The Role of Wellness in Caring for Patients with Depression

Question:

"I have been reading about the concept of Wellness. Does this have a role in my practice (I take care of a lot of folks with depression)?"

Rakesh Jain, MD, MPH:

The World Health Organization boldly states that health is " A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. "1 This then raises the obvious questions: Are these lofty and unreasonable goals, or is Wellness a basic human right that all should strive for, regardless of whether they suffer from depression or not?

C. Robert Cloninger, MD, from the department of psychiatry of the Washington University School of Medicine recently wrote: " Psychiatry has failed to improve the average levels of happiness and well-being in the general population, despite vast expenditures on psychotropic drugs and psychotherapy manuals. "2

Ouch. That hurts.

While I think Dr. Cloninger is being a bit harsh, there is a large amount of truth in his statement. We clinicians, when treating patients with depression, focus on reducing symptoms and hopefully even eliminating them. As the WHO statement above tells us, Wellness is much more than the absence of symptoms; it’s the presence of Wellness and well-being too. But in average psychiatry and primary care practices, and in the minds of our patients, this is often not the ultimate goal of treatment.

Other visionary clinicians too have weighed in on this topic. Slade3 recently wrote an article that’s boldly titled " Mental Illness and Well-Being: The Central Importance of Positive Psychology and Recovery Approaches." His central theme is that well-being is a need for all, both for those who don’t have mental illness, as well as those who do. He has some specific recommendations for us clinicians who wish to incorporate the Wellness model into our practices. He extols us to assess patient’s strengths and weaknesses individually and that the patients own goals and strengths will guide us into specific Wellness recommendations. He also truthfully acknowledges that the illness model, and not the Wellness model, is the current model of health care delivery around the globe. If we were to accept this new model, significant changes are required in our thinking, treatment plan creation, patients’ psychoeducation, and, finally, in societal attitudes toward well-being.

Wellness is not good just for an individual, but also for those around them. For example, in a recent study, children’s risk for developmental problems at school entry was found to be related to maternal well-being.4 Is this positive impact found only in young children? Actually, even in adolescents, a parent’s mental well-being strongly and positively impacts the adolescent. A recent study by Giannakopoulos and colleagues5 revealed that a parent’s state of mental well-being impacts their adolescent children’s mental and physical well-being. How interesting!

Common sense dictates that this would be the case, but data like this convinces us clinicians to adopt the Wellness model. It’s good for our patients, and it’s good for those around our patients.

Just from the fact that you asked this question, I suspect you will find a related academic field in psychology of great interest. Positive Psychology, a fairly new but fascinating branch of psychology, has focused on strengths rather than weakness (the traditional model of both psychology and psychiatry, I am unhappy to report), and striking new research shows people can be helped to accept such new models of thinking. This leads to improved well-being. As an introduction to this topic, you may want to check out a book written by the father of positive psychology Martin E.P. Seligman, PhD—Authentic Happiness: Using the New Positive Psychology to Realize your Potential for Lasting Fulfillment . It’s a very good primer on the field of positive psychology and the ultimate goal we all strive for–Wellness. It’s a book I quite often recommend to my patients who are open to the idea of a higher goal than remission—that of sustained mental well-being.

Well-being absolutely has a role in our practices, no matter what the setting. There are many scales and screeners available for assessment of optimism, well-being, etc., and they are conveniently found on Dr. Seligman’s University of Pennsylvania Web site (https://www.authentichappiness.sas.upenn.edu/questionnaires.aspx). I encourage you to explore this site; I suspect that you too, just like me, will see many opportunities to bring Wellness into your everyday clinical practice. Your patients will undeniably benefit from this approach.

I very much am interested in your thoughts regarding well-being. Please do share them with me and other readers of this Community Forum. We could surely all learn much from each other.

On a final note, I will be presenting a seminar on Wellness at the 23rd Annual U.S. Psychiatric and Mental Health Congress in Orlando from November 18-21, 2010. I hope you will come attend this meeting as well as my presentation!

  —Rakesh Jain, MD, MPH

  References

1. World Health Organization. Promoting Mental Health. Concepts, Emerging Evidence, Practice. Geneva: World Health Organization; 2004.
2. Cloninger CR. The science of well-being: an integrated approach to mental health and its disorders. World Psychiatry . 2006;5(2):71-76.
3. Slade M. Mental illness and well-being: the central importance of positive psychology and recovery approaches. BMC Health Serv Res. 2010;10:26.
4. Tough SC, Siever JE, Benzies K, et al. Maternal well-being and its association to risk of developmental problems in children at school entry. BMC Pediatr. 2010;25(10):19. BMC Pediatr. 2010;25(10):19.
5. Giannakopoulos G, Dimitrakaki C, Pedeli X, et al. Adolescents’ wellbeing and functioning: relationships with parents’ subjective general physical and mental health. Health Qual Life Outcomes. 2009;7:100.