supports to foster positive emotions or manage distressing symptoms of disorders, as well as those who are troubled and need high-intensity or individualized mental health services.

Occupational Stress and Employees Complete Mental Health: A Cross-Cultural Empirical Study

Given the shortcomings of previous research on occupational stress and mental health (e.g., predominantly in Western, educated, industrialized, rich and democratic (WEIRD) societies, based on the traditional mental health model and a lack of comparative studies), this study aimed to (a) examine the relationship between occupational stress and complete mental health among employees in Cabo Verde and China, and also explored the mediation and moderation roles of burnout and optimism in accounting for the empirical link. Mental health was defined as comprised of two distinguishable factors: positive and negative mental health. The Pearson correlation test, structural equation modeling (SEM) analysis, bootstrap analysis, hierarchical moderated regression and an independent t-test were used to analyze the data. The results indicated that, in both countries, occupational stress showed a negative relation to positive mental health and lower psychopathology symptoms—and job burnout mediated the relation between occupational stress and mental health. Optimism moderated the relation between occupational stress and burnout, but not the relation between occupational stress and complete mental health. The results are interpreted in light of the comparative framework.