research studies on psychological well being

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• Published: 19 June 2020

Well-being is more than happiness and life satisfaction: a multidimensional analysis of 21 countries

• Kai Ruggeri 1 , 2 ,
• Eduardo Garcia-Garzon 3 ,
• Áine Maguire 4 ,
• Sandra Matz 5 &
• Felicia A. Huppert 6 , 7  

Health and Quality of Life Outcomes volume  18 , Article number:  192 ( 2020 ) Cite this article

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Recent trends on measurement of well-being have elevated the scientific standards and rigor associated with approaches for national and international comparisons of well-being. One major theme in this has been the shift toward multidimensional approaches over reliance on traditional metrics such as single measures (e.g. happiness, life satisfaction) or economic proxies (e.g. GDP).

To produce a cohesive, multidimensional measure of well-being useful for providing meaningful insights for policy, we use data from 2006 and 2012 from the European Social Survey (ESS) to analyze well-being for 21 countries, involving approximately 40,000 individuals for each year. We refer collectively to the items used in the survey as multidimensional psychological well-being (MPWB).

The ten dimensions assessed are used to compute a single value standardized to the population, which supports broad assessment and comparison. It also increases the possibility of exploring individual dimensions of well-being useful for targeting interventions. Insights demonstrate what may be masked when limiting to single dimensions, which can create a failure to identify levers for policy interventions.

Conclusions

We conclude that both the composite score and individual dimensions from this approach constitute valuable levels of analyses for exploring appropriate policies to protect and improve well-being.

What is well-being?

Well-being has been defined as the combination of feeling good and functioning well; the experience of positive emotions such as happiness and contentment as well as the development of one’s potential, having some control over one’s life, having a sense of purpose, and experiencing positive relationships [ 23 ]. It is a sustainable condition that allows the individual or population to develop and thrive. The term subjective well-being is synonymous with positive mental health. The World Health Organization [ 45 ] defines positive mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. This conceptualization of well-being goes beyond the absence of mental ill health, encompassing the perception that life is going well.

Well-being has been linked to success at professional, personal, and interpersonal levels, with those individuals high in well-being exhibiting greater productivity in the workplace, more effective learning, increased creativity, more prosocial behaviors, and positive relationships [ 10 , 27 , 37 ]. Further, longitudinal data indicates that well-being in childhood goes on to predict future well-being in adulthood [ 39 ]. Higher well-being is linked to a number of better outcomes regarding physical health and longevity [ 13 ] as well as better individual performance at work [ 30 ], and higher life satisfaction has been linked to better national economic performance [ 9 ].

Measurement of well-being

Governments and researchers have attempted to assess the well-being of populations for centuries [ 2 ]. Often in economic or political research, this has ended up being assessed using a single item about life satisfaction or happiness, or a limited set of items regarding quality of life [ 3 ]. Yet, well-being is a multidimensional construct, and cannot be adequately assessed in this manner [ 14 , 24 , 29 ]. Well-being goes beyond hedonism and the pursuit of happiness or pleasurable experience, and beyond a global evaluation (life satisfaction): it encompasses how well people are functioning, known as eudaimonic, or psychological well-being. Assessing well-being using a single subjective item approach fails to offer any insight into how people experience the aspects of their life that are fundamental to critical outcomes. An informative measure of well-being must encompass all the major components of well-being, both hedonic and eudaimonic aspects [ 2 ], and cannot be simplified to a unitary item of income, life satisfaction, or happiness.

Following acknowledgement that well-being measurement is inconsistent across studies, with myriad conceptual approaches applied [ 12 ], Huppert and So [ 27 ] attempted to take a systematic approach to comprehensively measure well-being. They proposed that positive mental health or well-being can be viewed as the complete opposite to mental ill health, and therefore attempted to define mental well-being in terms of the opposite of the symptoms of common mental disorders. Using the DSM-IV and ICD-10 symptom criteria for both anxiety and depression, ten features of psychological well-being were identified from defining the opposite of common symptoms. The features encompassed both hedonic and eudaimonic aspects of well-being: competence, emotional stability, engagement, meaning, optimism, positive emotion, positive relationships, resilience, self-esteem, and vitality. From these ten features an operational definition of flourishing, or high well-being, was developed using data from Round 3 of the European Social Survey (ESS), carried out in 2006. The items used in the Huppert and So [ 27 ] study were unique to that survey, which reflects a well-being framework based on 10 dimensions of good mental health. An extensive discussion on the development and validation of these measures for the framework is provided in this initial paper [ 27 ].

As this was part of a major, multinational social survey, each dimension was measured using a single item. As such, ‘multidimensional’ in this case refers to using available measures identified for well-being, but does not imply a fully robust measure of these individual dimensions, which would require substantially more items that may not be feasible for population-based work related to policy development. More detailed and nuanced approaches might help to better capture well-being as a multidimensional construct, and also may consider other dimensions. However, brief core measures such as the one implemented in the ESS are valuable as they provide a pragmatic way of generating pioneering empirical evidence on well-being across different populations, and help direct policies as well as the development of more nuanced instruments. While this naturally would benefit from complementary studies of robust measurement focused on a single topic, appropriate methods for using sprawling social surveys remain critical, particularly through better standardization [ 6 ]. While this paper will overview those findings, we strongly encourage more work to that end, particularly in more expansive measures to support policy considerations.

General approach and key questions

The aim of the present study was to develop a more robust measurement of well-being that allows researchers and policymakers to measure well-being both as a composite construct and at the level of its fundamental dimensions. Such a measure makes it possible to study overall well-being in a manner that goes beyond traditional single-item measures, which capture only a fraction of the dimensions of well-being, and because it allows analysts to unpack the measure into its core components to identify strengths and weaknesses. This would produce a similar approach as the most common reference for policy impacts: Gross Domestic Product (GDP), which is a composite measure of a large number of underlying dimensions.

The paper is structured as follows: in the first step, data from the ESS are used to develop a composite measure of well-being from the items suggested by Huppert & So [ 27 ] using factor analysis. In the second step, the value of the revised measure is demonstrated by generating insights into the well-being of 21 European countries, both at the level of overall well-being and at the level of individual dimensions.

The European social survey

The ESS is a biannual survey of European countries. Through comprehensive measurement and random sampling techniques, the ESS provides a representative sample of the European population for persons aged 15 and over [ 38 ]. Both Round 3 (2006–2007) and Round 6 (2012–2013) contained a supplementary well-being module. This module included over 50 items related to all aspects of well-being including psychological, social, and community well-being, as well as incorporating a brief measure of symptoms of psychological distress. As summarized by Huppert et al. [ 25 ], of the 50, only 30 items relate to personal well-being, of which only 22 are positive measures. Of those remaining, not all relate to the 10 constructs identified by Huppert and So [ 27 ], so only a single item could be used, or else the item that had the strongest face validity and distributional items were chosen.

Twenty-two countries participated in the well-being modules in both Round 3 and Round 6. As this it within a wider body of analyses, it was important to focus on those initially. Hungary did not have data for the vitality item in Round 3 and was excluded from the analysis, as appropriate models would not have been able to reliably resolve a missing item for an entire country. To be included in the analysis and remain consistent, participants therefore had to complete all 10 items used and have the age, gender, employment, and education variables completed. Employment was classified into four groups: students, employed, unemployed, retired; other groups were excluded. Education was classified into three groups: low (less than secondary school), middle (completed secondary school), and high (postsecondary study including any university and above). Using these criteria, the total sample for Round 6 was 41,825 people from 21 countries for analysis. The full sample was 52.6% female and ranged in age from 15 to 103 (M = 47.9; SD = 18.9). Other details about participation, response rates, and exclusion have been published elsewhere [ 38 ].

Huppert & So [ 27 ] defined well-being using 10 items extracted from the Round 3 items, which represent 10 dimensions of well-being. However, the items used in Round 3 to represent positive relationships and engagement exhibited ceiling effects and were removed from the questionnaire in Round 6. Four alternatives were available to replace each question. Based on their psychometric properties (i.e., absence of floor effects and wider response distributions), two new items were chosen for positive relationships and engagement (one item for each dimension). The new items and those they replaced can be seen in Table  1 (also see Supplement ).

Development of a composite measure of psychological well-being (MPWB)

A composite measure of well-being that yields an overall score for each individual was developed. From the ten indicators of well-being shown in Table 1 , a single factor score was calculated to represent MPWB. This overall MPWB score hence constitutes a summary of how an individual performs across the ten dimensions, which is akin to a summary score such as GDP, and will be of general value to policymakers. Statistical analysis was performed in R software, using lavaan [ 40 ] and lavaan.survey [ 35 ] packages. The former is a widely-used package for the R software designed for computing structural equation models and confirmatory factor analyses (CFA). The latter allows introducing complex survey design weights (combination of design and population size weights) when estimating confirmatory factor analysis models with lavaan, which ensures that MPWB scoring followed ESS guidelines regarding both country-level and survey specific weights [ 17 ]. Both packages have been previously tested and validated in various analyses using ESS data (as explained in detail in lavaan.survey documentation).

It should be noted that Round 6 was treated as the focal point of these efforts before repeating for Round 3, primarily due to the revised items that were problematic in Round 3, and considering that analyses of the 2006 data are already widely available.

Prior to analysis, all items were coded such that higher scores were more positive and lower scores more negative. Several confirmatory factor analysis models were performed in order to test several theoretical conceptualizations regarding MPWB. Finally, factor scores (expected a posteriori [ 15 ];) were calculated for the full European sample and used for descriptive purposes. The approach and final model are presented in supplemental material .

Factor scores are individual scores computed as weighted combinations of each person’s response on a given item and the factor scoring coefficients. This approach is to be preferred to using raw or sum scores: sum or raw scores fail to consider how well a given item serves as an indicator of the latent variable (i.e., all items are unrealistically assumed to be perfect and equivalent measures of MPWB). They also do not take into account that different items could present different variability, which is expected to occur if items present different scales (as in our case). Therefore, the use of such simple methods results in inaccurate individual rankings for MPWB. To resolve this, factor scores are both more informative and more accurate, as they avoid the propagation of measurement error in subsequent analyses [ 19 ].

Not without controversy (see Supplement ), factor scores are likely to be preferable to sum scores when ranking individuals on unobservable traits that are expected to be measured with noticeable measurement error (such as MPWB [ 32 ];). Similar approaches based on factor scoring have been successfully applied in large international assessment research [ 21 , 34 ]. With the aim of developing a composite well-being score, it was necessary to provide a meaningful representation of how the different well-being indicators are reflected in the single measure. A hierarchical model with one higher-order factor best approximated MPWB along with two first-order factors (see supplement Figure S 1 ). This model replicates the factor structure reported for Round 3 by Huppert & So [ 27 ]. The higher-order factor explained the relationship between two first-order factors (positive functioning and positive characteristics showed a correlation of ρ = .85). In addition, modelling standardized residuals showed that the items representing vitality and emotional stability and items representing optimism and self-esteem were highly correlated. The similarities in wording in both pairs of items (see Table 1 ) are suspected to be responsible for such high residual correlations. Thus, those correlations were included in the model. As presented in Table  2 , the hierarchical model was found to fit the data better than any other model but a bi-factor model including these correlated errors. The latter model resulted in collapsed factor structure with a weak, bi-polar positive functioning factor. However, this bi-factor model showed a problematic bi-polar group factor with weak loadings. Whether this group factor was removed (resulting in a S-1 bi-factor model, as in [ 16 ]), model fit deteriorated. Thus, neither bi-factor alternative was considered to be acceptable.

To calculate the single composite score representing MPWB, a factor scoring approach was used rather than a simplistic summing of raw scores on these items. Factor scores were computed and standardized for the sample population as a whole, which make them suitable for broad comparison [ 8 ]. This technique was selected for two reasons. First, it has the ability to take into account the different response scales used for measuring the items included in the multidimensional well-being model. The CFA model, from which MPWB scores were computed, was defined such that the metric of the MPWB was fixed, which results in a standardized scale. Alternative approaches, such as sum or raw scores, would result in ignoring the differential variability across items, and biased individual group scores. Our approach, using factor scoring, resolves this issue by means of standardization of the MPWB scores. The second reason for this technique is that it could take account of how strongly each item loaded onto the MPWB factor. It should be noted that by using only two sub-factors, the weight applied to the general factor is identical within the model for each round. This model was also checked to ensure it also was a good fit for different groups based on gender, age, education and employment.

Separate CFA analyses per each country indicate that the final model fit the data adequately in all countries (.971 < CFI < .995; .960 < TFI < .994; .020 < RMSEA < .05; 0,023 < SRMR < 0,042). All items presented substantive loadings on their respective factors, and structures consistently replicated across all tested countries. Largest variations were found when assessing the residual items’ correlations (e.g., for emotional stability and vitality correlation, values ranged from 0,076 to .394). However, for most cases, residuals correlations were of similar size and direction (for both cases, the standard deviation of estimated correlations was close of .10). Thus, strong evidence supporting our final model was systematically found across all analyzed countries. Full results are provided in the supplement (Tables S 2 -S 3 ).

Model invariance

In order to establish meaningful comparisons across groups within and between each country, a two-stage approach was followed, resulting in a structure that was successfully found to be similar across demographics. First, a descriptive comparison of the parameter estimates unveiled no major differences across groups. Second, factor scores were derived for the sample, employing univariate statistics to compare specific groups within country and round. In these analyses, neither traditional nor modern approaches to factor measurement invariance were appropriate given the large sample and number of comparisons at stake ([ 8 ]; further details in Supplement ).

From a descriptive standpoint, the hierarchical structure satisfactorily fit both Round 3 and Round 6 data. All indicators in both rounds had substantial factor loadings (i.e., λ > .35). A descriptive comparison of parameter estimates produced no major differences across the two rounds. The lack of meaningful differences in the parameter estimates confirms that this method for computing MPWB can be used in both rounds.

As MPWB scores from both rounds are obtained from different items that have different scales for responses, it is necessary to transform individual scores obtained from both rounds in order to be aligned. To do this between Round 3 and Round 6 items, a scaling approach was used. To produce common metrics, scores from Round 3 were rescaled using a mean and sigma transformation (Kolen & Brennan 2010) to align with Round 6 scales. This was used as Round 6 measures were deemed to have corrected some deficiencies found in Round 3 items. This does not change outcomes in either round but simply makes the scores match in terms of distributions relative to their scales, making them more suitable for comparison.

As extensive descriptive insights on the sample and general findings are already available (see [ 41 ]), we focus this section on the evidence derived directly from the proposed approach to MPWB scores. For the combined single score for MPWB, the overall mean (for all participants combined) is fixed to zero, and the scores represent deviation from the overall mean. In 2012 (Round 6), country scores on well-being ranged from − 0.41 in Bulgaria to 0.46 in Denmark (Fig.  1 ). There was a significant, positive relationship between national MPWB mean scores and national life satisfaction means ( r =  .56 (.55–.57), p  < .001). In addition, MPWB was negatively related with depression scores and positively associated with other well-being measurements (see Supplement ).

Distribution of national MPWB means and confidence intervals across Europe

Denmark having the highest well-being is consistent with many studies [ 4 , 18 ] and with previous work using ESS data [ 27 ]. While the pattern is typically that Nordic countries are doing the best and that eastern countries have the lowest well-being, exceptions exist. The most notable exception is Portugal, which has the third-lowest score and is not significantly higher than Ukraine, which is second lowest. Switzerland and Germany are second and third highest respectively, and show generally similar patterns to the Scandinavian countries (see Fig. 1 ). It should be noted that, for Figs.  1 , 2 , 3 , 4 , 5 , countries with the lowest well-being are at the top. This is done to highlight the greatest areas for potential impact, which are also the most of concern to policy.

Well-being by country and gender

Well-being by country and age

Well-being by country and employment

Well-being by country and education

General patterns across the key demographic variables – gender, age, education, employment – are visible across countries as seen in Figs.  1 , 2 , 3 , 4 , 5 (see also Supplement 2 ). These figures highlight patterns based on overall well-being as well as potential for inequalities. The visualizations presented here, though univariate, are for the purpose of understanding broad patterns while highlighting the need to disentangle groups and specific dimensions to generate effective policies.

For gender, women exhibited lower MPWB scores than men across Europe (β = −.09, t (36508) = − 10.37; p  < .001). However, these results must be interpreted with caution due to considerable overlap in confidence intervals for many of the countries, and greater exploration of related variables is required. This also applies for the five countries (Estonia, Finland, Ireland, Slovakia, Ukraine) where women have higher means than men. Only four countries have significant differences between genders, all of which involve men having higher scores than women: the Netherlands (β = −.12, t (1759) = − 3.24; p  < .001), Belgium (β = −.14, t (1783) = − 3.94; p  < .001), Cyprus (β = −.18, t (930) = − 2.87; p  < .001) and Portugal (β = −.19, t (1847) = − 2.50; p  < .001).

While older individuals typically exhibited lower MPWB scores compared to younger age groups across Europe (β 25–44  = −.05, t (36506) = − 3.686, p  < .001; β 45–65  = −.12, t (36506) = − 8.356, p  < .001; β 65–74  = −.16, t (36506) = − 8.807, p  < .001; β 75+  = −.28, t (36506) = − 13.568, p  < .001), the more compelling pattern shows more extreme differences within and between age groups for the six countries with the lowest well-being. This pattern is most pronounced in Bulgaria, which has the lowest overall well-being. For the three countries with the highest well-being (Denmark, Switzerland, Germany), even the mean of the oldest age group was well above the European average, while for the countries with the lowest well-being, it was only young people, particularly those under 25, who scored above the European average. With the exception of France and Denmark, countries with higher well-being typically had fewer age group differences and less variance within or between groups. Only countries with the lowest well-being showed age differences that were significant with those 75 and over showing the lowest well-being.

MPWB is consistently higher for employed individuals and students than for retired (β = −.31, t (36506) = − 21.785; p  < .00) or unemployed individuals (β = −.52, t (36556) = − 28.972; p  < .001). Unemployed groups were lowest in nearly all of the 21 countries, though the size of the distance from other groups did not consistently correlate with national MPWB mean. Unemployed individuals in the six countries with the lowest well-being were significantly below the mean, though there is little consistency across groups and countries by employment beyond that. In countries with high well-being, unemployed, and, in some cases, retired individuals, had means below the European average. In countries with the lowest well-being, it was almost exclusively students who scored above the European average. Means for retired groups appear to correlate most strongly with overall well-being. There is minimal variability for employed groups in MPWB means within and between countries.

There is a clear pattern of MPWB scores increasing with education level, though the differences were most pronounced between low and middle education groups (β = .12, t (36508) = 9.538; p  < .001). Individuals with high education were significantly higher on MPWB than those in the middle education group (β = .10, t (36508) =11.06; p  < .001). Differences between groups were noticeably larger for countries with lower overall well-being, and the difference was particularly striking in Bulgaria. In Portugal, medium and high education well-being means were above the European average (though 95% confidence intervals crossed 0), but educational attainment is significantly lower in the country, meaning the low education group represents a greater proportion of the population than the other 21 countries. In the six countries with the highest well-being, mean scores for all levels of education were above the European mean.

Utilizing ten dimensions for superior understanding of well-being

It is common to find rankings of national happiness and well-being in popular literature. Similarly, life satisfaction is routinely the only measure reported in many policy documents related to population well-being. To demonstrate why such limited descriptive approaches can be problematic, and better understood using multiple dimensions, all 21 countries were ranked individually on each of the 10 indicators of well-being and MPWB in Round 6 based on their means. Figure  6 demonstrates the variations in ranking across the 10 dimensions of well-being for each country.

Country rankings in 2012 on multidimensional psychological well-being and each of its 10 dimensions

The general pattern shows typically higher rankings for well-being dimensions in countries with higher overall well-being (and vice-versa). Yet countries can have very similar scores on the composite measure but very different underlying profiles in terms of individual dimensions. Figure  7 a presents this for two countries with similar life satisfaction and composite well-being, Belgium and the United Kingdom. Figure 7 b then demonstrates this even more vividly for two countries, Finland and Norway, which have similar composite well-being scores and identical mean life satisfaction scores (8.1), as well as have the highest two values for happiness of all 21 countries. In both pairings, the broad outcomes are similar, yet countries consistently have very different underlying profiles in individual dimensions. The results indicate that while overall scores can be useful for general assessment, specific dimensions may vary substantially, which is a relevant first step for developing interventions. Whereas the ten items are individual measures of 10 areas of well-being, had these been limited to a single domain only, the richness of the underlying patterns would have been lost, and the limitation of single item approaches amplified.

a Comparison of ranks for dimensions of well-being between two different countries with similar life satisfaction in 2012: Belgium and United Kingdom. b Comparison of ranks for dimensions of well-being between two similar countries with identical life satisfaction and composite well-being scores in 2012: Finland and Norway

The ten-item multidimensional measure provided clear patterns for well-being across 21 countries and various groups within. Whether used individually or combined into a composite score, this approach produces more insight into well-being and its components than a single item measure such as happiness or life satisfaction. Fundamentally, single items are impossible to unpack in reverse to gain insights, whereas the composite score can be used as a macro-indicator for more efficient overviews as well as deconstructed to look for strengths and weaknesses within a population, as depicted in Figs.  6 and 7 . Such deconstruction makes it possible to more appropriately target interventions. This brings measurement of well-being in policy contexts in line with approaches like GDP or national ageing indexes [ 7 ], which are composite indicators of many critical dimensions. The comparison with GDP is discussed at length in the following sections.

Patterns within and between populations

Overall, the patterns and profiles presented indicate a number of general and more nuanced insights. The most consistent among these is that the general trend in national well-being is usually matched within each of the primary indicators assessed, such as lower well-being within unemployed groups in countries with lower overall scores than in those with higher overall scores. While there are certainly exceptions, this general pattern is visible across most indicators.

The other general trend is that groups with lower MPWB scores consistently demonstrate greater variability and wider confidence intervals than groups with higher scores. This is a particularly relevant message for policymakers given that it is an indication of the complexity of inequalities: improvements for those doing well may be more similar in nature than for those doing poorly. This is particularly true for employment versus unemployment, yet reversed for educational attainment. Within each dimension, the most critical pattern is the lack of consistency for how each country ranks, as discussed further in other sections.

Examining individual dimensions of well-being makes it possible to develop a more nuanced understanding of how well-being is impacted by societal indicators, such as inequality or education. For example, it is possible that spending more money on education improves well-being on some dimensions but not others. Such an understanding is crucial for the implementation of targeted policy interventions that aim at weaker dimensions of well-being and may help avoid the development of ineffective policy programs. It is also important to note that the patterns across sociodemographic variables may differ when all groups are combined, compared to results within countries. Some effects may be larger when all are combined, whereas others may have cancelling effects.

Using these insights, one group that may be particularly important to consider is unemployed adults, who consistently have lower well-being than employed individuals. Previous research on unemployment and well-being has often focused on mental health problems among the unemployed [ 46 ] but there are also numerous studies of differences in positive aspects of well-being, mainly life satisfaction and happiness [ 22 ]. A large population-based study has demonstrated that unemployment is more strongly associated with the absence of positive well-being than with the presence of symptoms of psychological distress [ 28 ], suggesting that programs that aim to increase well-being among unemployed people may be more effective than programs that seek to reduce psychological distress.

Certainly, it is well known that higher income is related to higher subjective well-being and better health and life expectancy [ 1 , 42 ], so reduced income following unemployment is likely to lead to increased inequalities. Further work would be particularly insightful if it included links to specific dimensions of well-being, not only the comprehensive scores or overall life satisfaction for unemployed populations. As such, effective responses would involve implementation of interventions known to increase well-being in these groups in times of (or in spite of) low access to work, targeting dimensions most responsible for low overall well-being. Further work on this subject will be presented in forthcoming papers with extended use of these data.

This thinking also applies to older and retired populations in highly deprived regions where access to social services and pensions are limited. A key example of this is the absence in our data of a U-shaped curve for age, which is commonly found in studies using life satisfaction or happiness [ 5 ]. In our results, older individuals are typically lower than what would be expected in a U distribution, and in some cases, the oldest populations have the lowest MPWB scores. While previous studies have shown some decline in well-being beyond the age of 75 [ 20 ], our analysis demonstrates quite a severe fall in MPWB in most countries. What makes this insight useful – as opposed to merely unexpected – is the inclusion of the individual dimensions such as vitality and positive relationships. These dimensions are clearly much more likely to elicit lower scores than for younger age groups. For example, ageing beyond 75 is often associated with increased loneliness and isolation [ 33 , 43 ], and reduction in safe, independent mobility [ 31 ], which may therefore correspond with lower scores on positive relationships, engagement, and vitality, and ultimately lower scores on MPWB than younger populations. Unpacking the dimensions associated with the age-related decline in well-being should be the subject of future research. The moderate positive relationship of MPWB scores with life satisfaction is clear but also not absolute, indicating greater insights through multidimensional approaches without any obvious loss of information. Based on the findings presented here, it is clearly important to consider ensuring the well-being of such groups, the most vulnerable in society, during periods of major social spending limitations.

Policy implications

Critically, Fig.  6 represents the diversity of how countries reach an overall MPWB score. While countries with overall high well-being have typically higher ranks on individual items, there are clearly weak dimensions for individual countries. Conversely, even countries with overall low well-being have positive scores on some dimensions. As such, the lower items can be seen as potential policy levers in terms of targeting areas of concern through evidence-based interventions that should improve them. Similarly, stronger areas can be seen as learning opportunities to understand what may be driving results, and thus used to both sustain those levels as well as potentially to translate for individuals or groups not performing as well in that dimension. Collectively, we can view this insight as a message about specific areas to target for improvement, even in countries doing well, and that even countries doing poorly may offer strengths that can be enhanced or maintained, and could be further studied for potential applications to address deficits. We sound a note of caution however, in that these patterns are based on ranks rather than actual values, and that those ranks are based on single measures.

Figure 7 complements those insights more specifically by showing how Finland and Norway, with a number of social, demographic, and economic similarities, plus identical life satisfaction scores (8.1) arrive at similar single MPWB scores with very different profiles for individual dimensions. By understanding the levers that are specific to each country (i.e. dimensions with the lowest well-being scores), policymakers can respond with appropriate interventions, thereby maximizing the potential for impact on entire populations. Had we restricted well-being measurement to a single question about happiness, as is commonly done, we would have seen both countries had similar and extremely high means for happiness. This might have led to the conclusion that there was minimal need for interventions for improving well-being. Thus, in isolation, using happiness as the single indicator would have masked the considerable variability on several other dimensions, especially those dimensions where one or both had means among the lowest of the 21 countries. This would have resulted in similar policy recommendations, when in fact, Norway may have been best served by, for example, targeting lower dimensions such as Engagement and Self-Esteem, and Finland best served by targeting Vitality and Emotional Stability.

Targeting specific groups and relevant dimensions as opposed to comparing overall national outcomes between countries is perhaps best exemplified by Portugal, which has one of the lowest educational attainment rates in OECD countries, exceeded only by Mexico and Turkey [ 36 ]. This group thus skews the national MPWB score, which is above average for middle and high education groups, but much lower for those with low education. Though this pattern is not atypical for the 21 countries presented here, the size of the low education group proportional to Portugal’s population clearly reduces the national MPWB score. This implies that the greatest potential for improvement is likely to be through addressing the well-being of those with low education as a near-term strategy, and improving access to education as a longer-term strategy. It will be important to analyze this in the near future, given recent reports that educational attainment in Portugal has increased considerably in recent years (though remains one of the lowest in OECD countries) [ 36 ].

One topic that could not be addressed directly is whether these measures offer value as indicators of well-being beyond the 21 countries included here, or even beyond the countries included in ESS generally. In other words, are these measures relevant only to a European population or is our approach to well-being measurement translatable to other regions and purposes? Broadly speaking, the development of these measures being based on DSM and ICD criteria should make them relevant beyond just the 21 countries, as those systems are generally intended to be global. However, it can certainly be argued that these methods for designing measures are heavily influenced by North American and European medical frameworks, which may limit their appropriateness if applied in other regions. Further research on these measures should consider this by adding potential further measures deemed culturally appropriate and seeing if comparable models appear as a result.

A single well-being score

One potential weakness remains the inconsistency of scaling between ESS well-being items used for calculating MPWB. However, this also presents an opportunity to consider the relative weighting of each item within the current scales, and allow for the development of a more consistent and reliable measure. These scales could be modified to align in separate studies with new weights generated – either generically for all populations or stratified to account for various cultural or other influences. Using these insights, scales could alternatively be produced to allow for simple scoring for a more universally accessible structure (e.g. 1–100) but with appropriate values for each item that represents the dimensions, if this results in more effective communication with a general public than a standardized score with weights. Additionally, common scales would improve on attempts to use rankings for presenting national variability within and between dimensions. Researchers should be aware that factor scores are sample-dependent (as based on specific factor model parameters such as factor loadings). Nevertheless, future research focused on investigating specific item differential functioning (by means of multidimensional item response functioning or akin techniques) of these items across situations (i.e., rounds) and samples (i.e., rounds and countries) should be conducted in order to have a more nuanced understanding of this scale functioning.

What makes this discussion highly relevant is the value of a more informed measure to replace traditional indicators of well-being, predominantly life satisfaction. While life satisfaction may have an extensive history and present a useful metric for comparisons between major populations of interest, it is at best a corollary, or natural consequence, of other indicators. It is not in itself useful for informing interventions, in the same way limiting to a single item for any specific dimension of well-being should not alone inform interventions.

By contrast, a validated and standardized multidimensional measure is exceptionally useful in its suitability to identify those at risk, as well as its potential for identifying areas of strengths and weaknesses within the at-risk population. This can considerably improve the efficiency and appropriateness of interventions. It identifies well-understood dimensions (e.g. vitality, positive emotion) for direct application of evidence-based approaches that would improve areas of concern and thus overall well-being. Given these points, we strongly argue for the use of multidimensional approaches to measurement of well-being for setting local and national policy agenda.

There are other existing single-score approaches for well-being addressing its multidimensional nature. These include the Warwick-Edinburgh Mental Well-Being Scale [ 44 ] and the Flourishing Scale [ 11 ]. In these measures, although the single score is derived from items that clearly tap a number of dimensions, the dimensions have not been systematically derived and no attempt is made to measure the underlying dimensions individually. In contrast, the development approach used here – taking established dimensions from DSM and ICD – is based on years of international expertise in the field of mental illness. In other words, there have long been adequate measures for identifying and understanding illness, but there is room for improvement to better identify and understand health. With increasing support for the idea of these being a more central focus of primary outcomes within economic policies, such approaches are exceptionally useful [ 13 ].

Better measures, better insights

Naturally, it is not a compelling argument to simply state that more measures present greater information than fewer or single measures, and this is not the primary argument of this manuscript. In many instances, national measures of well-being are mandated to be restricted to a limited set of items. What is instead being argued is that well-being itself is a multidimensional construct, and if it is deemed a critical insight for establishing policy agenda or evaluating outcomes, measurements must follow suit and not treat happiness and life satisfaction values as universally indicative. The items included in ESS present a very useful step to that end, even in a context where the number of items is limited.

As has been argued by many, greater consistency in measurement of well-being is also needed [ 26 ]. This may come in the form of more consistency regarding dimensions included, the way items are scored, the number of items representing each dimension, and changes in items over time. While inconsistency may be prevalent in the literature to date for definitions and measurement, the significant number of converging findings indicates increasingly robust insights for well-being relevant to scientists and policymakers. Improvements to this end would support more systematic study of (and interventions for) population well-being, even in cases where data collection may be limited to a small number of items.

The added value of MPWB as a composite measure

While there are many published arguments (which we echo) that measures of well-being must go beyond objective features, particularly related to economic indicators such as GDP, this is not to say one replaces the other. More practically, subjective and objective approaches will covary to some degree but remain largely distinct. For example, GDP presents a useful composite of a substantial number of dimensions, such as consumption, imports, exports, specific market outcomes, and incomes. If measurement is restricted to a macro-level indicator such as GDP, we cannot be confident in selecting appropriate policies to implement. Policies are most effective when they target a specific component (of GDP, in this instance), and then are directly evaluated in terms of changes in that component. The composite can then be useful for comprehensive understanding of change over time and variation in circumstances. Specific dimensions are necessary for identifying strengths and weaknesses to guide policy, and examining direct impacts on those dimensions. In this way, a composite measure in the form of MPWB for aggregate well-being is also useful, so long as the individual dimensions are used in the development and evaluation of policies. Similar arguments for other multidimensional constructs have been made recently, such as national indexes of ageing [ 7 ].

In the specific instance of MPWB in relation to existing measures of well-being, there are several critical reasons to ensure a robust approach to measurement through systematic validation of psychometric properties. The first is that these measures are already part of the ESS, meaning they are being used to study a very large sample across a number of social challenges and not specifically a new measure for well-being. The ESS has a significant influence on policy discussions, which means the best approaches to utilizing the data are critical to present systematically, as we have attempted to do here. This approach goes beyond existing measures such as Gallup or the World Happiness Index to broadly cover psychological well-being, not individual features such as happiness or life satisfaction (though we reiterate: as we demonstrate in Fig.  7 a and b, these individual measures can and should still covary broadly with any multidimensional measure of well-being, even if not useful for predicting all dimensions). While often referred to as ‘comprehensive’ measurement, this merely describes a broad range of dimensions, though more items for each dimension – and potentially more dimensions – would certainly be preferable in an ideal scenario.

These dimensions were identified following extensive study for flourishing measures by Huppert & So [ 27 ], meaning they are not simply a mix of dimensions, but established systematically as the key features of well-being (the opposite of ill-being). Furthermore, the development of the items is in line with widely validated and practiced measures for the identification of illness. The primary adjustment has simply been the emphasis on health, but otherwise maintains the same principles of assessment. Therefore, the overall approach offers greater value than assessing only negative features and inferring absence equates to opposite (positives), or that individual measures such as happiness can sufficiently represent a multidimensional construct like well-being. Collectively, we feel the approach presented in this work is therefore a preferable method for assessing well-being, particularly on a population level, and similar approaches should replace single items used in isolation.

While the focus of this paper is on the utilization of a widely tested measure (in terms of geographic spread) that provides for assessing population well-being, it is important to provide a specific application for why this is relevant in a policy context. Additionally, because the ESS itself is a widely-recognized source of meaningful information for policymakers, providing a robust and comprehensive exploration of the data is necessary. As the well-being module was not collected in recent rounds, these insights provide clear reasoning and applications for bringing them back in the near future.

More specifically, it is critical that this approach be seen as advantageous both in using the composite measure for identifying major patterns within and between populations, and for systematically unpacking individual dimensions. Using those dimensions produces nuanced insights as well as the possibility of illuminating policy priorities for intervention.

In line with this, we argue that no composite measure can be useful for developing, implementing, or evaluating policy if individual dimensions are not disaggregated. We are not arguing that MPWB as a single composite score, nor the additional measures used in ESS, is better than other existing single composite scoring measures of well-being. Our primary argument is instead that MPWB is constructed and analyzed specifically for the purpose of having a robust measure suitable for disaggregating critical dimensions of well-being. Without such disaggregation, single composite measures are of limited use. In other words, construct a composite and target the components.

Well-being is perhaps the most critical outcome measure of policies. Each individual dimension of well-being as measured in this study represents a component linked to important areas of life, such as physical health, financial choice, and academic performance [ 26 ]. For such significant datasets as the European Social Survey, the use of the single score based on the ten dimensions included in multidimensional psychological well-being gives the ability to present national patterns and major demographic categories as well as to explore specific dimensions within specific groups. This offers a robust approach for policy purposes, on both macro and micro levels. This facilitates the implementation and evaluation of interventions aimed at directly improving outcomes in terms of population well-being.

Availability of data and materials

The datasets analysed during the current study are available in the European Social Survey repository, http://www.europeansocialsurvey.org/data/country_index.html

Abbreviations

Diagnostic and Statistical Manual of Mental Disorders

European Social Survey

Gross Domestic Product

International Classification of Disease

Multidimensional psychological well-being

Adler NE, Rehkopf DH. US disparities in health: descriptions, causes, and mechanisms. Annu Rev Public Health. 2008;29:235–52.

PubMed   Google Scholar  

Allin P, Hand DJ. New statistics for old?—measuring the wellbeing of the UK. J Royal Stat Soc Ser A. 2017;180(1):3–43.

Google Scholar  

Arechavala NS, Espina PZ, Trapero BP. The economic crisis and its effects on the quality of life in the European Union. Soc Indic Res. 2015;120(2):323–43.

Biswas-Diener R, Vittersø J, Diener E. The Danish effect: beginning to explain high well-being in Denmark. Soc Indic Res. 2010;97(2):229–46.

Blanchflower DG, Oswald AJ. Is well-being U-shaped over the life cycle? Soc Sci Med. 2008;66(8):1733–49.

Carreira H, Williams R, Strongman H, Bhaskaran K. Identification of mental health and quality of life outcomes in primary care databases in the UK: a systematic review. BMJ Open. 2019;9(7):e029227.

PubMed   PubMed Central   Google Scholar  

Chen C, Goldman DP, Zissimopoulos J, Rowe JW. Multidimensional comparison of countries’ adaptation to societal aging. Proc Natl Acad Sci. 2018;115(37):9169–74.

CAS   PubMed   PubMed Central   Google Scholar  

Cieciuch J, Davidov E, Schmidt P, Algesheimer R, Schwartz SH. Comparing results of exact vs. an approximate (Bayesian) measurement invariance test: a cross-country illustration with a scale to measure 19 human values. Front Psychol. 2014;8(5):982.

Deaton A. Income, health and wellbeing around the world: evidence from the Gallup world poll. J Econ Perspect. 2008;22(2):53–72.

Diener E. New findings and future directions for subjective well-being research. Am Psychol. 2012;67(8):590.

Diener E, Wirtz D, Tov W, Kim-Prieto C, Choi D, Oishi S, Biswas-Diener R. New measures of well-being: flourishing and positive and negative feelings. Soc Indic Res. 2009;39:247–66.

Diener E, Seligman ME. Beyond money toward an economy of well-being. Psychol Sci Public Interest. 2004;5(1):1–31.

Diener E, Pressman S, Hunter J, Chase D. If, why, and when subjective well-being influences health, and future needed research. Appl Psychol Health Well Being. 2017;9(2):133–67.

Dolan P, White MP. How can measures of subjective well-being be used to inform public policy? Perspect Psychol Sci. 2007;2(1):71–85.

Eastbrook R, Neale M. A comparison of factor score estimation methods in presence of missing data: reliability and an application to nicotine dependence. Multivar Behav Res. 2012;48(1):1–27.

Eid M, Krumm S, Koch T, Schulze J. Bifactor models for predicting criteria by general and specific factors: problems of Nonidentiability and alternative solutions. Journal of Intelligence. 2018;6(3):42.

European Social Survey (2014). Weighting European Social Survey Data. Retrieved from https://www.europeansocialsurvey.org/docs/methodology/ESS_weighting_data_1.pdf .

Farver-Vestergaard I, Ruggeri K. Setting National Policy Agendas in Light of the Denmark Results for Well-being. JAMA Psychiatry. 2017;74(8):773–4.

Ferrando PJ, Lorenzo-Seva U. A note on improving EAP trait estimation in oblique factor-analytic and item response theory models. Psicologica. 2016;37(2):235–47.

Gerstorf D, Hoppmann CA, Löckenhoff CE, Infurna FJ, Schupp J, Wagner GG, Ram N. Terminal decline in well-being: the role of social orientation. Psychol Aging. 2016;31(2):149.

Grundke, R., et al. Skills and global value chains: A characterisation, OECD Science, Technology and Industry Working Papers, No. 2017/05, OECD Publishing. 2017. https://doi.org/10.1787/cdb5de9b-en .

Gudmundsdottir DG. The impact of economic crisis on happiness. Soc Indic Res. 2013;110(3):1083–101.

Huppert FA. Psychological well-being: evidence regarding its causes and consequences†. Appl Psychol Health Well Being. 2009;1(2):137–64. https://doi.org/10.1111/j.1758-0854.2009.01008.x .

Article   Google Scholar  

Huppert FA. The state of well-being science: concepts, measures, interventions and policies. In: Huppert FA, Cooper CL, editors. Interventions and policies to enhance well-being. Oxford: Wiley-Blackwell; 2014.

Huppert FA, Marks N, Clark A, Siegrist J, Stutzer A, Vitterso J, Wahrendorf M. Measuring well-being across Europe: description of the ESS well-being module and preliminary findings. Soc Indic Res. 2009;91(3):301–15.

Huppert F, Ruggeri K. 15. Policy challenges: well-being as a priority in public mental health. In: Bhugra D, Bhui K, Wong S, Gilman S, editors. Oxford textbook of public mental health. Oxford: Oxford University Press; 2018.

Huppert FA, So TT. Flourishing across Europe: application of a new conceptual framework for defining well-being. Soc Indic Res. 2013;110(3):837–61.

Huppert FA, Whittington JE. Evidence for the independence of positive and negative well-being: implications for quality of life assessment. Br J Health Psychol. 2003;8(1):107–22.

Kahneman D, Krueger AB. Developments in the measurement of subjective well-being. J Econ Perspect. 2006;20(1):3–24.

Knapp M, McDaid D, Parsonage M. Mental health promotion and mental illness prevention: the economic case. London: London School of Economics; 2011.

Lihavainen K, Sipilä S, Rantanen T, Kauppinen M, Sulkava R, Hartikainen S. Effects of comprehensive geriatric assessment and targeted intervention on mobility in persons aged 75 years and over: a randomized controlled trial. Clin Rehabil. 2012;26(4):314–26.

McNeish, D., & Wolf, M. G. (2019). Sum Scores Are Factor Scores. https://doi.org/10.31234/osf.io/3wy47 .

Nicolaisen M, Thorsen K. Who are lonely? Loneliness in different age groups (18–81 years old), using two measures of loneliness. Int J Aging Hum Dev. 2014;78(3):229–57.

Nicoletti, G., Scarpetta, S., & Boylaud, O. Summary indicators of product market regulation with an extension to employment protection legislation, OECD Economics Department Working Paper s , no. 226, OECD publishing, Paris. 2000. https://doi.org/10.1787/215182844604 .

Oberski D. Lavaan.Survey: an R package for complex survey analysis of structural equation models. J Stat Softw. 2014;57(1):1–27.

OECD. Education at a glance 2014: OECD indicators. Portugal. Retrieved on January 28, 2016 at http://bit.ly/2wqZweh . 2014.

Oishi S, Diener E, Lucas RE. The optimum level of well-being: can people be too happy? Perspect Psychol Sci. 2007;2(4):346–60.

Reibling N, Beckfield J, Huijts T, Schmidt-Catran A, Thomson KH, Wendt C. Depressed during the depression: has the economic crisis affected mental health inequalities in Europe? Findings from the European social survey (2014) special module on the determinants of health. Eur J Public Health. 2017;27:47–54.

Richards M, Huppert FA. Do positive children become positive adults? Evidence from a longitudinal birth cohort study. J Posit Psychol. 2011;6(1):75–87.

Roseel Y. Lavaan: an R package for structural equation modeling. J Stat Softw. 2012;48(2):1–36.

Ruggeri K, Garcia Garzon E, Maguire Á, Huppert F. Chapter 1: comprehensive psychological well-being. In: Looking through the wellbeing kaleidoscope: Results from the European Social Survey. London: New Economics Foundation; 2016.

Steptoe A, Deaton A, Stone AA. Subjective wellbeing, health, and ageing. Lancet. 2015;385(9968):640–8.

Steptoe A, Shankar A, Demakakos P, Wardle J. Social isolation, loneliness, and all-cause mortality in older men and women. Proc Natl Acad Sci. 2013;110(15):5797–801.

Tennant R, Hiller L, Fishwick R, Platt S, Joseph S, Weich S, et al. The Warwick-Edinburgh mental well-being scale (WEMWBS): development and UK validation. Health Qual Life Outcomes. 2007;5(1):63.

World Health Organization. The world health report 2001: mental health: new understanding, new hope. Geneva: World Health Organization; 2001.

Young C. Losing a job: the nonpecuniary cost of unemployment in the United States. Soc Forces. 2012;91(2):609–6.

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Acknowledgements

The authors would like to thank Ms. Sara Plakolm, Ms. Amel Benzerga, and Ms. Jill Hurson for assistance in proofing the final draft. We would also like to acknowledge the general involvement of the Centre for Comparative Social Surveys at City University, London, and the Centre for Wellbeing at the New Economics Foundation.

This work was supported by a grant from the UK Economic and Social Research Council (ES/LO14629/1). Additional support was also provided by the Isaac Newton Trust, Trinity College, University of Cambridge, and the UK Economic and Social Research Council (ES/P010962/1).

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KR is the lead author and researcher on the study, responsible for all materials start to finish. FH was responsible for the original grant award and the general theory involved in the measurement approaches. ÁM was responsible for broad analysis and writing. EGG was responsible for psychometric models and the original factor scoring approach, plus writing the supplementary explanations. SM provided input on later drafts of the manuscript as well as the auxiliary analyses. The authors read and approved the final manuscript.

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. Hierarchical approach to modelling comprehensive psychological well-being. Table S1 . Confirmatory Factor Structure for Round 6 and 3. Figure S2 . Well-being by country and gender. Figure S3 . Well-being by country and age. Figure S4 . Well-being by country and employment. Figure S5 . Well-being by country and education. Table S2 . Item loadings for Belgium to Great Britain. Table S3 . Item loadings for Ireland to Ukraine.

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Ruggeri, K., Garcia-Garzon, E., Maguire, Á. et al. Well-being is more than happiness and life satisfaction: a multidimensional analysis of 21 countries. Health Qual Life Outcomes 18 , 192 (2020). https://doi.org/10.1186/s12955-020-01423-y

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Psychological well-being as part of the public health debate? Insight into dimensions, interventions, and policy

• Claudia Trudel-Fitzgerald   ORCID: orcid.org/0000-0001-9989-4259 1 , 2 ,
• Rachel A. Millstein 3 , 4 ,
• Christiana von Hippel 1 , 5 ,
• Chanelle J. Howe 6 ,
• Linda Powers Tomasso 7 ,
• Gregory R. Wagner 7 &
• Tyler J. VanderWeele 8 , 9 , 10  

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Increasing evidence suggests that psychological well-being (PWB) is associated with lower disease and mortality risk, and may be enhanced with relatively low-cost interventions. Yet, dissemination of these interventions remains limited, in part because insufficient attention has been paid to distinct PWB dimensions, which may impact physical health outcomes differently.

This essay first reviews the empirical evidence regarding differential relationships between all-cause mortality and multiple dimensions of PWB (e.g., life purpose, mastery, positive affect, life satisfaction, optimism). Then, individual-level positive psychology interventions aimed at increasing PWB and tested in randomized-controlled trials are reviewed as these allow for easy implementation and potentially broad outreach to improve population well-being, in concert with efforts targeting other established social determinants of health.

Several PWB dimensions relate to mortality, with varying strength of evidence. Many of positive psychology trials indicate small-to-moderate improvements in PWB; rigorous institution-level interventions are comparatively few, but preliminary results suggest benefits as well. Examples of existing health policies geared towards the improvement of population well-being are also presented. Future avenues of well-being epidemiological and intervention research, as well as policy implications, are discussed.

Conclusions

Although research in the fields of behavioral and psychosomatic medicine, as well as health psychology have substantially contributed to the science of PWB, this body of work has been somewhat overlooked by the public health community. Yet, the growing interest in documenting well-being, in addition to examining its determinants and consequences at a population level may provoke a shift in perspective. To cultivate optimal well-being—mental, physical, social, and spiritual—consideration of a broader set of well-being measures, rigorous studies, and interventions that can be disseminated is critically needed.

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Over the past decades, evidence for the mental and physical health benefits of enhanced psychological well-being (PWB) has expanded dramatically [ 1 , 2 , 3 ]. Notably, research in the fields of behavioral and psychosomatic medicine, as well as health psychology have substantially contributed to this body of work [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Yet, such work is still overlooked by a considerable proportion of the public health community, despite accumulating compelling reasons for a paradigm shift [ 8 ]. Associations of PWB levels with subsequent physical health outcomes have been well-documented [ 1 , 2 ]. Easy-to-implement well-being interventions have been developed and evaluated in randomized-controlled trials (RCT), with many showing positive results [ 9 , 10 ]. The potential for developing scalable interventions to be broadly disseminated is substantial and, in many cases, could require only limited or no professional training resources [ 9 , 10 ]. Such interventions would improve not only PWB, but may have the potential to promote and maintain physical health as well [ 11 ]. This could be done in concert with efforts targeting other established social determinants of physical health/mortality (e.g., poverty, education, discrimination, social capital) [ 12 , 13 ]. Existing skepticism among scientists may be due to insufficient attention paid to distinct dimensions of PWB (e.g., positive affect, optimism), which could differentially impact physical health and explain certain conflicting findings [ 2 ]. If PWB’s importance is to be embraced by the public health community and incorporated into policies, these distinctions need to be made clear. In this debate article, we argue that PWB dimensions, including life purpose, personal growth, mastery, autonomy, ikigai, life satisfaction, positive affect, sense of coherence, and optimism, may relate differently to all-cause mortality, based on existing empirical evidence. We also discuss some available interventions promoting PWB and how these might be used and disseminated more broadly.

PWB is important not only because of its potential effects on physical health but also as its own end. The World Health Organization (WHO) defines health as a “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Importantly, PWB reflects more than the mere absence of psychological distress, such as anxiety or depressive symptoms. Although there is an inverse correlation between self-reported positive and negative psychological states, most coefficients vary from small-to-moderate, but are generally not strong in magnitude [ 14 , 15 , 16 ]. Psychological distress and well-being also have distinct biological correlates, further supporting the idea that they are separate rather than mirrored constructs [ 15 , 17 , 18 , 19 ]. Accordingly, a successful psychotherapeutic or pharmacological treatment of anxiety symptoms will decrease symptoms of psychological distress but will not necessarily translate into a greater sense of purpose in life, autonomy, or optimism.

If we are to take seriously the WHO’s integrative conceptualization of health, PWB should be embraced as a fundamental public health goal [ 8 ]. The adoption of policies and programs supporting PWB in individuals and groups requires an understanding of the potential community benefits of such efforts. Through our assessment of the research investigating the relationship between PWB and all-cause mortality, interventions to change PWB, and policy implications of well-being research, we aim to contribute to this understanding.

Defining well-being

Well-being is a complex and multifactorial construct. Measures of well-being are sometimes divided into objective measures, which mostly refer to “standard of living,” and subjective measures, which capture psychological, social, and spiritual aspects and are based on cognitive and affective judgements individuals make about their lives [ 20 ]. When these measures concern psychological aspects (e.g., happiness), they are often referred to as measures of psychological well-being (PWB). While certain PWB dimensions such as life satisfaction are often imbedded in “quality of life” measures, this latter multidimensional construct is much broader and includes other aspects related to mental and physical health like perceived stress, functioning/disability status, and physical symptoms [ 21 , 22 ]. PWB on its own has been a central area of research in psychology for decades [ 7 ]. It is also important to epidemiology, to understand its contribution to health outcomes [ 8 ], and more broadly to public health, notably to implement country-level monitoring and policies promoting overall health [ 7 ].

Distinct theoretical dimensions have been proposed to characterize PWB research thus far (see [ 1 ] for details) including: hedonic well-being (e.g., feeling happy), evaluative well-being (e.g. being satisfied with life), eudaimonic well-being (e.g., finding purpose in life, having a sense of mastery and autonomy in one’s own decisions), and other constructs that contribute to feeling whole or well (e.g., optimism). In the following section, we describe these PWB dimensions and illustrate their potential effects on physical health by examining the evidence on how each is associated with all-cause mortality. Even though composite PWB measures exist, some authors have shown that it remains difficult to measure PWB across a continuum (unidimensionally) [ 23 ] and others have insisted on understanding PWB as a multidimensional, rather than unidimensional, construct [ 24 ]. Moreover, research has documented statistically significant associations among PWB dimensions themselves, with magnitude of estimates varying from small to moderate when evaluated among adults from various countries [ 14 , 25 , 26 , 27 , 28 ]. Overall, these findings suggest that although PWB dimensions may share a latent factor, they do represent distinct constructs.

Psychological well-being and mortality

A growing body of evidence suggests that various PWB dimensions are associated with subsequent chronic diseases and mortality, and potential mechanisms explaining associations, including stress-buffering effects [ 1 , 2 ] and healthier behaviors [ 1 , 2 , 5 , 29 ]. For instance, prior epidemiological research has shown that individuals experiencing higher levels of optimism were more likely to subsequently engage in favorable habits (e.g., physical activity), reduce/cease detrimental ones (e.g., smoking), leading to an overall healthy lifestyle [ 30 , 31 , 32 , 33 ]; in turn, the adoption of such healthy habits may lower one’s risk of chronic diseases and mortality [ 1 , 2 ]. However, it is not always clear whether these longitudinal relationships remain after rigorous confounder control, whereby a third factor, such as socioeconomic status (e.g., education, personal income), influences both PWB and health. Likewise, whether these longitudinal associations do not simply capture reverse causation, whereby health status drives PWB levels, is sometimes uncertain. However, considering premature mortality risk, an objective endpoint, offers some methodological strengths such as virtually no misclassification and research based on longitudinal design by nature of the outcome. Recent meta-analyses have suggested that life satisfaction, positive affect, meaning/purpose in life, and optimism are protective against premature mortality [ 34 , 35 , 36 ], though the quality of statistical adjustment for potential confounders in these studies was variable. Here, we briefly discuss evidence as to whether and how various PWB dimensions are prospectively associated with premature all-cause mortality, specifically. Searches of literature written in English or French within PubMed and PsycInfo databases targeted individual prospective and longitudinal studies evaluating the role of at least one PWB dimension with mortality risk. Additional studies were obtained through bibliographies of eligible articles. Rigorous individual studies included in this narrative review all adjusted for baseline sociodemographics (e.g., age, sex, education), medical status (e.g., blood pressure, body mass index, chronic conditions), and health behaviors (e.g., smoking, physical activity). Some studies further adjusted for psychological distress, to determine PWB’s role on mortality beyond anxiety and depression symptoms, and for self-rated health.

• Purpose in life

Experiencing a sense of purpose and direction in one’s life has been consistently associated with reduced mortality. For instance, among 1236 older U.S. adults (mean age = 78 years), every standard deviation (SD) increase in life purpose was associated with 40% decreased hazard of 5-year mortality (hazard ratio, HR = 0.60; 95% confidence interval, CI = 0.42–0.87) [ 37 ]. In the Women’s Health Initiative cohort, after additional statistical control for psychological distress in multivariable models, greater life purpose was associated with lower likelihood of death over a 2-year period in 7675 older U.S. women [ 38 ]. Meta-analyses suggested similar effects (higher versus lower purpose in life; rate ratio, RR = 0.83, CI = 0.75–0.91) [ 35 ]. Some research has examined the role of meaning in life but the results are less convincing than those assessing purpose. A study of 1361 older U.S. adults (mean age = 79 years) over 5 years found no relationship of meaning in life with overall mortality (OR = 0.97; CI = 0.93–1.01) in multivariable models further adjusting for self-rated health [ 39 ]. These results raise the question of whether “meaning” and “purpose,” often used interchangeably, might capture distinct constructs that relate differently to mortality [ 40 ].

Personal growth

To our knowledge, personal growth –that is whether individuals seek to realize their full potential and recognize that the self is constantly developing– has been explored in relation to mortality in only a handful of studies. Notably, in the Women’s Health Initiative investigation described above, personal growth levels were associated with lower 2-year mortality rates, both continuously (per 1-unit increase: HR = 0.95; CI = 0.93–0.98) and categorically (lower versus higher [reference group] quartile: OR = 2.10, CI = 1.42–3.08) [ 38 ]. This study also evaluated life purpose, with contrasting multivariable-adjusted estimates suggesting stronger associations with life purpose than personal growth (ORs = 3.55 versus 2.10) on mortality.

Mastery –whether individuals effectively manage their environments or perceive life as being under their control– has also been well-studied in relation to mortality. An investigation following 2829 Dutch adults (ages 55–85) for up to 3 years found that a 1-unit rise was associated with lower mortality odds (OR = 0.94, CI = 0.89–0.99), even after extensive adjustment of covariates including self-rated health, social support, self-efficacy, and self-esteem [ 41 ]. Likewise, among English adults from the EPIC-Norfolk Study ( N  = 20,495; ages 41–80), every 1-SD increase in mastery was associated with a lower rate of death (RR = 0.82, CI = 0.76–0.89) over 5 years, further controlling for psychological distress [ 42 ]. Similar results were obtained in U.S. samples too [ 43 ].

Although research is sparse, available evidence suggests mortality risk is not strongly associated with autonomy, characterized as the extent to which individuals act independently without concern for external pressures. In a study of 9420 midlife British adults (mean age = 58 years) over a 5-year period, autonomy scores were unrelated to the hazard of death in multivariable models also controlling for self-rated health and psychological distress (per 1-unit increase: HR = 1.02; CI = 0.96–1.09) [ 44 ].

This Japanese term translates into the happiness, worth, and benefit of being alive. It captures not only eudaimonic well-being (e.g., life purpose) but also hedonic well-being (e.g., pleasure), though usually assessed with only one item. Using data from the nationwide Japan Collaborative Cohort Study for Evaluation of Cancer Risk ( N  = 73,272; ages 40–79), adults with higher (versus lower) levels of ikigai had a reduced hazard of mortality over 5 years (HR men  = 0.80; CI = 0.72–0.89; HR women  = 0.80; CI = 0.69–0.92) [ 45 ]. In another Japanese cohort ( N  = 43,391; ages 40–79), lower and moderate ikigai levels (versus higher) were related to an increased 7-year hazard of death (HR moderate  = 1.1; CI = 1.0–1.2; HR lower  = 1.5; CI = 1.3–1.7), with further adjustment for self-rated health not altering these results [ 46 ].

• Positive affect

Feeling happy, joyful, cheerful, excited and proud are often included in the construct of positive affect. Data from the German Aging Survey ( N  = 3124; ages 40–85) showed that every unit increase in positive affect was associated with a lower 14-year mortality risk, after adjusting for sociodemographics, medical status, psychological distress, and also life satisfaction (HR = 0.81, CI = 0.70–0.93), though further controlling for self-rated health and physical activity attenuated the association (HR = 0.88, CI = 0.76–1.02) [ 47 ]. Even if happiness is a pleasurable feeling that is sometimes included in positive affect, it has also been studied on its own in prior PWB-mortality research. In a subset of the Million Women Study ( N  = 719,617; ages 53–72), English women who said they were “unhappy” or “usually happy” on a 1-item measure did not differ in mortality risk in 10-year follow-up compared to those who said they were “happy most of the time” (RR = 0.98, CI = 0.94–1.01; RR = 0.99, CI = 0.96–1.01, respectively) [ 48 ]. While this study has drawn media attention because of its large sample size and control for multiple covariates, its conclusions based on the use of a single happiness item have also has generated some controversy. Likewise, another study of older adults found no association between happiness assessed with 2 items and mortality [ 49 ]. These results may suggest that the comprehensive experience of various types of positive affect, rather than the sole experience of feeling happy as captured by single items, is what matters in terms of longevity.

• Life satisfaction

Life satisfaction can be measured either globally, capturing the extent to which individuals judge their life as a whole to be satisfactory, or specifically by life domains (e.g., work, family). A Canadian population-based study ( N  = 73,904; ages 18 to > 80) revealed that “very dissatisfied” (versus “very satisfied or satisfied”) individuals had an increased mortality risk (HR = 1.70, CI = 1.16–2.51), after controlling for numerous relevant covariates [ 50 ]. In the German Aging Survey described above, mortality risk was reduced for each unit increase in life satisfaction after adjusting for sociodemographics, medical status, psychological distress and also positive affect (HR = 0.89, CI = 0.79–1.00), but became unrelated after additional controlling for self-rated health and physical activity [ 47 ]. Although the estimate appears stronger with positive affect than life satisfaction in this study, even after including both in statistical models, these dimensions were assessed with distinct scales and scores were not standardized, which precludes formal comparison.

Sense of coherence

One of the most rigorous early studies evaluating sense of coherence’s role in mortality risk has been conducted in the EPIC-Norfolk Study data ( N  = 16,668; ages 41–80) [ 51 ]. Sense of coherence was captured by the sum of 3 items measuring, respectively, the level of manageability, comprehensibility, and meaningfulness in one’s life. Adults with higher (versus lower) sense of coherence had a reduced risk of 6-year mortality (RR = 0.76, CI = 0.64–0.90), after statistical control for multiple covariates including psychological distress. These results have been replicated in a recent study of 585 men who were followed for 22 years and completed a more comprehensive assessment of the three constructs above [ 52 ]. Yet, it remains unclear whether any protective effects on mortality risk should instead be attributed to other PWB constructs captured by this scale. Notably, the meaningfulness item (“ Do you usually feel that your daily life is a source of personal satisfaction ?”) might relate to lower mortality risk because it captures, in fact, life satisfaction.

Multiple investigations indicate that dispositional optimism—a person’s general expectation that the future will turn out well or that good things will happen in the future—is associated with lower mortality rates. The Women’s Health Initiative ( N  = 97,253; ages 50–79) showed that higher versus lower quartiles of optimism were related to a reduced hazard of mortality over 8 years (HR = 0.86, CI = 0.79–0.93), after adding psychological distress to multivariable models [ 53 ]. Analyses conducted in another cohort of midlife U.S. women, the Nurses’ Health Study, replicated these results using the same research design [ 54 ]. Additionally, a Netherlands-based study among men and women ages 65–85 ( N  = 941) found a similar pattern over a 9-year period (HR higher versus lower quartiles  = 0.71; CI = 0.52–0.97), although results were not adjusted for psychological distress [ 55 ]. Altogether, these estimates are comparable to those reported by a recent meta-analysis (higher versus lower optimism; RR = 0.86; 95% CI, 0.80–0.92) [ 36 ].

Overall psychological well-being

Other authors have considered global measures of psychological well-being. For instance, in a subset of the Midlife in the United States Study ( N  = 3032; ages 25–74), scores on items assessing positive affect, life satisfaction, eudaimonic well-being and social well-being were combined to capture positive mental health—also labeled flourishing by the authors [ 56 ]. Multivariable findings indicated that lower versus higher flourishing levels were related to greater odds of 10-year mortality (OR = 1.62; CI = 1.00–2.62). While combining various components of PWB may form a stronger predictor of subsequent health [ 57 ], these composite scores also somewhat limit our understanding of the specific dimensions that matter and the recommendations for future interventions.

Overall, existing literature indicates that several PWB dimensions are associated with a reduced risk of premature all-cause mortality among the general population, with small to medium effects. These relationships were observed in studies with large sample sizes and over short to long follow-up periods. Associations were robust to adjustment for numerous covariates, including potential mechanisms that could explain associations (e.g., health behaviors); for some dimensions, associations were obtained despite the use of distinct PWB measures (e.g., optimism, sense of coherence). Among the dimensions reviewed, purpose in life, optimism, and ikigai , had the strongest evidence, followed by life satisfaction, positive affect, mastery, and sense of coherence. Available results with happiness, personal growth, and autonomy suggested no effect or were too limited to draw firm conclusions. Other PWB dimensions, including self-acceptance and emotional vitality, may have been investigated with all-cause mortality risk using prospective research designs, but studies using rigorous control for traditional medical and behavioral risk factors are scarce.

All studies reported above carefully controlled for sociodemographics, medical status, and health behaviors, and even after further adjustment for psychological distress, associations were generally evident, which further supports PWB as distinct from the absence of psychological distress. When more than one PWB dimension was investigated, however, very few authors evaluated their independent roles by including dimensions simultaneously in the models [ 47 ]. Thus, while these PWB factors appear conceptually distinct, it remains uncertain whether they independently reduce all-cause mortality and if so, the relative magnitude of their effects. When adjusting for self-rated health, some of the studies of certain domains, though not all, indicated null estimates. Self-rated health usually assesses, via one item, whether individuals perceive their health as excellent, very good, good, fair or poor, and is one of the strongest predictors of future morbidity and mortality risk [ 58 ]. However, controlling for self-rated health may sometimes be an overadjustment, because this rating is both defined and influenced by functional health, physical conditions, and most importantly, psychological distress and well-being [ 58 ]. Nevertheless, those PWB dimensions that are associated with lower mortality even after adjustment for self-rated health arguably manifest even stronger evidence for a causal relationship.

Psychological well-being and other outcomes

Although our narrative review focused on mortality, it is worth briefly noting that PWB may have important effects on numerous other outcomes. Observational and experimental research indicates that greater PWB levels are related to lower risk of cardiometabolic diseases, infectious illness and physical decline, though results with cancer are less clear [ 1 , 2 , 54 ]; PWB has also been related to more favorable health behaviors and healthier biological processes, which could act as mechanistic pathways relating PWB to chronic disease and mortality risk [ 1 , 2 , 29 , 33 ]. Observational and experimental research also suggests PWB relates to higher future levels of employment, income, and work retention, as well as greater social support later on [ 59 ]. Likewise, prospective observational studies show that low PWB levels, including dimensions like self-acceptance, autonomy, life purpose, positive relationships, and mastery, are associated with greater likelihood of clinical depression 10 years later, after controlling for baseline traditional risk factors and psychological distress [ 60 ]. PWB was predictive of post-treatment symptom severity and remission status, independent of initial symptoms of depression and anxiety, in a recent clinical trial evaluating the effectiveness of cognitive-behavioral therapy for anxiety disorders [ 61 ]. PWB is not simply the absence of mental illness, and, in fact, contributes to subsequently preventing its onset and relapse. Moreover, PWB is desired not primarily because of its effects on mental and physical health, but as an end itself [ 57 ]. Most people want to be happy, satisfied with their life, and pursue a life that has meaning. PWB is thus important in its own right.

• Interventions

Albeit approximately 30% of one’s PWB is explained by heritable/dispositional factors, it is clear that external life events and environmental influences can account for a large proportion of an individual’s PWB. For instance, it has been well documented that greater levels of PWB are associated with higher levels of education, income, occupational status, and social capital [ 3 , 7 , 62 , 63 ]. Intentional choices and behaviors, such as self-regulation and lifestyle habits, are also important determinants of PWB [ 5 , 63 ]. Positive psychology (PP) thus appears as a compelling intervention strategy, as it aims to improve the frequency and intensity of positive emotional experiences, including optimism, gratitude, purpose/satisfaction in life, and positive affect, through intentional actions in the form of targeted, structured activities [ 9 , 64 , 65 ]. While these interventions aim to improve PWB within individuals, individuals are not the sole responsible agent of such changes; in fact, leveraging community and institutional resources is also increasingly encouraged to promote all individuals’ PWB by making strategies accessible to diverse groups of the population. In this regard, various PP interventions have been evaluated and have shown to improve mood and well-being among different populations [ 7 , 9 , 10 , 65 ].

At the individual level, PP interventions are typically assigned, either separately or in combination, on a short-term regular basis (e.g., weekly) for participants to complete on their own, and then, in some cases, reviewed with a clinical or research professional to further elicit PWB [ 66 ]. Individual, group, and self-help interventions, including acts of kindness, counting blessings, and mindfulness, were first evaluated in non-clinical samples (e.g., community, students; examples in Table  1 with complete references in the Additional file 1 ) [ 9 , 63 , 64 ].

In an early meta-analysis of 49 randomized or quasi-experimental studies ( N  = 4235), such PP interventions improved well-being, with a small but clinically meaningful mean effect size ( r  = 0.29, CI = 0.21–0.37) [ 64 ]. A more recent meta-analysis of 39 RCTs ( N  = 6139) [ 9 ] showed a similar effect of PP interventions on PWB (Cohen’s d  = 0.20, CI = 0.09–0.30), with strongest effects for strategies targeting optimism, gratitude, and kindness [ 67 ], and with gains persisting for up to 6 months post-intervention ( d =  0.16, CI = 0.02–0.30). Comparable effects are observed among clinical populations. A meta-analysis of 30 studies ( N  = 1864) in participants with either a psychiatric disorder (e.g., depression, anxiety) or a somatic condition (e.g., cardiometabolic disease, cancer) indicated that PP interventions had a small but meaningful effect on PWB (Hedges’ g  = 0.24, CI = 0.13–0.35) [ 65 ]. Yet, it is still unclear whether longer-term health outcomes, including disease incidence and premature mortality, may be altered by improving PWB through these brief PP interventions, or if longer, more intensive interventions would be required [ 2 ].

Considering PP interventions at the institutional level is also critical. Because even changes of small magnitude at the individual level may translate into large changes at the population level, the potential benefits of such interventions on mental and physical health, including mortality risk, may be substantial. For instance, recent research has estimated a 5% decreased risk of stroke for individuals endorsing higher vs. lower levels of optimism, via optimism’ role on healthy lifestyle [ 33 ]. Such reduction in risk would indeed have major repercussions on a population’s health and economy .

In 2018, a public health summit of experts in mental and occupational health urged for building scientific evidence in the workplace that supports specific interventions aiming to improve and maintain employees’ health, including PWB [ 68 ]. Practices supporting, for instance, work-life balance and a physically/psychologically safe environment contributed to job satisfaction, independently of wages [ 20 , 68 ]. Because employees’ general sense of well-being, beyond job satisfaction, could contribute to productivity and profitability [ 20 , 68 ], broadly defined well-being interventions are increasingly evaluated in organizational settings. While the number of workplace-related RCTs is comparatively fewer, preliminary results are encouraging. A recent systematic review of RCTs and quasi-experimental studies indicated that PP interventions in the workplace were the only brief interventions to have a meaningful, albeit small, impact on employees’ mental health and well-being, whereas no evidence was found for strategies like relaxation and massage [ 69 ]. A subsequent RCT tested a 5-week online PP intervention adapted for the workplace among U.K. government employees (Table  2 ) [ 10 ]. Participants receiving the intervention ( n  = 170; vs. wait-list control group, n  = 160) reported enhanced levels of positive affect and flourishing ( p <  .05), but not life satisfaction, post-intervention [ 10 ], reinforcing further empirical attention to PWB facets separately.

Besides the workplace, institution-based RCTs have also been conducted in schools (examples in Table  2 with complete references in the Additional file 1 ). While most studies have evaluated multicomponent interventions, making it difficult to disentangle the contribution of specific strategies, beneficial effects on PWB and other psychosocial outcomes were often observed. Other interventions relying on cognitive-behavioral strategies, like the Penn Resiliency Program, have been successful in improving psychosocial outcomes, including PWB, in schools and other settings (e.g., U.S. Army, see details in [ 11 ]).

Policy implications

Over the past decade, governments from a dozen countries have also initiated regular well-being surveys as a component of public health data collection. Some countries evaluate hedonic PWB through a four-to-six domain questionnaire. Notably, in Bhutan, PWB is evaluated every few years with items like “ All things considered, how satisfied are you with your life as a whole these days? ”, along with other complimentary domains including social support, negative emotional experience, and spirituality. Likewise, the U.K. national survey includes a similar life satisfaction question, as well as items probing meaningful activities and positive/negative affect. Other national surveys use broader, culturally-relevant indices or objective well-being measures that capture infrastructure and services, environment and landscape factors, social relationships and even trust in government (e.g., Italy, Israel, Canada). International well-being surveys sometimes issue an annual “happiest country on Earth.” This judgment pleases not only the popular press, but also national governments that increasingly recognize that well-being measures can be a crude but reliable indicator of overall citizen satisfaction. Results from these surveys, after being reported to national assemblies, may also subsequently spur policy interventions. For example, the U.K. initiated the 24-h, free and confidential helpline, “Silver Line”, in 2013 in response to survey feedback of decreasing social connectedness among the aged [ 70 ]. Over 5 years, 2 million calls were received and over 70% reported that the helpline not only enhanced their social lives but also their happiness [ 70 ]; the U.K.’s first Minister of Loneliness was subsequently appointed in 2018.

Besides the importance of systematic monitoring of well-being indicators at the population level, implementing effective well-being policies is key to having a broader outreach in addition to individually tailored interventions. Notably, the Health-in-All-Policies (HiAP) approach, originating in South Australia, Europe, and Canada, has introduced a strategic way to better tackle social determinants of health, as documented in the 2010 Adelaide Statement [ 71 ]. This administrative process, more recently adapted by U.S. state and local governments, integrates health as a central outcome of all departments regardless of their functional oversight. Consequently, all sectors (e.g., employment, parks and recreation, housing administrations) become responsible for health-related interventions (e.g., facilitating access to greenness), rather than relying solely on public health policies [ 72 ]. For instance, better transport opportunities (e.g., cycling and walking paths) and reducing environmental degradation (e.g., pollution) may be ensured by leveraging a collaborative workforce as well as cross-cutting information and evaluation systems [ 71 ]. Such collaborative approaches can in turn enhance a population’s physical health more efficiently, via downstream consequences on common risk factors (e.g., obesity) and chronic conditions (e.g., cardiovascular diseases). HiAP could be improved by further integrating well-being science, including brief and relatively low-cost empirically-based PP interventions, into such municipal- and state-led strategies. Even though effects observed in individual-level RCTs are small in magnitude, such improvements in PWB could translate into notable changes at the population-level.

In parallel, policy strategies should address “the causes of the cause,” namely upstream social determinants that may drive PWB per se. As briefly mentioned previously, higher levels of education, income, occupational status, and social capital [ 3 , 7 , 62 , 63 ], to name a few, have been associated with enhanced levels of PWB. Coordinated government actions, notably via the HiAP approach, tackle such social determinants. For example, working towards educational attainment and employment stability across various sociodemographic groups would not only create engaged citizens and promote better physical health, but also potentially increase their PWB [ 71 ]. Additionally, anti-discrimination policies, including the Equal Employment Opportunity Act, have historically helped to minimize group-based disparities in the social determinants of mental and physical health [ 73 ]. Therefore, stronger enforcement of anti-discrimination policies might be another way to alter downstream PWB. Efforts to support families and opportunities for community participation could likely increase levels of PWB as well [ 8 , 57 ]. Lastly, because economic motives may act as a barrier to seeking mental health support, adequate reimbursement of psychotherapy services could also be implemented to enhance PWB [ 74 ].

Existing community initiatives might be disseminated across the country as well. Among others, the Office of Civic Wellbeing located in and supported by the city of Santa Monica, California, has launched the Wellbeing Project in 2013 [ 75 ]. This groundbreaking model for city governments uses the science of well-being to document community’s strengths and needs, along with the multiple determinants involved, to improve collective well-being. Moving from data to action, the Office has now various ongoing projects dealing with social determinants of PWB. One of them, in partnership with the Los Angeles County Department of Public Social Services, enrolls eligible Santa Monica residents for “CalFresh,” a public benefit program that supports individuals to meet their nutritional needs and improve healthy eating [ 75 ].

Limitations and future avenues

PWB has promising potential to improve mental and physical health, derived from epidemiological studies and clinical trials described above. Although the current review was comprehensive but non-systematic by nature, some limitations were evident and should guide future research and practice. Firstly, PWB-mortality associations have been rarely investigated across sociodemographic groups (i.e., by explicitly evaluating effect modification, beyond statistical adjustment), and many interventions have been restricted to clinical or convenience samples, mostly in high-income countries, which may not be generalizable to other populations. Yet, preliminary observational findings from these studies hint at effect modification by sex [ 34 , 45 ], race/ethnicity [ 53 ], educational attainment [ 43 ], as well as specific causes of death (e.g., cardiovascular versus cancer) [ 42 , 45 , 53 ]. As for age, insight about the role of PWB, as experienced during childhood or adolescence, in health would be informative from a lifecourse perspective. However, most epidemiological cohorts have not queried PWB indicators in early life, and studies in younger individuals do not have the required follow-up to evaluate PWB’s role in mortality.

With regard to lower-middle-income countries, a handful of studies have examined the interplay between mental and physical health. However, to our knowledge they either have not collected data on PWB indicators specifically to date (e.g., the Kenyan Grandparents Study) or did not yet investigate PWB’s role in mortality, most likely because they were initiated recently (e.g., the Brazilian Longitudinal Study of Aging, Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa). Besides country-level income, the role of other indicators of socioeconomic status (SES) in the PWB-mortality relationship specifically is less known. In fact, although most rigorous studies cited above have controlled for education level, fewer investigations have adjusted for individual/family income [ 38 , 44 , 53 ], occupation status/types [ 42 , 45 , 46 , 51 , 53 , 55 ], or area deprivation [ 48 ], and did not formally assess effect modification. Hence, it remains unclear as of now whether findings obtained from studies assessing the PWB-mortality association in high-income countries and adjusting for certain SES indicators may generalize to those of lower-middle-income countries and other socioeconomic groups.

Furthermore, rigorous methodologies should be favored (e.g., lagged analyses to address potential for reverse causation, repeated PWB measurements to capture changes, comprehensive set of covariates to account for confounding, simultaneous adjustment for multiple dimensions of PWB). In addition to improving methodological rigor, systematically incorporating well-being scales in large national cohort studies will help solidify the evidence of PWB’s causal role in health outcomes [ 8 ].

Of course, PWB measure selection depends on the context. For instance, for a multi-purpose epidemiological cohort study, with limited space on the questionnaires, or for studies in which PWB is investigated only as an outcome, a composite PWB measure might be sufficient. However, to advance science and be more precise, and consistent with the argument that PWB is a multidimensional rather than unidimensional construct detailed above, dimension-specific measures should be favored. To date, numerous large-scale studies have administered at least one PWB measure to their participants (e.g., Women’s Health Initiative cohort, Nurses’ Health Study, Midlife in the United States Study, Health and Retirement Study, Longitudinal Aging Study Amsterdam, EPIC-Norfolk Study, Japan Collaborative Cohort Study). Including additional PWB measures in these studies, to permit comparison across constructs, and expanding PWB assessments to other large national cohorts is warranted. Consequently, such evidence will guide the development of more targeted and efficient intervention, as well as primary/primordial prevention strategies. For instance, PP interventions implemented earlier in the lifecourse may have the potential to reduce adverse behaviors and detrimental biological processes over time, possibly lowering likelihood of chronic illness later in life.

Lastly, additional research exploring whether and how well-being strategies and policies can be implemented in communities will be needed to achieve a population-level impact. Notably, health professionals should assess the barriers and benefits of integrating PWB into standard clinical practices focused on deficits and disorders. Leveraging input from local agents who grasp the needs and characteristics of certain subgroups would facilitate the crafting and delivery of empirically-based PP interventions (e.g., teachers in targeted schools of low-SES neighborhoods). Eventually, public health policy-makers will have to evaluate the cost-effectiveness of implementing PP interventions in these distinct environments (e.g., medical settings, schools, neighborhoods) [ 76 ].

Existing research to date suggests that many, though not all, dimensions of psychological well-being (PWB) are associated with all-cause mortality. Building from the evidence of associations between PWB and mortality, this essay then discusses interventions to promote PWB. Many randomized-controlled trials evaluating positive psychology interventions at the individual level indicate small-to-moderate improvements in various PWB dimensions; rigorous institution-level interventions are comparatively few, but preliminary results suggest benefits as well. These interventions have the potential to be easily implemented and, in turn, have a broad outreach to improve population well-being. Existing health policies geared towards the improvement of population well-being could also leverage the science of PWB.

While this body of work has been overlooked by part of the public health community [ 8 , 11 ], the growing interest in documenting well-being, in addition to examining its determinants and consequences at a population level may provoke a shift in perspective. Over the past decade, numerous countries have initiated well-being assessment via national surveys, which have led to the implementation of some institutional policies geared towards PWB’s enhancement. However, there is at present no attempt at national measurement in the U.S.; it is perhaps time that this be changed. To cultivate optimal well-being—mental, physical, social, and spiritual—consideration of a broader set of well-being measures, rigorous studies, as well as public and private interventions is critically needed.

Availability of data and materials

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Abbreviations

Confidence interval

Health-in-All-Policies

Hazard ratio

Positive psychology

Psychological well-being

Randomized-controlled trial

Relative risk

Standard deviation

United Kingdom

United States

Boehm JK, Kubzansky LD. The heart's content: the association between positive psychological well-being and cardiovascular health. Psychol Bull. 2012;138(4):655–91.

Article   PubMed   Google Scholar  

Pressman SD, Jenkins BN, Moskowitz JT. Positive affect and health: what do we know and where next should we go? Annu rev Psychol; 2019.

Google Scholar  

Steptoe A. Happiness and health. Annu Rev Public Health. 2019;40:339–59.

Folkman S, Moskowitz JT. Positive affect and the other side of coping. Am Psychol. 2000;55(6):647–54.

Article   CAS   PubMed   Google Scholar  

Van Cappellen P, Rice EL, Catalino LI, Fredrickson BL. Positive affective processes underlie positive health behaviour change. Psychol Health. 2018;33(1):77–97.

Seligman ME, Csikszentmihalyi M. Positive psychology: an introduction. Am Psychol. 2000;55(1):5–14.

Kobau R, Seligman ME, Peterson C, Diener E, Zack MM, Chapman D, et al. Mental health promotion in public health: perspectives and strategies from positive psychology. Am J Public Health. 2011;101(8):e1–9.

Article   PubMed   PubMed Central   Google Scholar  

VanderWeele TJ, Chen Y, Long K, Kim ES, Trudel-Fitzgerald C, Kubzanksy LD. Positive Epidemiology? in press. https://doi.org/10.1097/EDE.0000000000001147 .

Bolier L, Haverman M, Westerhof GJ, Riper H, Smit F, Bohlmeijer E. Positive psychology interventions: a meta-analysis of randomized controlled studies. BMC Public Health. 2013;13:119.

Oliver JJ, MacLeod AK. Working adults' well-being: an online self-help goal-based intervention. J Occup Organ Psychol. 2018;91(3):665–80.

Kobau R, Sniezek J, Zack M, Lucas RE, Burns A. Well-being assessment: an evaluation of well-being scales for public health and population estimates of well-being among US adults. Appl Psychol Health Well Being. 2010;2(3):272–97.

Article   Google Scholar  

Marmot M, Wilkinson RG. In: Marmot M, Wilkinson RG, editors. Social determinants of health. United States: Oxford; 2005. 376 p.

Chapter   Google Scholar  

Berkman LF, Kawachi I, Glymour MM. Social Epidemiology. 2nd ed. New York: Oxford University Press; 2014.

Ryff CD, Keyes CL. The structure of psychological well-being revisited. J Pers Soc Psychol. 1995;69(4):719–27.

Ryff CD, Dienberg Love G, Urry HL, Muller D, Rosenkranz MA, Friedman EM, et al. Psychological well-being and ill-being: do they have distinct or mirrored biological correlates? Psychother Psychosom. 2006;75(2):85–95.

Baselmans BML, Willems YE, van Beijsterveldt CEM, Ligthart L, Willemsen G, Dolan CV, et al. Unraveling the genetic and environmental relationship between well-being and depressive symptoms throughout the lifespan. Front Psychiat. 2018;9:261.

Rector JL, Tay L, Wiese CW, Friedman EM. Relative sensitivity of cortisol indices to psychosocial and physical health factors. PLoS One. 2019;14(4):e0213513.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Cole SW, Levine ME, Arevalo JM, Ma J, Weir DR, Crimmins EM. Loneliness, eudaimonia, and the human conserved transcriptional response to adversity. Psychoneuroendocrinology. 2015;62:11–7.

Okbay A, Baselmans BM, De Neve JE, Turley P, Nivard MG, Fontana MA, et al. Genetic variants associated with subjective well-being, depressive symptoms, and neuroticism identified through genome-wide analyses. Nat Genet. 2016;48(6):624–33.

Schulte PA, Guerin RJ, Schill AL, Bhattacharya A, Cunningham TR, Pandalai SP, et al. Considerations for incorporating "well-being" in public policy for workers and workplaces. Am J Public Health. 2015;105(8):e31–44.

Centers for Disease Control and Prevention. Well-being concepts 2018 [Available from: https://www.cdc.gov/hrqol/wellbeing.htm#eight .

Salvador-Carulla L, Lucas R, Ayuso-Mateos JL, Miret M. Use of the terms “wellbeing” and “quality of life” in health sciences: a conceptual framework. Eur J Psychiat. 2014;28(1):50–65.

Abbott RA, Ploubidis GB, Huppert FA, Kuh D, Croudace TJ. An evaluation of the precision of measurement of Ryff's psychological well-being scales in a population sample. Soc Indic Res. 2010;97(3):357–73.

Linton MJ, Dieppe P, Medina-Lara A. Review of 99 self-report measures for assessing well-being in adults: exploring dimensions of well-being and developments over time. BMJ Open. 2016;6(7):e010641.

Hsu H, Hsu T, Lee K, Wolff L. Evaluating the construct validity of Ryff’s scales of psychological well-being using exploratory structural equation modeling. J Psychoeduc Assess. 2017;35(6):633–8.

Abbott RA, Ploubidis GB, Huppert FA, Kuh D, Wadsworth ME, Croudace TJ. Psychometric evaluation and predictive validity of Ryff's psychological well-being items in a UK birth cohort sample of women. Health Qual Life Outcomes. 2006;4:76.

Clarke PJ, Marshall VW, Ryff CD, Wheaton B. Measuring psychological well-being in the Canadian study of health and aging. Int Psychogeriatr. 2001;13(Supp 1):79–90.

Lucas RE, Diener E, Suh E. Discriminant validity of well-being measures. J Pers Soc Psychol. 1996;71(3):616–28.

Trudel-Fitzgerald C, Qureshi F, Appleton AA, Kubzansky LD. A healthy mix of emotions: underlying biological pathways linking emotions to physical health. Curr Opin Behav Sci. 2017;15:16–21.

Progovac AM, Chang YF, Chang CH, Matthews KA, Donohue JM, Scheier MF, et al. Are optimism and cynical hostility associated with smoking cessation in older women? Ann Behav Med. 2017;51(4):500–10.

Progovac AM, Donohue JM, Matthews KA, Chang CH, Habermann EB, Kuller LH, et al. Optimism predicts sustained vigorous physical activity in postmenopausal women. Prev Med Rep. 2017;8:286–93.

Giltay EJ, Geleijnse JM, Zitman FG, Buijsse B, Kromhout D. Lifestyle and dietary correlates of dispositional optimism in men: the Zutphen elderly study. J Psychosom Res. 2007;63(5):483–90.

Trudel-Fitzgerald C, James P, Kim ES, Zevon ES, Grodstein F, Kubzansky LD. Prospective associations of happiness and optimism with lifestyle over up to two decades. Prev Med. 2019;126:105754.

Martin-Maria N, Miret M, Caballero FF, Rico-Uribe LA, Steptoe A, Chatterji S, et al. The impact of subjective well-being on mortality: a meta-analysis of longitudinal studies in the general population. Psychosom Med. 2017;79(5):565–75.

Cohen R, Bavishi C, Rozanski A. Purpose in life and its relationship to all-cause mortality and cardiovascular events: a meta-analysis. Psychosom Med. 2016;78(2):122–33.

Rozanski A, Bavishi C, Kubzansky LD, Cohen R. Association of optimism with cardiovascular events and all-cause mortality: a systematic review and meta-analysis. JAMA Netw Open. 2019;2(9):e1912200.

Boyle PA, Barnes LL, Buchman AS, Bennett DA. Purpose in life is associated with mortality among community-dwelling older persons. Psychosom Med. 2009;71(5):574–9.

Zaslavsky O, Rillamas-Sun E, Woods NF, Cochrane BB, Stefanick ML, Tindle H, et al. Association of the selected dimensions of eudaimonic well-being with healthy survival to 85 years of age in older women. Int Psychogeriatr. 2014;26(12):2081–91.

Krause N. Meaning in life and mortality. J Gerontol. 2009;64(4):517–27.

Hanson JA, VanderWeele TJ. (upcoming, 2020). The Comprehensive Measure of Meaning: Psychological and philosophical foundations. In: M. Lee LDK and T.J. VanderWeele, editors. Measuring Well-Being: Interdisciplinary Perspectives from the Social Sciences and the Humanities. England: Oxford University Press; (upcoming, 2020).

Penninx BW, van Tilburg T, Kriegsman DM, Deeg DJ, Boeke AJ, van Eijk JT. Effects of social support and personal coping resources on mortality in older age: the longitudinal aging study Amsterdam. Am J Epidemiol. 1997;146(6):510–9.

Surtees PG, Wainwright NW, Luben R, Khaw KT, Day NE. Mastery, sense of coherence, and mortality: evidence of independent associations from the EPIC-Norfolk prospective cohort study. Health Psychol. 2006;25(1):102–10.

Turiano NA, Chapman BP, Agrigoroaei S, Infurna FJ, Lachman M. Perceived control reduces mortality risk at low, not high, education levels. Health Psychol. 2014;33(8):883–90.

Netuveli G, Pikhart H, Bobak M, Blane D. Generic quality of life predicts all-cause mortality in the short term: evidence from British household panel survey. J Epidemiol Community Health. 2012;66(10):962–6.

Tanno K, Sakata K, Ohsawa M, Onoda T, Itai K, Yaegashi Y, et al. Associations of ikigai as a positive psychological factor with all-cause mortality and cause-specific mortality among middle-aged and elderly Japanese people: findings from the Japan collaborative cohort study. J Psychosom Res. 2009;67(1):67–75.

Sone T, Nakaya N, Ohmori K, Shimazu T, Higashiguchi M, Kakizaki M, et al. Sense of life worth living (ikigai) and mortality in Japan: Ohsaki study. Psychosom Med. 2008;70(6):709–15.

Wiest M, Schuz B, Webster N, Wurm S. Subjective well-being and mortality revisited: differential effects of cognitive and emotional facets of well-being on mortality. Health Psychol. 2011;30(6):728–35.

Liu B, Floud S, Pirie K, Green J, Peto R, Beral V. Does happiness itself directly affect mortality? The prospective UK million women study. Lancet. 2016;387(10021):874–81.

Koopmans TA, Geleijnse JM, Zitman FG, Giltay EJ. Effects of happiness on all-cause mortality during 15 years of follow-up: the Arnhem elderly study. J Happiness Stud. 2010;11:113–24.

Rosella LC, Fu L, Buajitti E, Goel V. Death and chronic disease risk associated with poor life satisfaction: A population-based cohort study. Am J Epidemiol. 2019;188(2):323–31.

Article   PubMed Central   Google Scholar  

Surtees P, Wainwright N, Luben R, Khaw KT, Day N. Sense of coherence and mortality in men and women in the EPIC-Norfolk United Kingdom prospective cohort study. Am J Epidemiol. 2003;158(12):1202–9.

Geulayov G, Drory Y, Novikov I, Dankner R. Sense of coherence and 22-year all-cause mortality in adult men. J Psychosom Res. 2015;78(4):377–83.

Tindle HA, Chang YF, Kuller LH, Manson JE, Robinson JG, Rosal MC, et al. Optimism, cynical hostility, and incident coronary heart disease and mortality in the Women's Health Initiative. Circulation. 2009;120(8):656–62.

Kim ES, Hagan KA, Grodstein F, DeMeo DL, De Vivo I, Kubzansky LD. Optimism and cause-specific mortality: a prospective cohort study. Am J Epidemiol. 2017;185(1):21–9.

Giltay EJ, Geleijnse JM, Zitman FG, Hoekstra T, Schouten EG. Dispositional optimism and all-cause and cardiovascular mortality in a prospective cohort of elderly dutch men and women. Arch Gen Psychiatry. 2004;61(11):1126–35.

Keyes CL, Simoes EJ. To flourish or not: positive mental health and all-cause mortality. Am J Public Health. 2012;102(11):2164–72.

VanderWeele TJ. On the promotion of human flourishing. Proc Natl Acad Sci U S A. 2017;114(31):8148–56.

Jylha M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med (1982). 2009;69(3):307–16.

Lyubomirsky S, King L, Diener E. The benefits of frequent positive affect: does happiness lead to success? Psychol Bull. 2005;131(6):803–55.

Wood AM, Joseph S. The absence of positive psychological (eudemonic) well-being as a risk factor for depression: a ten year cohort study. J Affect Disord. 2010;122(3):213–7.

Teismann T, Brailovskaia J, Totzeck C, Wannemuller A, Margraf J. Predictors of remission from panic disorder, agoraphobia and specific phobia in outpatients receiving exposure therapy: the importance of positive mental health. Behav Res Ther. 2018;108:40–4.

Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et al. The lancet commission on global mental health and sustainable development. Lancet. 2018;392(10157):1553–98.

Kubzansky LD, Huffman JC, Boehm JK, Hernandez R, Kim ES, Koga HK, et al. Positive psychological well-being and cardiovascular disease: JACC health promotion series. J Am Coll Cardiol. 2018;72(12):1382–96.

Sin NL, Lyubomirsky S. Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis. J Clin Psychol. 2009;65(5):467–87.

Chakhssi F, Kraiss JT, Sommers-Spijkerman M, Bohlmeijer ET. The effect of positive psychology interventions on well-being and distress in clinical samples with psychiatric or somatic disorders: a systematic review and meta-analysis. BMC Psychiat. 2018;18(1):211.

Huffman JC, Millstein RA, Mastromauro CA, Moore SV, Celano CM, Bedoya CA, et al. A positive psychology intervention for patients with an acute coronary syndrome: treatment development and proof-of-concept trial. J Happiness Stud. 2016;17(5):1985–2006.

Gorlin EI, Lee J, Otto MW. A topographical map approach to representing treatment efficacy: a focus on positive psychology interventions. Cogn Behav Ther. 2018;47(1):34–42.

Goetzel RZ, Roemer EC, Holingue C, Fallin MD, McCleary K, Eaton W, et al. Mental health in the workplace: a call to action proceedings from the mental health in the workplace - public health summit. J Occup Environ Med. 2018;60(4):322–30.

Ivandic I, Freeman A, Birner U, Nowak D, Sabariego C. A systematic review of brief mental health and well-being interventions in organizational settings. Scand J Work Environ Health. 2017;43(2):99–108.

The Silver Line: helpline for older people. Annual report and financial statements. Calico Row: Trade Tower; 2018.

World Health Organization. Adelaide statement on health in all policies. Adelaide: Government of South Australia; 2010.

Baum F, Lawless A, Delany T, Macdougall C, Williams C, Broderick D, et al. Evaluation of Health in All Policies: concept, theory and application. Health Promotion Int. 2014;29(Suppl. 1):i130ei42.

Hahn RA, Truman BI, Williams DR. Civil rights as determinants of public health and racial and ethnic health equity: health care, education, employment, and housing in the United States. SSM Popul Health. 2018;4:17–24.

Lianov LS, Fredrickson BL, Barron C, Krishnaswami J, Wallace A. Positive psychology in lifestyle medicine and health care: strategies for implementation. Am J Lifestyle Med. 2019;13(5):480–6.

The Office of Civic Wellbeing. The Wellbeing Project. City of Santa Monica [Available from: https://wellbeing.smgov.net/ .

Diener E, Seligman MEP. Beyond money: Progress on an economy of well-being. Perspect Psychol Sci. 2018;13(2):171–5.

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Acknowledgements

We thank Dr. Laura D. Kubzansky for prior discussions on this topic.

Funding: This work was supported by salary and training support from the Canadian Institute of Health Research and the Fonds de Recherche du Québec – Santé (postdoctoral fellowships) to CTF, the National Institutes of Health to RAM, CVH, and LPT (NHLBI grant K23 HL135277, NCI grant 3R25CA057711, and T32-ES007069, respectively), as well as the John Templeton Foundation (grant 61075) to TJV. These funding bodies were not involved in the design of the current study, nor the collection, analysis, or interpretation of data and in writing the current manuscript.

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Trudel-Fitzgerald, C., Millstein, R.A., von Hippel, C. et al. Psychological well-being as part of the public health debate? Insight into dimensions, interventions, and policy. BMC Public Health 19 , 1712 (2019). https://doi.org/10.1186/s12889-019-8029-x

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ORIGINAL RESEARCH article

The relationship between psychological well-being and autonomy in young people according to age.

• 1 Faculty of Education, Universidad Nacional de Educación a Distancia, Madrid, Spain
• 2 Faculty of Psychology, Universidad Santo Tomás, Bogotá, Colombia

Psychological well-being manifests itself in all aspects of human activity and is essential to understanding whether young people experience life satisfaction and whether, as they mature, well-being can be associated with different levels of personal autonomy. This quantitative study was developed within the framework of international research on young people’s autonomy in the transition to adulthood. Its main objectives were to analyze the relationship between psychological well-being and autonomy and examine potential variations between the two variables according to age. To this end, Ryff’s Psychological Well-Being Scale and the Transition to Adulthood Autonomy Scale (EDATVA) designed by Bernal et al., were used with a sample of 1,148 young people aged 16–21 from Madrid, Spain, and Bogotá, Colombia. The results show that almost all the dimensions on the Psychological Well-Being Scale correlate significantly and positively with the dimensions on the EDATVA scale. Specifically, moderate correlations were obtained between self-organization on the EDATVA scale and purpose in life ( r = 0.568; p = 0.01) and environmental mastery ( r = 0.447; p = 0.01) on the Psychological Well-Being Scale. In turn, autonomy on Ryff’s scale obtained the highest correlation ( r = 0.382; p = 0.01) with understanding context on the EDATVA scale. It was also found that the older 18–21 age group obtained higher scores than the younger 16–17 age group in all dimensions on both the EDATVA and the Psychological Well-Being Scale. Earlier studies endorse the results found in this research, especially the differences in the scores for both scales according to age groups. This opens avenues for future research to analyze the relationship between psychological well-being and autonomy as independent variables in other sectors of the population.

Introduction

Advances in positive psychology have given rise to heightened interest in psychological well-being across various disciplines ( Henn et al., 2016 ; Hides et al., 2016 ). This has led to the scientific literature taking an approach to the construct from two polarized perspectives. In the first one, psychological well-being is construed from a hedonic perspective, the result of an internal state that the individual experiences on a subjective temporal plane, associated with high levels of positive affect and life satisfaction ( Weiss et al., 2016 ; Opree et al., 2018 ). Consequently, it focuses on subjective experiences of well-being specifically relating to happiness, life satisfaction, and positive affect ( Henn et al., 2016 ). In contrast, in the second perspective, psychological well-being is construed from a eudemonic perspective as a process of self-realization through which individuals evolve over time. Subsequently, it is not associated with results but with capacities ( Díaz et al., 2015 ; Berzonsky and Cieciuch, 2016 ; Disabato et al., 2016 ; Urquijo et al., 2016 ).

In line with the second perspective, Ryff (2014 ; 2018 ; 2019 ) designed a series of indicators based on the theory of positive human functioning that are consistent with a eudemonic perspective on happiness. To this end, she configured a composite and multidimensional model, the Psychological Well-Being Scale, that has been used as the basis for this study, comprising self-acceptance , positive relations with others , autonomy , environmental mastery , personal growth , and purpose in life . These dimensions focus on the different capacities of individuals to regulate their own behavior, assume the demands of the context, develop individual potential by maintaining positive relations with others , accept their own limitations while maintaining a positive attitude, and establish meaning and direction in their own lives ( Keyes et al., 2002 ; Viejo et al., 2018 ; Gómez-López et al., 2019 ). In turn, these dimensions, and in particular environmental mastery , are closely related to the individual’s sense of autonomy and capacity for self-determination and independence ( Rosa-Rodríguez et al., 2015 ). As a result, these indicators are often referred to as “health assets” given that they affect young people’s physical and mental health and, ultimately, the development of their behavior ( Chen et al., 2019 ).

Moreover, it has been determined that sociodemographic correlates, such as age, are linked to psychological well-being in various ways. It has also been determined that psychological well-being is related to psychological constructs, such as life experiences, emotional intelligence, and personality traits, and that there is a significant positive correlation between level of education and psychological well-being—in reference to personal growth and purpose in life ( Bucchianeri et al., 2016 ; Henn et al., 2016 ; Butler-Barnes et al., 2017 ). In turn, Mayordomo et al. (2016) found a positive correlation between age and level of psychological well-being, which might be the result of successful adaptation to the social environment. In this regard, these authors specify that adaptability can be defined as the flexibility to choose how to govern one’s own behavior. In contrast, the progressive loss of psychological well-being could denote exposure to threats and challenges which the individual in question cannot resolve due to lack of adequate skills ( Bradshaw et al., 2013 ).

In the transition to adulthood, psychological well-being evolves to the extent to which the individual is capable of successfully interacting with their environment and assuming the vital challenges inherent to the different stages in life ( Vera-Villarroel et al., 2013 ; Bluth et al., 2017 ; Gómez-López et al., 2019 ). To this end, García-Moya et al. (2015) suggest that psychological well-being can be promoted through the generation of positive experiences in young people’s environments which help them perceive their purpose and direction in life and set their own goals. However, promoting psychological well-being requires identifying which variables interfere with or condition well-being.

In this context, autonomy is seen as one of the dimensions that constitute psychological well-being ( Ryff, 1989 ). Consequently, the interaction between both variables is often taken for granted, as autonomy is considered an integral construct of well-being that describes people’s positive functioning based on their ability to maintain their individuality in different contexts and situations. As a result, the study of autonomy has been approached from various disciplines, including psychoanalysis, philosophy, pedagogy, politics, psychology, and biology, inter alia . Importantly, all agree that autonomy is a complex concept in which different perspectives can be identified and grouped. One such group is the one that focuses on the study of an individual’s ability to make decisions or govern their actions according to their own criteria, which are independent from external influences ( Garberoglio et al., 2017 ). In a broad sense, this perspective emphasizes the development and construction of the criteria used by individuals to make decisions and act in consequence. Other perspectives on autonomy recognize the influence of different scenarios in which individuals construct decision-making processes. Similarly, some authors defend that within decision-making and the very construct of autonomy, the idea of interdependence between individuals takes on a leading role ( Álvarez, 2015 ; Seidl-De-Moura et al., 2017 ).

Personal autonomy as an integral part of quality of life has been studied as a process that develops throughout an individual’s lifetime. Thus, several studies in this respect show that the older a person is, the greater the degree of autonomy ( Barbosa and Wagner, 2015 ). In this regard, Campione-Barr et al. (2015) analyzed the effect of age on young people’s autonomy and the impact of siblings’ ordinal positions within the family. The authors conclude that both age and the organization of fraternal subsystems are important in the development of autonomy in individuals. In the same vein, Barbosa and Wagner (2015) found that higher levels of autonomy are found in groups of older young people. In this regard, it was determined that the desire for autonomy increases during adolescence regardless of gender ( Alonso-Stuyck and Aliaga, 2017 ). However, Mayordomo et al. (2016) conducted a study with more than 700 participants distributed in three different age groups—young people, adults, and older adults—which revealed that there were no significant differences in autonomy between adults and older adults on Ryff’s Psychological Well-Being Scale, although both groups scored higher than the group of young people.

These studies highlight the importance of research on young people’s autonomy which could lead to a better understanding of their life cycle development processes, as well as the ways in which they assume responsibility in life and for their own well-being ( Davies et al., 2015 ; Li and Hein, 2019 ). Taking into account the aforementioned literature, our study is based on the approach designed by Bernal Romero et al. (2020) , in which autonomy is considered as a wide-ranging, complex construct that involves the capacity to ask oneself questions, reflect on one’s life in relation to others, make interdependent decisions and assume the consequences, and organize oneself in relation to others and society. In consequence, Bernal Romero et al. (2019) designed a model, called the Transition to Adulthood Autonomy Scale (EDATVA), comprising four fundamental dimensions for understanding autonomy in young people: self-organization , understanding context , critical thinking , and sociopolitical engagement . This approach has been incorporated to this study with the aim of determining the potential relationships between young people’s psychological well-being and autonomy in their transition to adulthood.

Materials and Methods

Specific objectives.

This article presents selected partial results from research performed in Spain and Colombia as part of a wider study on the autonomy of young people and psychological well-being. The main objective of the study was to analyze the relationships between young people’s psychological well-being and autonomy. This responds to the hypothesis (H1) that there are statistically significant relationships between psychological well-being and autonomy for the sample participating in the study. The second objective was to examine the differences between psychological well-being and autonomy according to age by establishing two groups: young people under 18 and those 18 and over. This responds to the hypothesis (H2) that there are statistically significant differences in both the dimensions of psychological well-being and autonomy as a function of age, the assumption being that participants in the older age group will have higher scores.

For practical reasons and according to the nature of this descriptive study, a quantitative methodology and an ex post facto pre-experimental design were used.

Participants

The field work was performed from late 2018 to early 2019. An incidental non-probabilistic sampling was performed in which 1,148 young people aged 16–21 were selected ( M = 18.20; SD = 1.80). Of the total, 60.3% were female and 39.7% were male. The percentage of adolescents aged 16–17 was 39.7%, while those aged 18–21 at the time of the study represented 60.3%. The sample was divided into these two subgroups, given that the legal age is 18 in both countries. Most of the young people were Colombian (55.7%, from Bogotá), while the rest were Spanish (44.3%, from Madrid).

Most of the participants were studying in high schools and universities. Data were also collected from young people who were employed, as well as from participants who were under the tutelage of child protection services. As an exclusion criterion, it was decided not to include those individuals who had functional, physical, or mental difficulties that prevented them from participating in the study.

Two methods were used to perform the study. The first one, Ryff’s Psychological Well-Being Scale adapted in Spanish by Díaz et al. (2006) , is a multidimensional scale that assesses the factors that contribute to an individual’s psychological well-being. It has 39 items with responses from 1 (strongly disagree) to 6 (strongly agree) on a Likert-type assessment scale, with six dimensions corresponding to the positive attributes of psychological well-being established by Ryff (1989) . The first dimension is self-acceptance or fostering a positive attitude toward one’s self. This dimension presents six items (α = 0.83) and measures self-esteem and the awareness of one’s own strengths and weaknesses. The second is positive relations with others . This dimension also has six items (α = 0.81) and measures an individual’s ability to maintain trusting, stable, and intimate relationships. The third is autonomy , which has eight items (α = 0.73) that measure an individual’s capacity to maintain their individuality in different contexts and situations with determination, independence, and personal authority. The fourth is environmental mastery and has six items (α = 0.71); it explores whether individuals consider themselves to be efficient at managing and controlling their daily responsibilities. This dimension is intimately related to the locus of control, self-efficacy, and the capacity to generate favorable environments that enable the individual to satisfy their needs and desires. The fifth dimension is personal growth , which has seven items (α = 0.68) and examines an individual’s capacity to evolve, develop their potential, and continue to grow on the basis of positive learning. Finally, the sixth dimension is purpose in life which comprises six items (α = 0.83) and measures an individual’s positive psychological well-being by analyzing their capacity to set goals, establish objectives, maintain the level of motivation to achieve them, and give purpose to their life.

The second method, which was used to measure young people’s autonomy, is the Transition to Adulthood Autonomy Scale (hereinafter EDATVA) designed by Bernal Romero et al. (2020) . It has a total of 19 items composed of statements with responses on a Likert-type scale with four options (1 = strongly disagree and 4 = strongly agree). The items are grouped in four dimensions. The first dimension is self-organization , which comprises six items (α = 0.80) that examine whether young people successfully plan their time and the processes in which they participate. This capacity requires young people to make personal choices according to their priorities ( Lammers et al., 2016 ; Bernal Romero et al., 2019 ). The second dimension is understanding context , which has four items (α = 0.74) and explores young people’s interaction with their environment, which leads to them becoming more autonomous ( Reis et al., 2018 ). The third dimension is critical thinking , which has five items (α = 0.70) and aims to measure an individual’s competence in establishing their position and guaranteeing their interests in relation to different social situations that affect them and/or may interest them ( Van Petegem et al., 2015 ). Finally, the fourth dimension is sociopolitical engagement , which has four items (α = 0.77). This dimension measures young people’s commitment to the society they belong to, the processes of community participation, and the political rights of contemporary citizens ( Young, 2017 ). As a whole, the model obtained a Cronbach’s alpha of 0.84.

Procedure and Data Analysis

This study adheres to the Declaration of Helsinki (64th WMA, Brazil, October 2013) and was approved by the Human Research Ethics Committee of the universities involved in the research. The application of the models was systematic, and data were collected using a pencil and paper format mostly during school hours. Approval and informed consent were obtained from the participating centers, as well as the legal guardians and the participants themselves. Once the data had been collected, the responses were coded, arranged, and recorded in a computer database for subsequent statistical processing.

Descriptive statistics of the participants’ general characteristics were then calculated. Pearson’s correlation coefficient was also calculated for the study’s first objective, aimed at determining the relationship between the dimensions of the well-being scale and EDATVA for the sample as a whole. For the second objective, the assumptions of the statistical tests were verified using common procedures (e.g., Kolmogorov–Smirnov test, Shapiro–Wilk tests, Levene’s test, histograms, and Q-Q and P-P diagrams for normality). Mean difference analyses were performed for the two groups to determine potential differences according to age. The effect sizes were estimated using Cohen’s d . Non-parametric tests were used in those cases where assumptions of normality were not met, specifically the Mann–Whitney U test with the Bonferroni correction.

All statistical analyses were performed using the SPSS version 25.0 statistical package for Macintosh (IBM ® , SPSS ® , Statistics 25). The statistical significance level was set at <0.05.

The following are the results for the first objective, in which the relationships between the dimensions of the Psychological Well-Being Scale and EDATVA were analyzed. Table 1 shows the results of Pearson’s correlation coefficient for the different dimensions of the Psychological Well-Being Scale and EDATVA. Significant correlations with positive directionality were found between almost all dimensions on both scales. High correlations were obtained in self-organization on the EDATVA scale and purpose in life ( r = 0.568; p = 0.01) and environmental mastery ( r = 0.447; p = 0.01) on the Psychological Well-Being Scale. These results give rise to moderate correlations and show that the higher young people score in self-organization , the higher they score in purpose in life and environmental mastery .

Table 1. Correlation between autonomy and psychological wellbeing.

The dimension understanding context obtained the highest correlations with autonomy ( r = 382; p = 0.01) and personal growth ( r = 0.356; p = 0.01) on the Psychological Well-Being Scale.

Critical thinking obtained the highest correlations with personal growth ( r = 0.279; p = 0.01) and purpose in life ( r = 0.276; p = 0.01).

Sociopolitical engagement obtained the lowest overall correlations, while purpose in life obtained the highest ( r = 0.186; p = 0.01).

The overall results show that all the dimensions on the EDATVA scale correlate significantly with the dimensions on the Psychological Well-Being Scale. In this regard, self-organization obtained the highest total correlation ( r = 0.437; p = 0.01), followed by understanding context ( r = 0.426; p = 0.01). In turn, purpose in life obtained the highest correlation between the Psychological Well-Being Scale and EDATVA ( r = 0.466; p = 0.01), followed by environmental mastery ( r = 0.406; p = 0.01). Lastly, the total for both scales gave a result of 0.441 ( p = 0.01).

Comparison of Mean Values Between the Psychological Well-Being Scale and EDATVA According to Age

In order to determine the potential differences for each of the scales according to age, tests were performed to contrast central tendency scores.

The Psychological Well-Being Scale is represented in Table 2 , which shows the size of each group, mean values, and standard deviation. For both groups of young people, the highest average scores were found in autonomy and personal growth . Moreover, in all cases, the results show that those aged 18–21 obtained higher scores than those aged 16–17. However, the results of Student’s t -test show statistically significant differences in five of the six dimensions of psychological well-being and for the scale’s total score. No statistically significant differences were found in positive relations with others .

Table 2. Differences on the psychological well-being scale according to age.

In relation to EDATVA, Table 3 shows the size of each group, the mean values, the Mann–Whitney U statistic, the statistical classification and significance, and the effect size. In turn, the results show that the 18–21 group obtained the highest average scores in self-organization and critical thinking . For the under 18 group, the dimensions with the highest average scores were sociopolitical engagement and understanding context . Similarly, the effect of age on autonomy is also shown. As can be seen, the older group of young people obtained higher average scores. These differences are statistically significant in all dimensions except sociopolitical engagement .

Table 3. Differences in perceived autonomy according to age.

The results of our study confirmed the hypothesis (H1) that there are statistically significant relationships between the dimensions on the Psychological Well-Being Scale and the autonomy dimensions on the EDATVA scale. A significant positive correlation was identified between the total of the Ryff’s scale and the total of the EDATVA scale. We consider the relationship between the two scales to be highly significant, given that autonomy is only considered as one of the factors of psychological well-being and conceived as a multidimensional construct in other studies ( Panahi et al., 2013 ; Roslan et al., 2017 ; Gao and McLellan, 2018 ; Ryff, 2019 ). In our study, psychological well-being and autonomy are considered as two different constructs. In the Psychological Well-Being Scale, autonomy is construed as an individual’s capacity for self-regulation independent of others, whereas in EDATVA, it is conceived as a construct defined as a complex process of reflection and decision-making interdependent of others, constituting a relational construct ( Bernal Romero et al., 2020 ). This conceptual difference highlights the importance of establishing relationships between the two constructs, as in this study.

Earlier studies had already documented correlations between psychological well-being and autonomy, conceiving both concepts as independent processes. Thus, studies by Rivas et al. (2012) and Romero et al. (2013) correlated psychological well-being with perceived autonomy, taking into account two dimensions of the latter: choice and volitional intention. Both studies found that the greater the perceived autonomy, the greater the level of well-being, with the exception of the volitional dimension of autonomy. In turn, other studies also coincide with our study by determining that increased levels of autonomy are associated with higher levels of well-being ( Ratelle et al., 2013 ; Weiting, 2014 ; De Leersnyder and Kim, 2015 ).

In this study, we also found significant positive relationships between almost all the dimensions on the two scales. The correlations are higher between self-organization on the EDATVA scale and purpose in life and environmental mastery on the Psychological Well-Being Scale. This suggests that those individuals whose life goals and objectives are clearer and who are better able to control their environment according to their needs may also be better at organizing themselves to make better decisions, which gives them more autonomy ( Valle et al., 2011 ).

Interestingly, autonomy on the Psychological Wellness Scale presents three positive and significant correlations with the EDATVA dimensions: the highest correlations were obtained with understanding context . In this regard, the results suggest that the more younger people are concerned about their development and giving direction to their lives, the more they are able to defend their ideas and uphold their decisions. These findings are similar to those of other studies ( Morales and González, 2014 ; Rodríguez-Fernández et al., 2016 ; Valle et al., 2019 ).

Other results to be considered are that the lowest correlations in our study were found between all the dimensions on the Ryff’s scale and sociopolitical engagement on the EDATVA scale. This can be attributed to the fact that the Psychological Well-Being Scale focuses on intrasubjective aspects, while the EDATVA focuses on intersubjective aspects. Specifically, sociopolitical engagement involves a tendency to construct autonomy in relation to others, rather than to oneself. Thus, Arnett (2014) describes how young people are more focused on their processes of individuation, leaving aside the effects of their decisions on the context. In contrast, Valle et al. (2019) found that psychological well-being is related to the relationships established by individuals in public domains. Based on the difference in the results, future research needs to study this aspect further ( García-Alandete et al., 2018 ).

Our study’s second objective, namely the hypothesis (H2) of the existence of statistically significant differences both in the dimensions of psychological well-being and in the dimensions of autonomy according to age, was also confirmed. The results prove the existence of variations in psychological well-being according to age coinciding with other studies ( Ryff, 1989 , 1991 , 2014 , 2019 ; Ryff and Keyes, 1995 ; Springer et al., 2011 ). Specifically, we found that the older group scored higher than the younger group. In this regard, Bluth et al. (2017) state that during adolescence, well-being tends to decrease due to the changes experienced during that particular period, which could partly explain our findings. However, in relation to the positive correlations with other dimensions on the Psychological Well-Being Scale, no differences were found between the two age groups. These results are consistent with the studies by Roecke et al. (2009) and Carstensen et al. (2011) , who determined that affective relationships are more stable the older the individual.

On the other hand, the differences caused in autonomy as an effect of age during transition to adult life must also be taken into account. In this respect, our findings indicate that there is a significant increase in the levels of autonomy in older individuals. These results coincide with the ones obtained by Ryff (1989 , 2014) , Barbosa and Wagner (2015) ; Campione-Barr et al. (2015) , Mayordomo et al. (2016) , and Alonso-Stuyck and Aliaga (2017) . In line with the said studies, our findings show that young people over the age of 18 achieved a higher average score and that their highest average ranking was in self-organization and critical thinking. Among other factors, this result can be explained by the fact that during this period young people are making very important decisions that require looking toward the future, for example in choosing what they are going to study at university ( Kiang and Bhattacharjee, 2018 ).

It should also be noted that the results for sociopolitical engagement on the EDATVA scale were not significant. According to Ryff (1989) and Barrera et al. (2019) , autonomy involves adopting personal standards that allow the individual to take control of their decisions and discard external influences in relation to personal choices. However, in the case of EDATVA, these influences are taken into account, especially in sociopolitical engagement . Therefore, it is noteworthy that the differences according to age are not maintained in this dimension, which involves the individual reflecting on the consequences of their decisions on others. From a developmental perspective, it might be expected that this level of reflection would increase with age as in the other dimensions of autonomy, but this was not the case with the sample in this study. Likewise, Parés and Subirats (2016) research findings corroborate that young people’s political behavior is diverse, and the differences are not the result of age. Consequently, we believe that this is an area that requires future research.

Lastly, although the data in our study confirmed our hypotheses, we should not ignore its limitations. This study dealt with two particularly complex objectives within the concept of young people’s transition to adulthood. Future research should take into account other sectors of the population when exploring the relationship between psychological well-being and autonomy: different age ranges, problems, nationalities, and contexts.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics Statement

The studies involving human participants were reviewed and approved by the UNED Ethical Committee; USTA Ethical Committee. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.

Author Contributions

ÁD-J coordinated the project, designed the database, completed the statistical analysis, and reviewed the final version of the article. TB and RG prepared the introduction and theoretical framework, and wrote the discussion section. RG reviewed the references section. All authors wrote the initial version of the article.

This manuscript documents the study performed by the Faculty of Psychology’s Psychology, Life Cycle and Rights Research Group at the Universidad Santo Tomás (Colombia), and TABA International Research, Social Inclusion and Human Rights, UNED (Spain), directed by TB. This study was funded through the Research Project on the Design and Validation of a Transition to Adulthood Autonomy Scale (Call 2018 FODEIN Research Development Fund Universidad Santo Tomás, Colombia, Project Code 18645020) and Project EVAP-SETVA 2015–2020 (Assessment of Personal Autonomy – Assessment in the Transition to Adulthood) UNED, funded by the Autonomous Region of Madrid General Directorate of Family and Minors, Fundación ISOS, Reina Sofia Center for Adolescence and Youth (FAD), and the Fundación Santa María.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We would like to thank Miguel Melendro, Claudia Charry, Gema Campos, Isabel Martínez, Francisco Javier García-Castilla, and Ana Eva Rodríguez-Bravo, members of the TABA International Research Group, for their work in the design and validation of EDATVA.

Alonso-Stuyck, P., and Aliaga, F. M. (2017). Demanda de autonomía en la relación entre los adolescentes y sus padres: normalización del conflicto. ESE Estud. Educ. 33, 77–101. doi: 10.15581/004.33.77-101

CrossRef Full Text | Google Scholar

Álvarez, S. (2015). La autonomía personal y la autonomía relacional. Anális. Filosófico 35, 13–26.

Google Scholar

Arnett, J. J. (2014). Emerging Adulthood: The Winding Road from the Late Teens Through the Twenties , 2nd. Edn. New York, NY: Oxford University Press.

Barbosa, P. V., and Wagner, A. (2015). Como se define a autonomia?: O perfil discriminante em adolescentes gaúchos. Temas Psicol. 23, 1077–1090. doi: 10.9788/tp2015.4-20

Barrera, L. F., Sotelo, M. A., Barrera, R., and Acebes, J. (2019). Bienestar psicológico y rendimiento académico en estudiantes universitarios. Enseñanza Investig. Psicol. 1, 244–251.

Bernal Romero, T., Melendro, M., and Charry, C. (2020). Transition to Adulthood Autonomy Scale for Young People: Design and Validation. Front. Psychol. 11:457. doi: 10.3389/fpsyg.2020.00457

PubMed Abstract | CrossRef Full Text | Google Scholar

Bernal Romero, T., Melendro, M., Charry, C., Campos, G., Goig, R., De-Juanas, A., et al. (2019). Manual Escala de Autonomía para el Tránsito a la Vida Adulta (EDATVA). Spain: Universidad Nacional de Educación a Distancia.

Berzonsky, M. D., and Cieciuch, J. (2016). Mediational role of identity commitment in relationships between identity processing style and psychological well-being. J. Happiness Stud. 17, 145–162. doi: 10.1007/s10902-014-9588-2

Bluth, K., Campo, R. A., Futch, W. S., and Gaylord, S. A. (2017). Age and gender differences in the associations of self-compassion and emotional well-being in a large adolescent sample. J. Youth Adolesc. 46, 840–853. doi: 10.1007/s10964-016-0567-2

Bradshaw, J., Martorano, B., Natali, L., and De Neubourg, C. (2013). Children’s subjective well-being in rich countries. Child Indic. Res. 6, 619–635. doi: 10.1007/s12187-013-9196-4

Bucchianeri, M. M., Fernandes, N., Loth, K., Hannan, P. J., Eisenberg, M. E., and Neumark-Sztainer, D. (2016). Body dissatisfaction: Do associations with disordered eating and psychological well-being differ across race/ethnicity in adolescent girls and boys? Cult. Divers. Ethn. Minor. Psychol. 22, 137–146. doi: 10.1037/cdp0000036

Butler-Barnes, S. T., Martin, P. P., and Boyd, D. T. (2017). African American adolescents’ psychological well-being: The impact of parents’ religious socialization on adolescents’ religiosity. Race Soc. Probl. 9, 115–126. doi: 10.1007/s12552-017-9199-8

Campione-Barr, N., Lindell, A., Short, S., Greer, K., and Drotar, S. (2015). First- and second-born adolescents’ decision-making autonomy throughout adolescence. J. Adolesc. 45, 250–262. doi: 10.1016/j.adolescence.2015.10.009

Carstensen, L. L., Turan, B., Scheibe, S., Ram, N., Ersner-Hershfiel, H., Samanez-Larki, G. R., et al. (2011). Emotional experience improves with age: Evidence based on over 10 years of experience sampling. Psychol. Agin. 26, 21–33. doi: 10.1037/a0021285

Chen, Y., Kim, E. S., Koh, H. K., Frazier, A. L., and VanderWeele, T. J. (2019). Sense of mission and subsequent health and well-being among young adults: an outcome-wide analysis. Am. J. Epidemiol. 188, 664–673. doi: 10.1093/aje/kwz009

Davies, J., Kelly, D., and Hannigan, B. (2015). Autonomy and dependence: a discussion paper on decision−making in teenagers and young adults undergoing cancer treatment. J. Adv. Nurs. 71, 2031–2040. doi: 10.1111/jan.12669

De Leersnyder, J., and Kim, H. (2015). Feeling right is feeling good: psychological well-being and emotional fit with culture in autonomy- versus relatedness-promoting situations. Front. Psychol. 6:1–12. doi: 10.3389/fpsyg.2015.00630

Díaz, D., Rodríguez-Carvajal, R., Blanco, A., Moreno-Jiménez, B., Gallardo, I., and Valle, et al (2006). Adaptación española de las escalas de bienestar psicológico de Ryff. Psicothema 18, 572–577.

Díaz, D., Stavraki, M., Blanco, A., and Gandarillas, B. (2015). The eudaimonic component of satisfaction with life and psychological well-being in Spanish cultures. Psicothema 27, 247–253.

Disabato, D. J., Goodman, F. R., Kashdan, T. B., Short, J. L., and Jarden, A. (2016). Different types of well-being? A cross-cultural examination of hedonic and eudaimonic well-being. Psychol. Assess. 28, 471–482. doi: 10.1037/pas0000209

Gao, J., and McLellan, R. (2018). Using Ryff’s scales of psychological well-being in adolescents in mainland China. BMC Psychol. 6:17. doi: 10.1186/s40359-018-0231-6

Garberoglio, C. L., Schoffstall, S., Cawthon, S., Bond, M., and Caemmerer, J. M. (2017). The antecedents and outcomes of autonomous behaviors: Modeling the role of autonomy in achieving sustainable employment for deaf young adults. J. Dev. Phys. Disabil. 29, 107–129. doi: 10.1007/s10882-016-9492-2

García-Alandete, J., Martínez, E. R., Sellés, P., and Soucase, B. (2018). Meaning in Life and Psychological Well-Being in Spanish Emerging Adults. Acta Colombiana Psicol. 21, 206–216. doi: 10.14718/ACP.2018.21.1.9

García-Moya, I., Brooks, F., Morgan, A., and Moreno, C. (2015). Subjective well-being in adolescence and teacher connectedness: A health asset analysis. Health Educ. J. 74, 641–654. doi: 10.1177/0017896914555039

Gómez-López, M., Viejo, C., and Ortega-Ruiz, R. (2019). Psychological Well-Being during adolescence: Stability and association with romantic relationships. Front. Psychol. 10:1772. doi: 10.3389/fpsyg.2019.01772

Henn, C. M., Hill, C., and Jorgensen, L. I. (2016). An investigation into the factor structure of the Ryff Scales of Psychological Well-Being. S A. J. Ind. Psychol. 42, 1–12. doi: 10.4102/sajip.v42i1.1275

Hides, L., Quinn, C., Stoyanov, S., Cockshaw, W., Mitchell, T., and Kavanagh, D. J. (2016). Is the mental wellbeing of young Australians best represented by a single, multidimensional or bifactor model? Psychiatry Res. 241, 1–7. doi: 10.1016/j.psychres.2016.04.077

Keyes, C. L., Ryff, C. D., and Shmotkin, D. (2002). Optimizing Well-Being: The Empirical Encounter of Two Traditions. J. Pers. Soc. Psychol. 82, 1007–1022. doi: 10.1037/0022-3514.82.6.1007

Kiang, L., and Bhattacharjee, K. (2018). Developmental Change and Correlates of Autonomy in Asian American Adolescents. J. Youth Adolesc. 48, 410–421. doi: 10.1007/s10964-018-0909-3

Lammers, J., Stoker, J. I., Rink, F., and Galinsky, A. D. (2016). To have control over or to be free from others? The desire for power reflects a need for autonomy. Pers. Soc. Psychol. Bull. 42, 498–512. doi: 10.1177/0146167216634064

Li, N., and Hein, S. (2019). Parenting, Autonomy in Learning, and Development During Adolescence in China. N. Dir. Child Adolesc. Dev. 2019, 67–80. doi: 10.1002/cad.20272

Mayordomo, T., Sales, A., Satorres, E., and Meléndez, J. (2016). Bienestar psicológico en función de la etapa de vida, el sexo y su interacción. Pensamiento Psicol. 14, 101–112. doi: 10.11144/Javerianacali.PPSI14-2.bpfe

Morales, M., and González, A. (2014). Resiliencia-Autoestima-Bienestar psicológico y Capacidad intelectual de estudiantes de cuarto medio de buen rendimiento de liceos vulnerables. Estud. Pedagógicos 40, 215–228. doi: 10.4067/S0718-07052014000100013

Opree, S., Buijzen, M., and Van Reijmersdal, E. (2018). Development and validation of the psychological well-being scale for children (PWB-c). Societies 8, 18–23. doi: 10.3390/soc8010018

Panahi, S., Suraya, Y., and Roslan, S. (2013). Correlates of Psychological Well-being amongst Graduate Students in Malaysia. Life Sci. J. 10, 1859–1870.

Parés, M., and Subirats, J. (2016). Muy jóvenes, jóvenes y menos jóvenes. El lío de la juventud y la política. Rev. Estud. Juv. 114, 45–58.

Ratelle, C., Simard, K., and Guay, F. (2013). University Students’ Subjective Well-being: The Role of Autonomy Support from Parents, Friends, and the Romantic Partner. J. Happiness Stud. 14, 893–910. doi: 10.1007/s10902-012-9360-

Reis, H. T., Sheldon, K. M., Gable, S. L., Roscoe, J., and Ryan, R. M. (2018). “Daily well-being: The role of autonomy, competence, and relatedness,” in Relationships, Well-Being and Behaviour , ed. H. T. Reis (London, UK: Routledge), 317–349. doi: 10.1177/0146167200266002

Rivas, C., Romero, A., Pérez-Llantada, M., López de la Llave, A., Pourtau, M., Molina, I., et al. (2012). Bienestar psicológico, salud general, autonomía percibida y lesiones en futbolistas. Rev. Psicol. Deporte 2, 365–371. doi: 10.13140/RG.2.1.3162.6964

Rodríguez-Fernández, A., Ramos-Díaz, E., Madariaga, J. M., Arri-billaga, A., and Galende, N. (2016). Steps in the constructionand verification of an explanatory model of psychosocial adjust-ment. Eur. J. Psychol. Educ. 9, 20–28. doi: 10.1016/j.ejeps.2015.11.002

Roecke, C., Li, S. C., and Smith, J. (2009). Intraindividual variability in positive and negative affect over 45 days: Doolder adults fluctuate less than younger adults? Psychol. Aging 24, 863–878. doi: 10.1037/a0016276

Romero, A., Zapata, R., Letelier, A., López, I., and García-Mas, A. (2013). Autonomy, Coping strategies and Psychological Well-Being in Young Professional Tennis Players. Span. J. Psychol. 16, 1–11. doi: 10.1017/sjp.2013.70

Rosa-Rodríguez, Y., Cartagena, N. N., Peña, Y. M., Berrios, A. Q., and Osorio, N. T. (2015). Dimensiones de bienestar psicológico y apoyo social percibido con relación al sexo y nivel de estudio en universitarios. Av. Psicol. Latinoam. 33, 31–43. doi: 10.12804/apl33.01.2015.03

Roslan, S., Ahmad, N. A., Nabilla, N., and Zeinab, G. (2017). Psychological well-being among postgraduate students. Acta Med. Bul. 44, 35–41. doi: 10.1515/amb-2017-0006

Ryff, C. D. (1989). Happiness is Everything, or is It? Explorations on the Meaning of Psychological Well-Being. J. Pers. Soc. Psychol. 57, 1069–1081. doi: 10.1037//0022-3514.57.6.1069

Ryff, C. D. (1991). Possible selves in adulthood and old age: A tale of shifting horizons. Psychol. Aging 6, 286–295. doi: 10.1037/0882-7974.6.2.286

Ryff, C. D. (2014). Psychological well-being revisited: Advances in the science and practice of eudaimonia. Psychother. Psychosom. 83, 10–28. doi: 10.1159/000353263

Ryff, C. D. (2018). “Eudaimonic Well−being,” in Diversity in Harmony: Proceedings of the 31st International Congress of Psychology , (New York: John Wiley & Sons), 375.

Ryff, C. D. (2018). Well-Being with Soul: Science in Pursuit of Human Potential. Perspect. Psychol. Sci. 13, 242–248. doi: 10.1177/1745691617699836

Ryff, C. D. (2019). Entrepreneurship and eudaimonic well-being: Five venues for new science. J. Bus. Ventur. 34, 646–663. doi: 10.1016/j.jbusvent.2018.09.003

Ryff, C. D., and Keyes, C. L. M. (1995). The Structure of Psychological Well-Being Revisited. J. Pers. Soc. Psychol. 69, 719–727. doi: 10.1037//0022-3514.69.4.719

Seidl-De-Moura, M. L., Pessoa, L. F., Mendes, D. M., Ramos, D., Fioravanti-Bastos, A. C., Carvalho, R. V., et al. (2017). Concepções sobre autonomia em faixas etárias diversas. Estud. Psicol. 34, 293–303. doi: 10.1590/1982-02752017000200010

Springer, K. W., Pudrovska, T., and Hauser, R. M. (2011). Does psychological well-being change with age? Longitudinal tests of age variations and further exploration of the multidimensionality of Ryff’s model of psychological well-being. Soc. Sci. Res. 40, 392–398. doi: 10.1016/j.ssresearch.2010.05.008

Urquijo, I., Extremera, N., and Villa, A. (2016). Emotional intelligence, life satisfaction, and psychological well-being in graduates: The mediating effect of perceived stress. Appl. Res. Qual. Life 11, 1241–1252. doi: 10.1007/s11482-015-9432-9

Valle, M., Beramendi, M., and Delfino, G. (2011). Bienestar psicológico y social en jóvenes universitarios argentinos. Revista de psicología 7, 7–26.

Valle, M., Beramendi, M., and Delfino, G. (2019). Bienestar Psicológico y Social en jóvenes universitarios argentinos. Rev. Psicol. 7, 7–26.

Van Petegem, S., Soenens, B., Vansteenkiste, M., and Beyers, W. (2015). Rebels with a cause? Adolescent defiance from the perspective of reactance theory and self−determination theory. Child Dev. 86, 903–918. doi: 10.1111/cdev.12355

Vera-Villarroel, P., Urzúa, A., Silvac, J., Pavez, P., and Celis-Atenas, K. (2013). Escala de bienestar de Ryff: análisis comparativo de los modelos teóricos en distintos grupos de edad. Psicol. Reflex Crit. 26, 106–112. doi: 10.1590/S0102-79722013000100012

Viejo, C., Gómez-López, M., and Ortega-Ruiz, R. (2018). Adolescents’ psychological well-being: A multidimensional measure. Int. J. Environ. Res. Public Health 15, 2325–2329. doi: 10.3390/ijerph15102325

Weiss, L. A., Westerhof, G. J., and Bohlmeijer, E. T. (2016). Can we increase psychological well-being? The effects of interventions on psychological well-being: A meta-analysis of randomized controlled trials. PLoS One 11:58092. doi: 10.1371/journal.pone.0158092

Weiting, N. (2014). Processes Underlying Links to Subjective Well-being: Material Concerns, Autonomy, and Personality. J. Happiness Stud. 16, 1575–1591. doi: 10.1007/s10902-014-9580-x

Young, R. (2017). Personal autonomy: Beyond negative and positive liberty. London, UK: Routledge.

Keywords : autonomy, psychological well-being, transition to adulthood, young people, positive psychology, self-organization

Citation: De-Juanas Á, Bernal Romero T and Goig R (2020) The Relationship Between Psychological Well-Being and Autonomy in Young People According to Age. Front. Psychol. 11:559976. doi: 10.3389/fpsyg.2020.559976

Received: 07 May 2020; Accepted: 14 October 2020; Published: 10 December 2020.

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*Correspondence: Ángel De-Juanas, [email protected]

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Understanding and shaping the future of work with self-determination theory

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Self-determination theory has shaped our understanding of what optimizes worker motivation by providing insights into how work context influences basic psychological needs for competence, autonomy and relatedness. As technological innovations change the nature of work, self-determination theory can provide insight into how the resulting uncertainty and interdependence might influence worker motivation, performance and well-being. In this Review, we summarize what self-determination theory has brought to the domain of work and how it is helping researchers and practitioners to shape the future of work. We consider how the experiences of job candidates are influenced by the new technologies used to assess and select them, and how self-determination theory can help to improve candidate attitudes and performance during selection assessments. We also discuss how technology transforms the design of work and its impact on worker motivation. We then describe three cases where technology is affecting work design and examine how this might influence needs satisfaction and motivation: remote work, virtual teamwork and algorithmic management. An understanding of how future work is likely to influence the satisfaction of the psychological needs of workers and how future work can be designed to satisfy such needs is of the utmost importance to worker performance and well-being.

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Introduction

The nature of work is changing as technology enables new forms of automation and communication across many industries. Although the image of human-like robots replacing human jobs is vivid, it does not reflect the typical ways people will engage with automation and how technology will change job requirements in the future. A more relevant picture is one in which people interact over dispersed networks using continuously improving communication platforms mediated by artificial intelligence (AI). Examples include the acceleration of remote working arrangements caused by the COVID-19 pandemic and the increased use of remote control operations across many industries including mining, manufacturing, transport, education and health.

Historically, automation has replaced more routine physically demanding, dangerous or repetitive work in industries such as manufacturing, with little impact on professional and managerial occupations 1 . However, since the mid-2010s, automation has replaced many repetitive error-prone administrative tasks such as processing legal documents, directing service queries and employee selection screening 2 , 3 . Thus, work requirements for employees are increasingly encompassing tasks that cannot be readily automated, such as interpersonal negotiations and service innovations 4 : in other words, work that cannot be easily achieved through algorithms.

The role of motivation is often overlooked when designing and implementing technology in the workplace, even though technological changes can have a major impact on people’s motivation. Self-determination theory offers a useful multidimensional conceptualization of motivation that can help predict these impacts. According to self-determination theory 5 , 6 , three psychological needs must be fulfilled to adequately motivate workers and ensure that they perform optimally and experience well-being. Specifically, people need to feel that they are effective and masters of their environment (need for competence), that they are agents of their own behaviour as opposed to a ‘pawn’ of external pressures (need for autonomy), and that they experience meaningful connections with other people (need for relatedness) 5 , 7 . Meta-analytic evidence shows that satisfying these three needs is associated with better performance, reduced burnout, more organizational commitment and reduced turnover intentions 8 .

Self-determination theory also distinguishes between different types of motivation that workers might experience: intrinsic motivation (doing something for its own sake, out of interest and enjoyment), extrinsic motivation (doing something for an instrumental reason) and amotivation (lacking any reason to engage in an activity). Extrinsic motivation is subdivided according to the degree to which external influences are internalized (absorbed and transformed into internal tools to regulate activity engagement) 5 , 9 . According to meta-analytic evidence, more self-determined (that is, intrinsic or more internalized) motivation is more positively associated with key attitudinal and performance outcomes, such as job satisfaction, organizational commitment, job performance and proactivity than more controlled motivation (that is, extrinsic or less internalized) 10 . Consequently, researchers advocate the development and promotion of self-determined motivation across various life domains, including work 11 . Satisfaction of the three psychological needs described above is significantly related to more self-determined motivation 8 .

Given the impact of the needs proposed in self-determination theory on work motivation and consequently work outcomes (Fig.  1 ), it is important to find ways to satisfy these needs and avoid undermining them in the workplace. Organizational research has consequently focused on managerial and leadership behaviours that support or thwart these needs and promote different types of work motivation 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 (Fig.  2 ). There is also substantial research on the effects of work design (the nature and organization of people’s work tasks within a job or role, such as who makes what decisions, the extent to which people’s tasks are varied, or whether people work alone or in a team structure) and compensation systems on need satisfaction and work motivation 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , and how individuals can seek to meet their needs and enhance their motivation through proactive efforts to craft their jobs 38 , 39 , 40 .

According to self-determination theory, satisfaction of three psychological needs (competence, autonomy and relatedness) influences work motivation, which influences outcomes. More intrinsic and internalized motivations are associated with more positive outcomes than extrinsic and less internalized motivations. These needs and motivations might be influenced by the increased uncertainty and interdependence that characterize the future of work.

Summary of research findings 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 and available meta-analyses 8 , 10 . In cases where the evidence is mixed, a negative sign indicates a negative correlation, a positive sign indicates a positive correlation, and a zero indicates no statistically significant correlation.

Importantly, the work tasks that people are more likely to do in future work will require high-level cognitive and emotional skills that are more likely to be developed, used, and sustained when underpinned by self-determined motivation 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 . Therefore, if individuals are to be effective in future work, it is important to understand how future work might meet — or fail to meet — the psychological needs proposed by self-determination theory.

In this Review, we outline how work is changing and explain the consequences of these changes for satisfying workers’ psychological needs. We then focus on two areas where technology is already changing the worker experience: when workers apply for jobs and go through selection processes; and when the design of their work — what work they do, as well as how, when and where they do it — is transformed by technology. In particular, we focus on three domains where technology is already changing work design: remote work, virtual teams and algorithmic management. We conclude by discussing the importance of satisfying the psychological needs of workers when designing and implementing technologies in the workplace.

Future work requirements

The future workplace might evolve into one where psychological needs are better fulfilled, or one where they are neglected. In addition, there is growing concern that future work will meet the needs of people with adequate access to technology and the skills to use it, but will further diminish fulfillment for neglected and disadvantaged groups 51 (Box  1 ). To understand how future work might align with human needs, it is necessary to map key work features to core constructs of self-determination theory. Future work might be characterized by environmental uncertainty interdependence, complexity, volatility and ambiguity 52 . Here we focus on uncertainty and interdependence because these features capture core concerns about the future and its implication for connections among people in the changing context of work 53 . Higher levels of uncertainty require more adaptive behaviours, whereas higher levels of interdependence require more social, team-oriented and network-oriented behaviours 54 .

We first consider the increasing role of uncertainty in the workplace. Rapid changes in technology and global supply chains mean that the environment is more unpredictable and that there is increasing uncertainty about what activities are needed to be successful. Reducing uncertainty is central to most theories of human adaptation 55 and is a strong motivational basis for goals and behaviour 56 . If uncertainty becomes a defining and pervasive feature of organizational life, organizational leaders should think beyond reducing uncertainty and instead leverage and even create it 55 . In other words, in a highly dynamic context, it might be more functional and adaptive for employees and organizational leaders to consider more explorative approaches to coping with uncertainty, such as experimentation and improvization. All of these considerations imply that future effective work will require adaptive behaviours such as modifying the way work is done, and proactive behaviours such as innovating and creating new ways of working 54 .

Under higher levels of uncertainty, specific actions are difficult to define in advance. In contrast to action sequences that can be codified (for example, with algorithms) and repeated in predictable environments, the best action sequence is likely to involve flexibility and experimentation when the workplace is more uncertain. In this context, individuals must be motivated to explore new ideas, adjust their behaviour and engage with ongoing change. In stable and predictable environments, less self-determined forms of motivation might be sufficient to maintain the enactment of repetitive tasks and automation is more feasible as a replacement or support. However, under conditions of uncertainty, individuals will benefit from showing cognitive flexibility, creativity and proactivity, all behaviours that are more likely to emerge when people have self-determined motivation 40 , 41 , 44 , 46 , 47 , 48 , 49 , 57 .

Adaptive (coping with and responding to change) and proactive (initiating change) performance can be promoted by satisfying the needs for competence, autonomy and relatedness, and self-determined motivation 4 , 58 . For example, when individuals experience internalized motivation, they have a ‘reason to’ engage in the sometimes psychologically risky behaviour of proactivity 40 . Both adaptivity and proactivity depend on individuals having sufficient autonomy to work differently, try new ideas and negotiate multiple pathways to success. Hence, successful organizational functioning depends on people who can act autonomously to regulate their behaviour in response to a more unpredictable and changing environment 31 , 54 , 59 .

The second feature of the evolving workplace is an increasing level of interdependence among people, systems and technology. People will connect with each other in more numerous and complex ways as communication technologies become more reliable, deeply networked and faster. For example, medical teams from disparate locations might collaborate more easily in real time to support remote surgical procedures. They will also connect with automated entities such as cobots (robots that interact with humans) and decision-making aids supported by constantly updating algorithms. For example, algorithms might provide medical teams with predictive information about patient progress based on streaming data such as heart rate. As algorithms evolve in complexity and predictive accuracy, they will modify the work context and humans will need to adapt to work with the new information created 60 .

This interconnected and evolving future workplace requires individuals who can interact effectively across complex networks. The nature of different communication technologies can both increase and decrease feelings of relatedness depending on the extent to which they promote meaningful interactions. Typically, work technologies are developed to facilitate productivity and efficiency. However, given that human performance is also influenced by feelings of relatedness 8 , it is important to ensure that communication technologies and the way networks of people are managed by these technologies can fulfill this need.

The rapid growth of networks enabled by communication technologies (for example, Microsoft Teams, Slack and Webex) has produced positive and negative effects on performance and well-being. For example, these technologies can be a buffer against loneliness for remote workers or homeworkers 61 and enable stronger connections among distributed workers 62 . However, networking platforms lead some individuals to experience more isolation rather than more connectedness 63 . Workplace networks might also engender these contrasting effects by, for example, building a stronger understanding between individuals in a work group who do not usually get to interact or by limiting contact to more superficial communication that prevents individuals from building stronger relationships.

Both uncertainty and interdependence will challenge people’s feelings of competence. Uncertainty can lead to reduced access to predictable resources and less certainty about the success of work effort; the proliferation of networks and media can lead to feeling overwhelmed and to difficulties in managing communication and relationships. Moreover, technologies and automation can lead to the loss of human competencies as people stop using these skills 64 , 65 , 66 , 67 . For example, automating tasks that require humans to have basic financial skills diminishes opportunities for humans to develop expertise in financial skills.

Uncertainty and interdependence are likely to persist and increase in the future. This has implications for whether and how psychological needs will be satisfied or frustrated. In addition, because uncertainty and interdependence require people to behave in more adaptive and proactive ways, it is important to create future work that satisfies psychological needs.

Box 1 Inequalities caused by future work

Future work is likely to exacerbate inequalities. First, the digital divide (unequal access to, and ability to use, information communication technologies) 51 is likely to be exacerbated by technological advances that might become more costly and require more specialized skills. Moreover, the COVID-19 pandemic exacerbated work inequalities by providing better opportunities to those with digital access and skills 210 , 211 . The digital divide now also includes ‘algorithm awareness’ (knowing what algorithms do) which influences whether and how people are influenced by technology. Indeed, the degree to which algorithms influence attitudes and behaviours is negatively associated with the degree to which people are aware of algorithms and understand how they work 212 .

Second, future work is likely to require new technical and communication skills, as well as adaptive and proactive skills. Thus, people with such skills are more likely to find work than those who do not or who have fewer opportunities (for example, education access) to develop them. Even gig work requires that workers have access to relevant platforms and adequate skills for using them. These future work issues are therefore likely to increase gaps between skilled and non-skilled segments of the population, and consequently to increase societal pay disparities and poverty.

For example, workforce inequalities between mature and younger workers are likely to increase owing to real or perceived differences in technology-related skills, with increased disparities in the type of jobs these workers engage in 210 , 213 . Older workers might miss out on opportunities to upskill or might choose to leave the workforce early rather than face reskilling. This could decrease workforce diversity and strengthen negative stereotypes about mature workers (such as that they are not flexible, adaptable or motivated to keep up with changing times) 214 . Furthermore, inequalities in terms of pay have already been observed between men and women 215 . Increased robotization increases the gender pay gap 216 , and this gap is likely to be exacerbated as remote working becomes more common (as was shown during the pandemic) 217 . For example, one study found that salaries did not increase as much for women working flexibly compared to men 218 ; another study found that home workers tended to be employees with young children and these workers were 50% less likely to be promoted than those based in the office 140 .

To promote equality in future work and ensure that psychological needs are met, managers will need to adopt ‘meta-strategies’ to promote inclusivity (ensuring that all employees feel included in the workplace and are treated fairly, regardless of whether they are working remotely or not), individualization of work (ensuring that work is tailored to individual needs and desires) and employee integration (promoting interaction between employees of all ages, nationalities and backgrounds) 213 .

The future of employee selection

Changing economies are increasing demand for highly skilled labour, meaning that employers are forced to compete heavily for talent 68 . Meanwhile, technological developments, largely delivered online, have radically increased the reach, scalability and variety of selection methods available to employers 69 . Technology-based assessments also afford candidates the autonomy to interact with prospective employers at times and locations of their choosing 70 , 71 . Furthermore, video-based, virtual, gamified and AI-based assessment technologies 3 , 72 , 73 , 74 have improved the fidelity and immersion of the selection process. The fidelity of a selection assessment represents the extent to which it can reproduce the physical and psychological aspects of the work situation that the assessment is intended to simulate 75 . Virtual environments and video-based assessments can better reproduce working environments than traditional ‘paper and pencil’ assessments, and AI is being used to simulate social interactions in work or similar contexts 74 . Immersion represents how engrossing or absorbing an assessment experience is. Immersion is enhanced by richer media and gamified assessment elements 75 , 76 . These benefits have driven the widespread adoption of technology in recruitment practices 77 , but they have also attracted criticism. For example, the use of AI to analyse candidate data (such as CVs, social media profiles, text-based responses to interview questions, and videos) 78 raises concerns about the relevance of data being collected for selecting employees, transparency in how the data are used, and biases in selection based on these data 79 .

Candidates with a poor understanding of what data are being collected and how they are being used might experience a technology-based selection process as autonomy-thwarting. For example, the perceived job-relatedness of an assessment is associated with whether or not candidates view the assessment positively 69 , 80 . However, with today’s technology, assessments that appear typical or basic (such as a test or short recorded interview response) might also involve the collection of additional ‘trace’ data such as mouse movements and clicks (in the case of tests), or ancillary information such as ‘micro-expressions’ or candidates’ video backdrops 81 . We expect that it would be difficult for candidates to evaluate the job-relatedness of this information, unless provided with a rationale. Candidates may also feel increasing pressure to submit to employers’ requests to share personal information, such as social media profiles, which may further frustrate autonomy to the extent that candidates are reluctant to share this information 82 .

Furthermore, if candidates do not understand how technology-driven assessments work and are not able to receive feedback from assessment systems, their need for competence may be thwarted 83 . For example, initial research shows that people perceive fewer opportunities to demonstrate their strengths and capabilities in interviews they know will be evaluated by AI, compared to those evaluated by humans 83 .

Finally, because candidates are increasingly interacting with systems, rather than people, their opportunities to build relatedness with employers might be stifled. A notable exemplar is the use of asynchronous video interviews 70 , 71 , a type of video-based assessment where candidates log into an online system, are presented with a series of questions, and are asked to video-record their responses. Unlike a traditional or videoconference interview, candidates completing an asynchronous video interview do not interact directly with anyone from the employer organization, and they consequently often describe the experience as impersonal 84 . Absent any interventions, the use of asynchronous video interviews removes the opportunity for candidates to meet the employer and get a feel for what it might be like to work for the employer, or to ask questions of their own 84 .

Because technologies have changed rapidly, research on candidates’ reactions to these new selection methods has not kept up 69 . Nonetheless, to the extent that test-related and technology-related anxiety influences motivation and performance when completing an online assessment or a video interview, the performance of applicants might be adversely affected 85 . Furthermore, candidate experience can influence decisions to accept a job offer and how positively the candidate will talk about the organization to other potential candidates and even clients, thereby influencing brand reputation 86 . Thus, technology developments offer clear opportunities to improve the satisfaction of candidates’ needs and to assess them in richer environments that more closely resemble work settings. However, there are risks that technology that is needs-thwarting or is implemented in a needs-thwarting manner, will add to the uncertainty already inherent in competitive job applications. In the context of a globally competitive skills market, employers risk losing high-quality candidates.

The future of work design

Discussion in the popular press about the impact of AI and other forms of digitalization focuses on eradicating large numbers of jobs and mass unemployment. However, the reality is that tasks within jobs are being influenced by digitalization rather than whole jobs being replaced 87 . Most occupations in most industries have at least some tasks that could be replaced by AI, yet currently there is no occupation in which all tasks could be replaced 88 . The consequence of this observation is that people will need to increasingly interact with machines as part of their jobs. This raises work design questions, such as how people and machines should share tasks, and the consequences of different choices in this respect.

Work design theory is intimately connected to self-determination theory, with early scholars arguing that work arrangements should create jobs in which employees can satisfy their core psychological needs 89 . Core aspects of work design, including decision-making power, the opportunity to use skills and do a variety of tasks, the ability to ascertain the impact of one’s work, performance feedback 90 , social contact, time pressure, emotional demands and role conflict 91 are important predictors of job satisfaction, job performance 92 and work motivation 93 . Some evidence suggests that these motivating characteristics (considered ‘job resources’ according to the jobs demands–resources model) 94 are especially important for fostering motivation or reducing strain when job demands (aspects of a job that require sustained physical, emotional or mental effort) are high 93 , 95 . For example, autonomy and social support can reduce the effect of workload on negative outcomes such as exhaustion 96 .

Technology can potentially influence work design and therefore employee motivation in positive ways 1 . Increasing workers’ task variety and opportunities for more complex problem-solving should occur whenever technology takes over tasks (such as assembly line or mining work). Leaving the less routine and more interesting tasks for people to do 97 increases the opportunity for workers to fulfill their need for competence. For example, within manufacturing, complex production systems in which cyber-machines are connected in a factory-wide information network require strategic human decision-makers operating in complex, varied and high-level autonomy jobs 98 . Technology (such as social media) can also enhance social contact and support in some jobs and under some circumstances 86 , 87 (but see ref. 63 ), increasing opportunities for meeting relatedness needs.

However, new technologies can also undermine the design of motivating work, and thus reduce workers’ need satisfaction 1 . For example, in the aviation industry, manual flying skills can become degraded due to a lack of opportunity to practice when aircraft are highly automated 99 , decreasing the opportunity for pilots to meet their need for competence. As another example, technology has enabled the introduction of ‘microwork’ in which jobs are broken down into small tasks that are then carried out via information communication technologies 100 . Such jobs often lack variety, skill use and meaning 101 , again reducing the opportunity for the work to meet competence needs. In an analysis of robots in surgery, technology designed purely for ‘efficiency’ reduced the opportunities for trainee surgeons to engage in challenging tasks and resulted in impaired skill development 102 , and therefore probably reduced competence need satisfaction. Thus, poor work design might negatively influence work motivation through poor need satisfaction, especially the need for competence, owing to the lack of opportunity to maintain one’s skills or gain new ones 2 .

As the above examples show, the impact of new technologies on work design, and hence on need satisfaction, is powerful — but also mixed. That is, digital technologies can increase or decrease motivational work characteristics and can thereby influence need satisfaction (Fig.  3 ). The research shows that there is no deterministic relationship between technology and work design; instead, the effect of new technology on work design, and hence on motivation, depends on various moderating factors 1 . These moderating factors include individual aspects, such as the level of skill an individual has or the individual’s personality. Highly skilled individuals or those with proactive personalities might actively shape the technology and/or craft their work design to better meet their needs and increase their motivation 1 . For example, tech-savvy Uber drivers subject to algorithmic management sometimes resist or game the system, such as by cancelling rides to avoid negative ratings from passengers 103 .

The causal relationships among the possible (but not exhaustive) variables implicated in the influence of technology on work design and work motivation discussed in this Review.

More generally, individuals proactively seek a better fit with their job through behaviours such as idiosyncratic deals (non-standard work arrangements negotiated between an employee and an employer) and job crafting (changing one’s work design to align one’s job with personal needs, goals and skills) 39 , 40 (Box  2 ). Consequently, although there is relatively little research on proactivity in work redesign through technology, it is important to recognize that individuals will not necessarily be passive in the face of negative technologies. Just as time pressure can stimulate proactivity 104 , we should expect that technology that creates poor work design will motivate job crafting and other proactive behaviours from workers seeking to meet their psychological needs better 105 . This perspective fits with a broader approach to technology that emphasizes human agency 106 .

Importantly, mitigating and managing the impact of technology on work is not the sole responsibility of individuals. Organizational implementation factors (for example, whether technology is selected, designed and implemented in a participatory way or how much training is given to support the introduction of technology) and technological design factors (for example, how much worker control is built into automated systems) are also fundamental in shaping the effect of technology on work design. Understanding these moderating factors is important because they provide potential ‘levers’ for creating more motivating work while still capitalizing on the advantages of technologies. For example, in one case study 107 , several new digital technologies such as cobots and digital paper flow (systems that integrate and automate different organizational functions, such as sales and purchasing with accounting, inventory control and dispatch) were implemented following a strong technocentric approach (that is, highly focused on engineering solutions) with little worker participation, and with limited attention to creating motivating work design. A more human-centred approach could have prevented the considerable negative outcomes that followed (including friction, reduced morale, loss of motivation, errors and impaired performance) 107 . Ultimately, how technology is designed and implemented should be proactively adapted to better meet human competencies, needs and values.

Box 2 The future of careers

Employment stability started to decline during the 1980s with the rise of public ownership and international trade, the increased use of performance-based incentives and contracts, and the introduction of new technologies. Employment stability is expected to continue to decline with the growth of gig work and continued technological developments 219 , 220 . Indeed, people will more frequently be asked to change career paths as work is transformed by technology, to use and ‘sell’ their transferrable skills in creative ways, and to reskill. The rise of more precarious work and new employment relationships (for example, in gig work) adds to these career challenges 221 . The current generation of workers is likely to experience career shocks (disruptive events that trigger a sensemaking process regarding one’s career) caused by rapid technological changes, and indeed many workers have already experienced career shocks from the pandemic 222 . Moreover, rapid technological change and increasing uncertainty pushes organizations to hire for skill sets rather than fitting people into set jobs, requiring people to be aware of their skills and to know how to market them.

In short, the careers of the current and future workforce will be non-linear and will require people to be more adaptive and proactive in crafting their career. For this reason, the concept of a protean career, whereby people have an adaptive and self-directed career, is likely to be increasingly important 223 . A protean career is a career that is guided by a search for self-fulfillment and is characterized by frequent learning cycles that push an individual into constant transformation; a successful protean career therefore requires a combination of adaptivity skills and identity awareness 224 , 225 . Adaptivity allows people to forge their career by using, or even creating, emerging opportunities. Having a solid sense of self helps individuals to make choices according to personal strengths and values. However, a protean career orientation might fit only a small segment of the labour market. Change-averse individuals might regard protean careers as career-destructive and the identity changes associated with a protean career might be regarded as stressful. In addition, overly frequent transitions might limit deep learning opportunities and achievements, and disrupt important support networks 221 .

Nonetheless, career-related adaptive and proactive behaviours can be encouraged by satisfying psychological needs. In fact, protean careers tend to flourish in environments that provide autonomy and allow for proactivity, with support for competence and learning 223 , 226 . Moreover, people have greater self-awareness when they feel autonomous. Indeed, self-awareness is a component of authenticity and mindfulness, both of which are linked to the satisfaction of the need for autonomy 227 , 228 . Thus, supporting psychological needs during training, development and career transitions is likely to assist people in crafting successful careers.

Applications

In what follows, we describe three specific cases where technology is already influencing work design (virtual and remote work, virtual teamwork, and algorithmic management), and consider the potential consequences for worker need satisfaction and motivation.

Virtual and remote work

Technologies have significantly altered when and where people can work, with the Covid-19 pandemic vastly accelerating the extent of working from home (Box  3 ). Remote work has persisted beyond the early stages of the Covid-19 pandemic with hybrid working — where people work from home some days a week and at the workplace on other days — becoming commonplace 108 . The development of information communication technologies (such as Microsoft Teams) has enabled workers to easily connect with colleagues, clients and patients remotely 105 , for example, via online patient ‘telehealth’ consultations, webinars and discussion forums. Technology has even enabled the remote control of other technologies, such as manufacturing machinery, vehicles and remote systems that monitor hospital ward patient vital signs through AI 1 . However, even when people are working on work premises (that is, not working remotely), an increasing amount of work in many jobs is done virtually (for example, online training or communicating with a colleague next door via email).

Working virtually is inherently tied to changes in uncertainty and interdependence. Virtual work engenders uncertainty because workplace and interpersonal cues are less available or reliable in providing virtual employees with role clarity and ensuring smooth interactions. Indeed, ‘screen’ interactions are more stressful and effortful than face-to-face interactions. It is more difficult to decipher and synchronize non-verbal behaviour on a screen than face-to-face, particularly given the lack of body language cues due to camera frame limitations, increasing the cognitive load for meeting attendees 109 , 110 , 111 , 112 . Non-verbal synchrony can be affected by the video streaming speed, which also increases cognitive load 109 , 110 , 111 , 112 . Virtual interactions involve ‘hyper gaze’ from seeing grids of staring faces, which the brain interprets as a threat 109 , 110 , 111 , 112 . Seeing oneself on screen increases self-consciousness during social interactions, which can cause anxiety, especially in women and those from minoritized groups 109 , 110 , 111 , 112 . Finally, reduced mobility from having to stay in the camera frame has been shown to reduce individual performance relative to face-to-face meetings 109 , 110 , 111 , 112 . Research on virtual interactions is still in its infancy. In one study, workers were randomly assigned to have their camera either on or off during their daily virtual meetings for a week. Those with the camera on during meetings experienced more daily fatigue and less daily work engagement than those with the camera off 113 .

Lower-quality virtual communication between managers and colleagues can leave individuals unclear about their goals and priorities, and how they should achieve them 114 . This calls for more self-regulation 115 because employees must structure their daily work activities and remind themselves of their work priorities and goals, without relying on the physical presence of colleagues or managers. If virtual workers must coordinate some of their work tasks with colleagues, it can be difficult to synchronize and coordinate actions, working schedules and breaks, motivate each other, and assist each other with timely information exchange 115 . This can make it harder for employees to acquire and share information 53 .

Virtual work also affects work design and changes how psychological needs can be satisfied and frustrated (Table  1 ), which has implications for both managers and employees. Physical workplace cues that usually guide work behaviours and routines in the office do not exist in virtual work, consequently demanding more autonomous regulation of work behaviours 116 , 117 . Some remote workers experience an increased sense of control and autonomy over their work environment 118 , 119 , 120 under these circumstances, resulting in lower family–work conflict, depression and turnover 121 , 122 . However, managers and organizations might rob workers of this autonomy by closely monitoring them, for example by checking their computer or phone usage 123 . This type of close monitoring reflects a lack of manager trust in individuals’ abilities or intentions to work effectively remotely. This lack of trust leads to decreased feelings of autonomy 124 , increased employee home–work conflict 105 and distress 125 , 126 . Surveillance has been shown to decrease self-determined motivation 127 . It is therefore important to train managers in managing remote workers in an autonomy-supportive way to avoid these negative consequences 128 . The negative effects of monitoring can also be reduced if monitoring is used constructively to help employees develop through feedback 129 , 130 , 131 , 132 , 133 , and when employees participate in the design and control of the monitoring systems 134 , 135 .

Information communication technology might satisfy competence needs by increasing access to global information and communication and the ability to analyse data 136 . For example, online courses, training and webinars can improve workers’ knowledge, skills and abilities, and can therefore help workers to carry out their work tasks more proficiently, which increases self-efficacy and a sense of competence. Furthermore, the internet allows people to connect rapidly and asynchronously with experts around the world, who may be able to provide information needed to solve a work problem that local colleagues cannot help with 136 . This type of remote work is increasingly occurring whether or not individuals themselves are based remotely, and can potentially enhance performance.

At the same time, technology might thwart competence needs, and increase fatigue and stress. For example, constant electronic messages (such as email or keeping track of online messaging platforms such as Slack or Microsoft Teams) are likely to increase in volume when working remotely, but can be distracting and prevent individuals from completing core tasks while they respond to incoming messages 136 . The frustration of the need for competence can increase if individuals are constantly switching tasks to deal with overwhelming correspondence and failing to finish tasks in a timely manner. In addition, information communication technology enables access to what some individuals might perceive as an overwhelming amount of information (for example, through the internet, email and messages) which can lead to a lot of time spent sifting and processing information. This can be interpreted as a job demand that might make individuals feel incompetent if it is not clear what information is most important. Individuals might also require training in the use of information communication technology, and even then, technology can malfunction, preventing workers from completing tasks, and causing frustration and distress 136 , 137 .

Finally, remote workers can suffer from professional isolation because there are fewer opportunities to meet or be introduced to connections that enable career development and progression 138 , which could influence their feelings of competence in the long run. Although some research suggests that those who work flexibly are viewed as less committed to their career 139 and might be overlooked for career progression 140 , other research has found no relationship between remote working and career prospects 119 .

Virtual work can also present challenges for meeting workers’ need for relatedness 141 . Remote workers can feel isolated from, and excluded by, colleagues and fail to gain the social support they might receive if co-located 142 , 143 , weakening their sense of belonging to a team or organization 144 and their job performance 145 . This effect will probably be accentuated in the future: if the current trend for working from home continues, more people will be dissociated from office social environments more often and indefinitely. Office social environments could be degraded permanently if fewer people frequent the office on a daily basis, such that workers may not be in the office at the same time as collaborators, and there might be fewer people to ask for help or talk with informally. We do not yet know the long-term implications of a degraded social environment, but some suggest that extended virtual working could create a society where people have poor communication skills and in which social isolation and anxiety are exacerbated 146 . Self-determination theory suggests that it will be critical to actively design hybrid and remote work that meets relatedness needs to prevent these long-term issues. When working remotely, simple actions could be effective, such as actively providing opportunities for connecting with others, for example, through ‘virtual coffee breaks’ 147 . Individuals could also be ‘buddied’ up into pairs who regularly check in with each other via virtual platforms.

Hybrid work seems to offer the best of both worlds, providing opportunities for connection and collaboration while in the workplace, and affording autonomy in terms of flexible working. Some research suggests that two remote workdays a week provides the optimum balance 148 . However, it is likely that this balance will be affected by individual characteristics and desires, as well as by differences in work roles and goals. For example, Israeli employees with autism who had to work from home during the COVID-19 pandemic experienced significantly lower competence and autonomy satisfaction than before the pandemic 149 . Yet remote workers high in emotional stability and job autonomy reported higher autonomy and relatedness satisfaction compared to those with low emotional stability 120 . These findings suggest that managers and individuals should consider the interplay between individual characteristics, work design and psychological need satisfaction when considering virtual and remote work.

Box 3 The ‘great resignation’

‘The great resignation’ refers to the massive wave of employee departures during the COVID-19 pandemic in several parts of the world, including North America, Europe and China 229 , 230 , that can be attributed in part to career shocks caused by the pandemic 222 . In the healthcare profession, the shock consisted of an exponential increase in workload and the resulting exhaustion, coupled with the disorganization caused by lack of resources and compounded by health fears 231 . In other industries, the pandemic caused work disruptions by forcing or allowing people to work from home, furloughing employees for varying periods of time, or lay-offs caused by an abrupt loss of business (such as in the tourism and hospitality industries).

Scholars have speculated that these shocks have resulted in a staggering number of people not wanting to go back to work or quitting their current jobs 232 . For example, the hospitality and tourism industries failed to attract employees back following lay-offs 233 . Career shocks can trigger a sensemaking process that can lead one to question how time is spent at work and the benefits one draws from it. For example, the transition to working from home made employees question how and why they work 234 . Frequent health and financial concerns, juggling school closures and complications in caring for dependents have compounded exhaustion and disorganization issues. Some have even renamed ‘the great resignation’ as ‘the great discontent’ to highlight that many people reported wanting to quit because of dissatisfaction with their work conditions 235 .

It might be helpful to understand ‘the great resignation’ through the lens of basic psychological need satisfaction. Being stretched to the limit might influence the need for competence and relatedness when workers feel they have suboptimal ways to connect with colleagues and insufficient time to balance work with other life activities that connect them to family and friends 128 , 236 . The sensemaking process that accompanies career shocks might highlight a lack of meaningful work that decreases the satisfaction of the need for autonomy. This lack of need satisfaction might lead people to take advantage of the disruption to ‘cut their losses’ by reorienting their life priorities and career goals, leading to resignation from their current jobs 237 , 238 .

Alternatively, the experiences gained from working differently during the COVID-19 pandemic might have made many workers aware of how work could be (for example, one does not have to commute), emboldening them to demand better work design and work conditions for themselves. Not surprisingly, barely a year after ‘the great resignation’ many are now talking about ‘the great reshuffle’, suggesting that many people who quit their jobs used this time to rethink their careers and find more satisfying work 239 . Generally, this has meant getting better pay and seeking work that aligns better with individual values and that provides a better work–life balance: in other words, work that better meets psychological needs for competence, autonomy and relatedness.

Virtual teamwork

Uncertainty and interconnectedness make work more complex, increasing the need for teamwork across many industries 150 . Work teams are groups of individuals that must both collaborate and work interdependently to achieve shared objectives 151 . Technology has created opportunities to develop work teams that operate virtually. Virtual teams are individuals working interdependently towards a common goal but who are geographically dispersed and who rely on electronic technologies to perform their work 152 , 153 . Thus, virtual teamwork is a special category of virtual work that also involves collective psychological experiences (that are shaped by and interact with virtual work) 154 . This adds another layer of complexity and therefore requires a separate discussion.

Most research conceptualizes team virtuality as a construct with two dimensions: geographical dispersion and reliance on technology 153 , 155 . Notably, these dimensions are not completely independent because team members require technology to communicate and coordinate tasks when working in different locations 156 , 157 . Virtuality differs between and within teams. Team members might be in different locations on some days and the same location on other days, which changes the level of team virtuality over time. Thus, teams are not strictly virtual or non-virtual. Team virtuality influences how team members coordinate tasks and share information 130 , which is critical for team effectiveness (usually assessed by a team’s tangible outputs, such as their productivity, and team member reactions, such as satisfaction with, or commitment to, the team) 158 .

Although individual team members might react differently to working in a virtual team, multi-level theory suggests that team members collectively develop shared experiences, called team emergent states 159 , 160 . Team emergent states include team cohesion (the bond among group members) 161 , team trust 162 , and team motivation and engagement 159 , 163 . These emergent states arise out of individual psychological behaviours and states 164 and are influenced by factors that are internal (for example, interactions between team members) and external (for example, organizational team rewards, organizational leadership and project deadlines) to the team, as well as team structure (for example, team size and composition). Team emergent states, particularly team trust, are critical for virtual team effectiveness because reliance on technology often brings uncertainties and fewer opportunities for social control 165 .

Team virtuality is likely to affect team functioning via its impact on psychological need satisfaction, in a fashion similar to remote work. However, the need for coordination and information sharing to achieve team goals is likely to be enhanced by how team members support and satisfy each other’s psychological needs 166 , which might be more difficult under virtual work conditions. In addition to affecting individual performance, need satisfaction within virtual teams can also influence collective-level team processes, such as coordination and trust, which ultimately affect team performance. For example, working in a virtual team might make it more difficult to feel meaningful connections because team members in different locations often have less contact than co-located team members. Virtual team members predominantly interact via technology, which — as described in the previous section — might influence the quality of relationships they can develop with their team members 141 , 167 , 168 and consequently the satisfaction of relatedness needs 169 .

Furthermore, virtual team members must master electronic communication technology (including virtual meeting and breakout rooms, internet connectivity issues, meeting across different time zones, and email overload), which can lead to frustrations and ‘technostress’ 170 . Frustrations with electronic communication might diminish the psychological need for competence because team members might feel ineffective in mastering their environment.

In sum, virtual team members might experience lower relatedness and competence need satisfaction. However, these needs are critical determinants of work motivation. Furthermore, virtual team members can also develop shared collective experiences around their need satisfaction. Thus, self-determination theory offers explanatory mechanisms (that is, team members’ need satisfaction, which influences work motivation) that are at play in virtual teams and that organizations should consider when implementing virtual teams.

Algorithmic management

Algorithmic management refers to the use of software algorithms to partially or completely execute workforce management functions (for example, hiring and firing, coordinating work, and monitoring performance) 2 , 123 , 171 , 172 . This phenomenon first appeared on gig economy platforms such as Uber, Instacart and Upwork, where all management is automated 173 . However, it is rapidly spreading to traditional work settings. Examples include monitoring the productivity, activity and emotions of remote workers 174 , the algorithmic determination of truck drivers’ routes and time targets 175 , and automated schedule creation in retail settings 176 . The constant updating of the algorithms as more data is collected and the opacity of this process makes algorithmic management unpredictable, which produces more uncertainty for workers 177 .

Algorithmic management has repercussions for work design. Specifically, whether algorithmic management systems consider human motivational factors in their design influences whether workers are given enough autonomy, skills usage, task variety, social contact, role clarity (including knowing the impact of one’s work) and a manageable workload 123 . So far, empirical evidence show that algorithmic management features predominantly reduce employees’ basic needs for autonomy, competence and relatedness because of how they influence work design (Fig.  4 ).

Summary of the features and consequences of algorithmic management on autonomy needs, relatedness needs and competence needs.

Algorithmic management tends to foster the ‘working-for-data’ phenomenon (or datafication of work) 172 , 178 , 179 , leading workers to focus their efforts on aspects of work that are being monitored and quantified at the expense of other tasks that might be more personally valued or meaningful. This tendency is reinforced by the fact that algorithms are updated with new incoming data, increasing the need for workers to pay close attention to what ‘pays off’ at any given moment. Monitoring and quantifying worker behaviours might reduce autonomy because it is experienced as controlling and narrows goal focus to only quantifiable results 127 , 180 ; there is some evidence that this is the case when algorithmic management systems are used to this end 172 , 178 , 181 . Rigid rules about how to carry out work often determine performance ratings (for example, imposing a route to deliver goods or prescribing how equipment and materials must be used) and even future task assignments and firing decisions, with little to no opportunity for employee input 182 , 183 , 184 . Thus, the combination of telling workers what to do to reach performance targets and how to get it done significantly limits their autonomy to make decisions based on their knowledge and skills.

Some algorithmic management platforms do not reveal all aspects of a given task (for example, not revealing the client destination before work is accepted) or penalize workers who decline jobs 185 , thereby severely restricting their choices. This encourages workers to either overwork to the point of exhaustion, find ways to game the system 184 , or misbehave 186 . Moreover, the technical complexity and opacity of algorithmic systems 187 , 188 , 189 deprives workers of the ability to understand and master the system that governs their work, which limits their voice and enpowerment 172 , 185 , 190 . Workers’ typical response to the lack of transparency is to organize themselves on social media to share any insights they have on what the algorithm ‘wants’ as a way to gain back some control over their work 183 , 191 .

Finally, algorithmic management usually provides comparative feedback (comparing one’s results to other workers’) and is linked to incentive pay structures, both of which reduce self-determined motivation as they are experienced as more controlling 26 , 192 . For instance, after algorithms estimated normal time standards for each ‘act’, algorithmic tracking and case allocation systems forced homecare nurses to reduce the ‘social’ time spent with patients because they were assigned more patients per day, thereby limiting nurses’ autonomy to decide how to perform their work 181 . Because these types of quantified metric are often directly linked to performance scores, pay incentives and future allocation of tasks or schedules (that is, getting future work), algorithmic management reduces workers’ freedom in decision-making related to their work, which can significantly reduce their self-determined motivation 123 .

Algorithmic management also tends to individualize work, which affects the need for relatedness. For example, algorithmic management inevitably transforms or reduces (sometimes even eliminates) contact with a supervisor 2 , 182 , 193 , leading to the feeling that the organization does not care about the worker and provides little social support 194 , 195 . ‘App-workers’, who obtain work through gig-work platforms such as Uber, reportedly crave more social interactions and networking opportunities 179 , 185 , 194 and often attempt to compensate for a lack of relatedness by creating support groups that connect virtually and physically 183 , 191 , 195 . Increased competitive climates due to comparative feedback or displaying team members’ individual rankings 175 , 196 can also hamper relatedness. Indeed, when workers have to compete against each other to rank highly (which influences their chances of getting future work and the financial incentives they receive), they are less likely to develop trusting and supportive relationships.

Researchers have formulated contradictory predictions about the potential implications of algorithmic management on competence satisfaction. On the one hand, using quantified metrics, algorithmic management systems can provide more frequent, unambiguous and performance-related feedback, often in the form of ratings and rankings 177 , and simultaneously link this feedback to financial rewards. Informational feedback can enhance intrinsic motivation because it provides information about one’s competence. At the same time, linking rewards to this feedback could decrease intrinsic motivation, because the contingency between work behaviour and pay limits worker discretion and therefore reduces their autonomy 26 . The evidence so far suggests that the mostly comparative feedback provided by algorithmic management is insufficiently informative because the value of the feedback is short-lived — continuously updating algorithms change what is required to perform well 177 , 183 , 185 . This short-lived feedback can undermine feelings of mastery or competence. In addition, algorithmic management is often associated with simplified tasks, and with lower problem-solving opportunities and job variety 123 . However, gamification features on some platforms might increase intrinsic motivation 179 , 183 .

The nascent research on the effects of algorithmic management on workers’ motivation indicates mostly negative effects on self-determined forms of motivation, because the way it is designed decreases the satisfaction of competence, autonomy and relatedness needs. Algorithmic management is being rapidly adopted across an increasing number of industries. Thus, technology developers and those who implement the technology in organizations will need to pay closer attention to how it changes work design to avoid negative effects on work motivation.

Summary and future directions

Self-determination theory can help predict the motivational consequences of future work and these motivational considerations should be taken into account when designing and implementing technology. More self-determined motivation will be needed to deal with the uncertainty and interdependence that will characterize future work. Thus, research examining how need satisfaction and work motivation influence people’s ability to adapt to uncertainty, or even leverage it, is needed. For example, future research could examine how different managerial styles influence adaptivity and proactivity in highly uncertain work environments 197 . Need-satisfying leadership, such as transformational leadership (charismatic or inspirational) 15 , can encourage job crafting and other proactive work behaviours 198 , 199 . Transactional leadership (focused on monitoring, rewarding and sanctioning) might promote self-determined motivation during organizational crises 23 . In addition, research on the quality of interconnectedness (the breadth and depth of interactions and networks) could provide insight on how to manage the increased interconnectedness workers are experiencing.

Technology can greatly assist in recruiting and selecting workers; self-determination theory can inform guidelines on how to design and use such technologies. It is important that the technology is easy to use and perceived as useful to the candidates for best representing themselves 200 , 201 . This can be done by ensuring that candidates have complete instructions before an assessment starts, even possibly getting a ‘practice run’, to improve their feelings of competence. It is also important for candidates to feel some amount of control and less pressure associated with online asynchronous assessments. Giving candidates some choice over testing platforms and the order of questions or settings, explaining how the results will be used, or allowing candidates to ask questions, could improve feelings of autonomy 70 . Finally, it is crucial to enhance perceptions that the organization cares about getting to know candidates and forging connections with them despite using these tools. For example, enhancing these tools with personalized videos of organizational members and providing candidates with feedback following selection decisions might increase feelings of relatedness. These suggestions need to be empirically tested 202 .

More research is also needed on how technology is transforming work design, and consequently influencing worker need satisfaction and motivation. Research in behavioural health has examined how digital applications that encourage healthy behaviours can be designed to fulfill the needs for competence, autonomy and relatedness 203 . Whether and how technology designed for other purposes (such as industrial robots, information communication technology, or automated decision-making systems) can be deliberately designed to meet these core human needs remains an open question. To date, little research has examined how work technologies are created, and what can be done to influence the process to create more human-centred designs. Collaborative research across social science and technical disciplines (such as engineering and computing) is needed.

In terms of implementation, although there is a long history of studies investigating the impact of technology on work design, current digital technologies are increasingly autonomous. This situation presents new challenges: a human-centred approach to automation in which the worker has transparent influence over the technical system has frequently been recommended as the optimal way to achieve high performance and to avoid automation failures 1 , 204 . But it is not clear that this work design strategy will be equally effective in terms of safety, productivity and meeting human needs when workers can no longer understand or control highly autonomous technology.

Given the likely persistence of virtual and remote work into the future, there is a critical need to understand how psychological needs can be satisfied when working remotely. Multi-wave studies that explore the boundary conditions of need satisfaction would advance knowledge around who is most likely to experience need satisfaction, when and why. Such knowledge can be leveraged to inform the design of interventions, such as supervisor training, to improve well-being and performance outcomes for virtual and remote workers. Similarly, no research to date has used self-determination theory to better understand how team virtuality affects how well team members support each other’s psychological needs. Within non-virtual teams, need satisfaction is influenced by the extent to which team members exhibit need-supportive behaviours towards each other 205 . For example, giving autonomy and empowering virtual teams is crucial for good team performance 206 . Studies that track team activities and interaction patterns, including virtual communication records, over time could be used to examine the effects of need support and thwarting between virtual team members 207 , 208 .

Finally, although most studies have shown negative effects of algorithmic management on workers’ motivation and work design characteristics, researchers should not view the effects of algorithmic management as predetermined and unchangeable. Sociotechnical aspects of the system 2 , 209 (such as transparency, privacy, accuracy, invasiveness and human control) and organizational policies surrounding their use could mitigate the motivational effects of algorithmic management. In sum, it is not algorithms that shape workers’ motivation, but how organizations design and use them 3 . Given that applications that use algorithmic management are developed mostly by computer and data scientists, sometimes with input from marketing specialists 185 , organizations would benefit from employing psychologists and human resources specialists to enhance the motivational potential of these applications.

Parker, S. K. & Grote, G. Automation, algorithms, and beyond: why work design matters more than ever in a digital world. Appl. Psychol . https://doi.org/10.1111/apps.12241 (2020).

Article   PubMed   PubMed Central   Google Scholar  

Jarrahi, M. H. et al. Algorithmic management in a work context. Big Data Soc . 8 , https://doi.org/10.1177/20539517211020332 (2021).

Langer, M. & Landers, R. N. The future of artificial intelligence at work: a review on effects of decision automation and augmentation on workers targeted by algorithms and third-party observers. Comput. Hum. Behav. 123 , 106878 (2021).

Article   Google Scholar  

Gagné, M., Parker, S. K. & Griffin, M. A. in Research Agenda for Employee Engagement in a Changing World of Work (eds Meyer, J. P. & Schneider, B.) 137–153 (Edward Elgar, 2021).

Deci, E. L. & Ryan, R. M. Intrinsic motivation and Self-Determination in Human Behavior (Plenum, 1985).

Gagné, M. & Deci, E. L. Self-determination theory and work motivation. J. Organ. Behav. 26 , 331–362 (2005).

Deci, E. L. & Ryan, R. M. The ‘what’ and ‘why’ of goal pursuits: human needs and the self-determination of behavior. Psychol. Inq. 11 , 227–268 (2000).

Van den Broeck, A., Ferris, D. L., Chang, C.-H. & Rosen, C. C. A review of self-determination theory’s basic psychological needs at work. J. Manag. 42 , 1195–1229 (2016).

Google Scholar  

Howard, J., Gagné, M. & Morin, A. J. S. Putting the pieces together: reviewing the structural conceptualization of motivation within SDT. Motiv. Emot. 44 , 846–861 (2020).

Van den Broeck, A., Howard, J. L., Van Vaerenbergh, Y., Leroy, H. & Gagné, M. Beyond intrinsic and extrinsic motivation: a meta-analysis on self-determination theory’s multidimensional conceptualization of work motivation. Organ. Psychol. Rev. 11 , 240–273 (2021).

Ryan, R. M. & Deci, E. L. Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness (Guilford, 2017).

Charbonneau, D., Barling, J. & Kelloway, E. K. Transformational leadership and sports performance: the mediating role of intrinsic motivation. J. Appl. Soc. Psychol. 31 , 1521–1534 (2001).

Eyal, O. & Roth, G. Principals’ leadership and teachers’ motivation: self-determination theory analysis. J. Educ. Adm. 49 , 256–275 (2011).

Fernet, C., Trépanier, S.-G., Austin, S., Gagné, M. & Forest, J. Transformational leadership and optimal functioning at work: on the mediating role of employees’ perceived job characteristics and motivation. Work Stress 29 , 11–31 (2015).

Hetland, H., Hetland, J., Andreassen, C. S., Pallessen, S. & Notelaers, G. Leadership and fulfillment of the three basic psychological needs at work. Career Dev. Int. 16 , 507–523 (2011).

Kovajnic, S., Schuh, S. C. & Jonas, K. Transformational leadership and performance: an experimental investigation of the mediating effects of basic needs satisfaction and work engagement. J. Occup. Organ. Psychol. 86 , 543–555 (2013).

Kovajnic, S., Schuh, S. C., Klaus, J., Quaquebeke, N. & Dick, R. How do transformational leaders foster positive employee outcomes? A self-determination-based analysis of employees’ needs as mediating links. J. Organ. Behav. 33 , 1031–1052 (2012).

Lian, H., Lance Ferris, D. & Brown, D. J. Does taking the good with the bad make things worse? How abusive supervision and leader–member exchange interact to impact need satisfaction and organizational deviance. Organ. Behav. Hum. Decis. Process. 117 , 41–52 (2012).

Slemp, G. R., Kern, M. L., Patrick, K. J. & Ryan, R. M. Leader autonomy support in the workplace: a meta-analytic review. Motiv. Emot. 42 , 706–724 (2018).

Tims, M., Bakker, A. B. & Xanthopoulou, D. Do transformational leaders enhance their followers’ daily work engagement? Leadersh. Q. 22 , 121–131 (2011).

Wang, Z. N. & Gagné, M. A Chinese–Canadian cross-cultural investigation of transformational leadership, autonomous motivation and collectivistic value. J. Leadersh. Organ. Stud. 20 , 134–142 (2013).

Bono, J. E. & Judge, T. A. Self-concordance at work: understanding the motivational effects of transformational leaders. Acad. Manage. J. 46 , 554–571 (2003).

Gagné, M. et al. Uncovering relations between leadership perceptions and motivation under different organizational contexts: a multilevel cross-lagged analysis. J. Bus. Psychol. 35 , 713–732 (2020).

Cerasoli, C. P., Nicklin, J. M. & Ford, M. T. Intrinsic motivation and extrinsic incentives jointly predict performance: a 40-year meta-analysis. Psychol. Bull. 140 , 980–1008 (2014).

Article   PubMed   Google Scholar  

Cerasoli, C. P., Nicklin, J. M. & Nassrelgrgawi, A. S. Performance, incentives, and needs for autonomy, competence, and relatedness: a meta-analysis. Motiv. Emot. 40 , 781–813 (2016).

Deci, E. L., Koestner, R. & Ryan, R. M. A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychol. Bull. 125 , 627–668 (1999).

Kuvaas, B., Buch, R., Gagné, M., Dysvik, A. & Forest, J. Do you get what you pay for? Sales incentives and implications for motivation and changes in turnover intention and work effort. Motiv. Emot. 40 , 667–680 (2016).

Kuvaas, B., Shore, L. M., Buch, R. & Dysvik, A. Social and economic exchange relationships and performance contingency: differential effects of variable pay and base pay. Int. J. Hum. Resour. Manag. 31 , 408–431 (2020).

Nordgren Selar, A., Sverke, M., Falkenberg, H. & Gagné, M. It’s [not] all’bout the money: the relative importance of performance-based pay and support for psychological needs for job performance. Scand. J. Work Organ. Psychol. 5 , 1–14 (2020).

Olafsen, A. H., Halvari, H., Forest, J. & Deci, E. L. Show them the money? The role of pay, managerial need support, and justice in a self-determination theory model of intrinsic work motivation. Scand. J. Psychol. 56 , 447–457 (2015).

Parker, S. K., Wall, T. D. & Jackson, P. R. ‘That’s not my job’: developing flexible employee work orientations. Acad. Manage. J. 40 , 899–929 (1997).

Parker, S. L., Bell, K., Gagné, M., Carey, K. & Hilpert, T. Collateral damage associated with performance-based pay: the role of stress appraisals. Eur. J. Work Organ. Psychol. 28 , 691–707 (2019).

Thibault Landry, A., Forest, J., Zigarmi, D., Houson, D. & Boucher, É. The carrot or the stick? Investigating the functional meaning of cash rewards and their motivational power according to self-determination theory. Compens. Benefits Rev. 49 , 9–25 (2017).

Thibault Landry, A., Forest, J. & Zigarmi, D. Revisiting the use of cash rewards in the workplace: evidence of their differential impact on employees’ experiences in three samples using self-determination theory. Compens. Benefits Rev. 51 , 92–111 (2019).

Van den Broeck, A., Vansteenkiste, M., De Witte, H. & Lens, W. Explaining the relationships between job characteristics, burnout, and engagement: the role of basic psychological need satisfaction. Work Stress 22 , 277–294 (2008).

Weibel, A., Rost, K. & Osterloh, M. Pay for performance in the public sector — benefits and (hidden) costs. J. Public Adm. Res. Theory 20 , 387–412 (2010).

White, M. H. & Sheldon, K. M. The contract year syndrome in the NBA and MLB: a classic undermining pattern. Motiv. Emot. 38 , 196–205 (2014).

Bakker, A. B. & van Woerkom, M. Flow at work: a self-determination perspective. Occup. Health Sci. 1 , 47–65 (2017).

Tims, M., Bakker, A. B. & Derks, D. Development and validation of the job crafting scale. J. Vocat. Behav. 80 , 173–186 (2012).

Parker, S. K., Bindl, U. K. & Strauss, K. Making things happen: a model of proactive motivation. J. Manag. 36 , 827–856 (2010).

Amabile, T. M. Effects of external evaluations on artistic creativity. J. Pers. Soc. Psychol. 37 , 221–233 (1979).

Amabile, T. M. Motivation and creativity: effects of motivational orientation on creative writers. J. Pers. Soc. Psychol. 48 , 393–399 (1985).

Amabile, T. M., Hennessey, B. A. & Grossman, B. S. Social influences on creativity: the effects of contracted-for reward. J. Pers. Soc. Psychol. 50 , 14–23 (1986).

Boggiano, A. K., Flink, C., Shields, A., Seelbach, A. & Barrett, M. Use of techniques promoting students’ self-determination: effects on students’ analytic problem-solving skills. Motiv. Emot. 17 , 319–336 (1993).

Fabes, R. A., Moran, J. D. & McCullers, J. C. The hidden costs of reward and WAIS subscale performance. Am. J. Psychol. 94 , 387–398 (1981).

Koestner, R., Ryan, R. M., Bernieri, F. & Holt, K. Setting limits on children’s behavior: the differential effects of controlling vs informational styles on intrinsic motivation and creativity. J. Pers. 52 , 231–248 (1984).

McGraw, K. O. in The Hidden Costs of Reward (eds Lepper. M. R. & Greene, D.) 33–60 (Erlbaum, 1978).

McGraw, K. O. & McCullers, J. C. Evidence of a detrimental effect of extrinsic incentives on breaking a mental set. J. Exp. Soc. Psychol. 15 , 285–294 (1979).

Utman, C. H. Performance effects of motivational state: a meta-analysis. Personal. Soc. Psychol. Rev. 1 , 170–182 (1997).

Vansteenkiste, M., Simons, J., Lens, W., Sheldon, K. M. & Deci, E. L. Motivating, learning, performance, and persistence: the synergistic effects of intrinsic goal contents and autonomy-supportive contexts. J. Pers. Soc. Psychol. 87 , 246–260 (2004).

Van Dijk, J. The Digital Divide (Wiley, 2020).

Latham, G. P. & Ernst, C. T. Keys to motivating tomorrow’s workforce. Hum. Resour. Manag. Rev. 16 , 181–198 (2006).

Yang, L. et al. The effects of remote work on collaboration among information workers. Nat. Hum. Behav . 6 , 43–54 (2022).

Griffin, M. A., Neal, A. & Parker, S. K. A new model of work role performance: positive behavior in uncertain and interdependent contexts. Acad. Manage. J. 50 , 327–347 (2007).

Griffin, M. A. & Grote, G. When is more uncertainty better? A model of uncertainty regulation and effectiveness. Acad. Manage. Rev. 45 , 745–765 (2020).

Van Den Bos, K. & Lind, E. A. in Handbook of the Uncertain Self (eds Arkin, R. M., Oleson, K. C. & Carroll, P. J.) 122–141 (Routledge, 2013).

Amabile, T. M. The social psychology of creativity: a componential conceptualization. J. Pers. Soc. Psychol. 45 , 357–376 (1983).

Gagné, M., Forest, J., Vansteenkiste, M., Crevier-Braud, L. & Broeck, A. The multidimensional work motivation scale: validation evidence in seven languages and nine countries. Eur. J. Work Organ. Psychol. 24 , 178–196 (2015).

Wall, T. D. & Jackson, P. R. in The Changing Nature of Work (ed. Howard, A.) 139–174 (Jossey-Bass, 1995).

Sturm, T. et al. Coordinating human and machine learning for effective organizational learning. MIS Q. 45 , 1581–1602 (2021).

Hislop, D. et al. Variability in the use of mobile ICTs by homeworkers and its consequences for boundary management and social isolation. Inf. Organ. 25 , 222–232 (2015).

Kellogg, K. C., Orlikowski, W. J. & Yates, J. Life in the trading zone: structuring coordination across boundaries in postbureaucratic organizations. Organ. Sci. 17 , 22–44 (2006).

Lisitsa, E. et al. Loneliness among young adults during covid-19 pandemic: the mediational roles of social media use and social support seeking. J. Soc. Clin. Psychol. 39 , 708–726 (2020).

Bhardwaj, S., Bhattacharya, S., Tang, L. & Howell, K. E. Technology introduction on ships: the tension between safety and economic rationality. Saf. Sci. 115 , 329–338 (2019).

Rani, U. & Furrer, M. Digital labour platforms and new forms of flexible work in developing countries: algorithmic management of work and workers. Compet. Change 25 , 212–236 (2021).

Schörpf, P., Flecker, J., Schönauer, A. & Eichmann, H. Triangular love–hate: management and control in creative crowdworking. N. Technol. Work Employ. 32 , 43–58 (2017).

World Economic Forum. The future of jobs: employment, skills and workforce strategy for the fourth industrial revolution. WEF https://www.weforum.org/reports/the-future-of-jobs (2016).

World Economic Forum. The future of jobs report 2020. WEF https://www.weforum.org/reports/the-future-of-jobs-report-2020 (2020).

Woods, S. A., Ahmed, S., Nikolaou, I., Costa, A. C. & Anderson, N. R. Personnel selection in the digital age: a review of validity and applicant reactions, and future research challenges. Eur. J. Work Organ. Psychol. 29 , 64–77 (2020).

Lukacik, E.-R., Bourdage, J. S. & Roulin, N. Into the void: a conceptual model and research agenda for the design and use of asynchronous video interviews. Hum. Resour. Manag. Rev . 32 , 100789 (2020).

Dunlop, P. D., Holtrop, D. & Wee, S. How asynchronous video interviews are used in practice: a study of an Australian-based AVI vendor. Int. J. Sel. Assess . https://doi.org/10.1111/ijsa.12372 (2022).

Armstrong, M. B., Ferrell, J. Z., Collmus, A. B. & Landers, R. N. Correcting misconceptions about gamification of assessment: more than SJTs and badges. Ind. Organ. Psychol. 9 , 671–677 (2016).

Armstrong, M. B. Landers, R. N. & Collmus, A. B. in Emerging Research and Trends in Gamification (eds Gangadharbatla, H. & Davis, D. Z.) 140–165 (IGI Global, 2016).

Kotlyar, I. & Krasman, J. Virtual simulation: new method for assessing teamwork skills. Int. J. Sel. Assess . https://doi.org/10.1111/ijsa.12368 (2021).

Alexander, A. L., Brunyé, T. T., Sidman, J. & Weil, S. A. From Gaming to Training: A Review of Studies on Fidelity, Immersion, Presence, and Buy-in and Their Effects on Transfer in PC-Based Simulations and Games (DARWARS Training Impact Group, 2005).

Buil, I., Catalán, S. & Martínez, E. Understanding applicants’ reactions to gamified recruitment. J. Bus. Res. 110 , 41–50 (2020).

Basch, J. M. & Melchers, K. G. The use of technology-mediated interviews and their perception from the organization’s point of view. Int. J. Sel. Assess . 29 , 495–502 (2021).

Raghavan, M., Barocas, S., Kleinberg, J. & Levy, K. in Proc. 2020 Conf. Fairness Account. Transparency 469–481 (ACM, 2020).

Tippins, N. T., Oswald, F. L. & McPhail, S. M. Scientific, legal, and ethical concerns about AI-based personnel selection tools: a call to action. Pers. Assess. Decis . 7 , 1 (2021).

Hausknecht, J. P., Day, D. V. & Thomas, S. C. Applicant reactions to selection procedures: an updated model and meta-analysis. Pers. Psychol. 57 , 639–683 (2004).

Auer, E. M., Mersy, G., Marin, S., Blaik, J. & Landers, R. N. Using machine learning to model trace behavioral data from a game-based assessment. Int. J. Sel. Assess. 30 , 82–102 (2021).

Cook, R., Jones-Chick, R., Roulin, N. & O’Rourke, K. Job seekers’ attitudes toward cybervetting: scale development, validation, and platform comparison. Int. J. Sel. Assess. 28 , 383–398 (2020).

Langer, M., König, C. J. & Hemsing, V. Is anybody listening? The impact of automatically evaluated job interviews on impression management and applicant reactions. J. Manag. Psychol. 35 , 271–284 (2020).

Guchait, P., Ruetzler, T., Taylor, J. & Toldi, N. Video interviewing: a potential selection tool for hospitality managers — a study to understand applicant perspective. Int. J. Hosp. Manag. 36 , 90–100 (2014).

Vansteenkiste, M. et al. Autonomous and controlled regulation of performance-approach goals: their relations to perfectionism and educational outcomes. Motiv. Emot. 34 , 333–353 (2010).

McCarthy, J. M. et al. Applicant perspectives during selection: a review addressing “so what?,” “what’s new?,” and “where to next?” J. Manag. 43 , 1693–1725 (2017).

Jesuthasan, R. & Boudreau, J. W. Reinventing Jobs: A Four-Step Approach for Applying Automation to Work (Harvard Business, 2018).

Brynjolfsson, E., Mitchell, T. & Rock, D. What can machines learn, and what does it mean for occupations and the economy? AEA Pap. Proc. 108 , 43–47 (2018).

Hackman, J. R. & Lawler, E. E. Employee reactions to job characterisitics. J. Appl. Psychol. 55 , 259–286 (1971).

Hackman, J. R. & Oldham, G. R. Development of the job diagnostics survey. J. Appl. Psychol. 60 , 159–170 (1975).

Parker, S. K., Wall, T. D. & Cordery, J. L. Future work design research and practice: towards an elaborated model of work design. J. Occup. Organ. Psychol. 74 , 413–440 (2001).

Humphrey, S. E., Nahrgang, J. D. & Morgeson, F. P. Integrating motivational, social and contextual work design features: a meta-analytic summary and theoretical extension of the work design literature. J. Appl. Psychol. 92 , 1332–1356 (2007).

Gagné, M. & Panaccio, A. in Oxford Handbook of Employee Engagement, Motivation, and Self-Determination Theory (ed. Gagné, M.) 165–180 (Oxford Univ. Press, 2014).

Demerouti, E., Bakker, A. B., Nachreiner, F. & Schaufeli, W. B. The job demands–resources model of burnout. J. Appl. Psychol. 86 , 499–512 (2001).

Bakker, A. B. & Demerouti, E. Job demands–resources theory: taking stock and looking forward. J. Occup. Health Psychol. 22 , 273–285 (2017).

Bakker, A. B., Demerouti, E. & Euwema, M. C. Job resources buffer the impact of job demands on burnout. J. Occup. Health Psychol. 10 , 170–180 (2005).

Walsh, S. M. & Strano, M. S. Robotic Systems and Autonomous Platforms (Woodhead, 2019).

Waschull, S., Bokhorst, J. A. C., Molleman, E. & Wortmann, J. C. Work design in future industrial production: transforming towards cyber-physical systems. Comput. Ind. Eng. 139 , 105679 (2020).

Haslbeck, A. & Hoermann, H.-J. Flying the needles: flight deck automation erodes fine-motor flying skills among airline pilots. Hum. Factors 58 , 533–545 (2016).

Lehdonvirta, V. & Ernkvist, M. Knowledge Map of the Virtual Economy: Converting the Virtual Economy into Development Potential (World Bank, 2011).

Kittur, A. et al. in Proc. 2013 Conf. Comput. Support. Coop. Work 1301–1318 (ACM, 2013).

Beane, M. Shadow learning: building robotic surgical skill when approved means fail. Adm. Sci. Q. 64 , 87–123 (2019).

Mohlmann, M. & Zalmanson, L. in Proc. Int. Conf. Inf. Syst. 1–17 (ICIS, 2017).

Ohly, S. & Fritz, C. Work characteristics, challenge appraisal, creativity, and proactive behavior: a multi-level study. J. Organ. Behav. 31 , 543–565 (2010).

Wang, B., Liu, Y. & Parker, S. K. How does the use of information communication technology affect individuals? A work design perspective. Acad. Manag. Ann. 14 , 695–725 (2020).

Orlikowski, W. J. The duality of technology: rethinking the concept of technology in organizations. Organ. Sci. 3 , 398–427 (1992).

Kadir, B. A. & Broberg, O. Human-centered design of work systems in the transition to industry 4.0. Appl. Ergon. 92 , 103334 (2021).

Bloom, N. How working from home works out (Stanford Univ., 2020).

Bailenson, J. N. Nonverbal overload: a theoretical argument for the causes of Zoom fatigue. Technol. Mind Behav . https://doi.org/10.1037/tmb0000030 (2021).

Jun, H. & Bailenson, J. N. in International Handbook of Emotions and Media (eds Döveling, K. & Konijn, E. A.) 303–315 (Routledge, 2021).

Ratan, R., Miller, D. B. & Bailenson, J. N. Facial appearance dissatisfaction explains differences in zoom fatigue. Cyberpsychol. Behav. Soc. Netw. 25 , 124–129 (2021).

Riedl, R. On the stress potential of videoconferencing: definition and root causes of Zoom fatigue. Electron. Mark. https://doi.org/10.1007/s12525-021-00501-3 (2021).

Shockley, K. M. et al. The fatiguing effects of camera use in virtual meetings: a within-person field experiment. J. Appl. Psychol. 106 , 1137–1155 (2021).

Raghuram, S., Garud, R., Wiesenfeld, B. & Gupta, V. Factors contributing to virtual work adjustment. J. Manag. 27 , 383–405 (2001).

Raghuram, S., Wiesenfeld, B. & Garud, R. Technology enabled work: the role of self-efficacy in determining telecommuter adjustment and structuring behavior. J. Vocat. Behav. 63 , 180–198 (2003).

Muraven, M. Autonomous self-control is less depleting. J. Res. Personal. 42 , 763–770 (2008).

Muraven, M., Gagne, M. & Rosman, H. Helpful self-control: autonomy support, vitality, and depletion. J. Exp. Soc. Psychol. 44 , 573–585 (2008).

Feldman, D. C. & Gainey, T. W. Patterns of telecommuting and their consequences: framing the research agenda. Hum. Resour. Manag. Rev. 7 , 369–388 (1997).

Gajendran, R. S. & Harrison, D. A. The good, the bad, and the unknown about telecommuting: meta-analysis of psychological mediators and individual consequences. J. Appl. Psychol. 92 , 1524–1541 (2007).

Perry, S. J., Rubino, C. & Hunter, E. M. Stress in remote work: two studies testing the demand-control-person model. Eur. J. Work Organ. Psychol. 27 , 577–593 (2018).

Kossek, E. E., Lautsch, B. A. & Eaton, S. C. Telecommuting, control, and boundary management: correlates of policy use and practice, job control, and work–family effectiveness. J. Vocat. Behav. 68 , 347–367 (2006).

Johnson, A. et al. A review and agenda for examining how technology-driven changes at work will impact workplace mental health and employee well-being. Aust. J. Manag. 45 , 402–424 (2020).

Parent-Rocheleau, X. & Parker, S. K. Algorithms as work designers: how algorithmic management influences the design of jobs. Hum. Resour. Manag. Rev. https://doi.org/10.1016/j.hrmr.2021.100838 (2021).

Seppälä, T., Lipponen, J., Pirttila-Backman, A.-M. & Lipsanen, J. Reciprocity of trust in the supervisor–subordinate relationship: the mediating role of autonomy and the sense of power. Eur. J. Work Organ. Psychol. 20 , 755–778 (2011).

Parker, S. K., Knight, C. & Keller, A. Remote Managers Are Having Trust Issues (Harvard Business, 2020).

Staples, D. S. A study of remote workers and their differences from non-remote workers. J. End User Comput. 13 , 3–14 (2001).

Enzle, M. E. & Anderson, S. C. Surveillant intentions and intrinsic motivation. J. Pers. Soc. Psychol. 64 , 257–266 (1993).

Senécal, C., Vallerand, R. J. & Guay, F. Antecedents and outcomes of work-family conflict: toward a motivational model. Pers. Soc. Psychol. Bull. 27 , 176–186 (2001).

Aiello, J. R. & Shao, Y. in Human–Computer Interaction: Applications and Case Studies (eds Smith, M. J. & Salvendy, G.) 1011–1016 (Elsevier Science, 1993).

Griffith, T. L. Monitoring and performance: a comparison of computer and supervisor monitoring. J. Appl. Soc. Psychol. 23 , 549–572 (1993).

Stone, E. F. & Stone, D. L. in Research in Personnel and Human Resource Management Vol. 8 (eds Ferris, G. R. & Rowland, K. M.) 349–411 (JAI, 1990).

Wells, D. L., Moorman, R. H. & Werner, J. M. The impact of the perceived purpose of electronic performance monitoring on an array of attitudinal variables. Hum. Resour. Dev. Q. 18 , 121–138 (2007).

Ravid, D. M., Tomczak, D. L., White, J. C. & Behrend, T. S. EPM 20/20: a review, framework, and research agenda for electronic performance monitoring. J. Manag. 46 , 100–126 (2020).

De Tienne, K. B. & Abbott, N. T. Developing an employee-centered electronic monitoring system. J. Syst. Manag. 44 , 12–13 (1993).

Stanton, J. M. & Barnes-Farrell, J. L. Effects of electronic performance monitoring on personal control, task satisfaction, and task performance. J. Appl. Psychol. 81 , 738–745 (1996).

Day, A., Barber, L. K. & Tonet, J. in The Cambridge Handbook of Technology and Employee Behavior (ed. Landers, R. N.) 580–607 (Cambridge Univ. Press, 2019).

Day, A., Scott, N. & Kevin Kelloway, E. in New Developments in Theoretical and Conceptual Approaches to Job Stress Vol. 8 (eds Perrewé, P. L. & Ganster, D. C.) 317–350 (Emerald, 2010).

Cooper, C. D. & Kurland, N. B. Telecommuting, professional isolation, and employee development in public and private organizations. J. Organ. Behav. 23 , 511–532 (2002).

Coltrane, S., Miller, E. C., DeHaan, T. & Stewart, L. Fathers and the flexibility stigma. J. Soc. Issues 69 , 279–302 (2013).

Bloom, N., Liang, J., Roberts, J. & Ying, Z. J. Does working from home work? evidence from a Chinese experiment. Q. J. Econ. 130 , 165–218 (2014).

Charalampous, M., Grant, C. A., Tramontano, C. & Michailidis, E. Systematically reviewing remote e-workers’ well-being at work: a multidimensional approach. Eur. J. Work Organ. Psychol. 28 , 51–73 (2019).

Bloom, N. Don’t Let Employees Pick Their WFH Days (Harvard Business, 2021).

Schade, H. M., Digutsch, J., Kleinsorge, T. & Fan, Y. Having to work from home: basic needs, well-being, and motivation. Int. J. Environ. Res. Public Health 18 , 1–18 (2021).

Morganson, V. J., Major, D. A., Oborn, K. L., Verive, J. M. & Heelan, M. P. Comparing telework locations and traditional work arrangements: differences in work–life balance support, job satisfaction, and inclusion. J. Manag. Psychol. 25 , 578–595 (2010).

Golden, T. D., Veiga, J. F. & Dino, R. N. The impact of professional isolation on teleworker job performance and turnover intentions: does time spent teleworking, interacting face-to-face, or having access to communication-enhancing technology matter? J. Appl. Psychol. 93 , 1412–1421 (2008).

Peiperl, M. & Baruch, Y. Back to square zero: the post-corporate career. Organ. Dyn. 25 , 7–22 (1997).

Akkirman, A. D. & Harris, D. L. Organizational communication satisfaction in the virtual workplace. J. Manag. Dev. 24 , 397–409 (2005).

Golden, T. D. & Veiga, J. F. The impact of extent of telecommuting on job satisfaction: resolving inconsistent findings. J. Manag. 31 , 301–318 (2005).

Goldfarb, Y., Gal, E. & Golan, O. Implications of employment changes caused by COVID-19 on mental health and work-related psychological need satisfaction of autistic employees: a mixed-methods longitudinal study. J. Autism Dev. Disord . 52 , 89–102 (2022).

O’Neill, T. A. & Salas, E. Creating high performance teamwork in organizations. Hum. Resour. Manag. Rev. 28 , 325–331 (2018).

Hollenbeck, J. R., Beersma, B. & Schouten, M. E. Beyond team types and taxonomies: a dimensional scaling conceptualization for team description. Acad. Manage. Rev. 37 , 82–106 (2012).

Gilson, L. L., Maynard, M. T., Young, N. C. J., Vartiainen, M. & Hakonen, M. Virtual teams research: 10 years, 10 themes, and 10 opportunities. J. Manag. 41 , 1313–1337 (2015).

Raghuram, S., Hill, N. S., Gibbs, J. L. & Maruping, L. M. Virtual work: bridging research clusters. Acad. Manag. Ann. 13 , 308–341 (2019).

Handke, L., Klonek, F. E., Parker, S. K. & Kauffeld, S. Interactive effects of team virtuality and work design on team functioning. Small Group. Res. 51 , 3–47 (2020).

Foster, M. K., Abbey, A., Callow, M. A., Zu, X. & Wilbon, A. D. Rethinking virtuality and its impact on teams. Small Group. Res. 46 , 267–299 (2015).

Lautsch, B. A. & Kossek, E. E. Managing a blended workforce: telecommuters and non-telecommuters. Organ. Dyn. 40 , 10–17 (2011).

Mesmer-Magnus, J. R., DeChurch, L. A., Jimenez-Rodriguez, M., Wildman, J. & Shuffler, M. A meta-analytic investigation of virtuality and information sharing in teams. Organ. Behav. Hum. Decis. Process 115 , 214–225 (2011).

Mathieu, J. & Gilson, L. in Oxford Handbook of Organizational Psychology Vol. 2 (ed. Kozlowski, S. W.) 910–930 (Oxford Univ. Press, 2012).

Chen, G. & Kanfer, R. Toward a systems theory of motivated behavior in work teams. Res. Organ. Behav. 27 , 223–267 (2006).

Marks, M. A., Mathieu, J. E. & Zaccaro, S. J. A temporally based framework and taxonomy of team processes. Acad. Manage. Rev. 26 , 356–376 (2001).

Beal, D. J., Cohen, R. R., Burke, M. J. & McLendon, C. L. Cohesion and performance in groups: a meta-analytic clarification of construct relations. J. Appl. Psychol. 88 , 989–1004 (2003).

de Jong, B., Dirks, K. T. & Gillespie, N. M. Trust and team performance: a meta-analysis of main effects, moderators, and covariates. J. Appl. Psychol. 101 , 1134–1150 (2016).

Barrick, M. R., Thurgood, G. R., Smith, T. A. & Courtright, S. H. Collective organizational engagement: linking motivational antecedents, strategic implementation, and firm performance. Acad. Manage. J. 58 , 111–135 (2015).

Waller, M. J., Okhuysen, G. A. & Saghafian, M. Conceptualizing emergent states: a strategy to advance the study of group dynamics. Acad. Manag. Ann. 10 , 561–598 (2016).

Breuer, C., Hüffmeier, J. & Hertel, G. Does trust matter more in virtual teams? A meta-analysis of trust and team effectiveness considering virtuality and documentation as moderators. J. Appl. Psychol. 101 , 1151–1177 (2016).

Gagne, M. A model of knowledge-sharing motivation. Hum. Resour. Manage. 48 , 571–589 (2009).

Sewell, G. & Taskin, L. Out of sight, out of mind in a new world of work? Autonomy, control, and spatiotemporal scaling in telework. Organ. Stud. 36 , 1507–1529 (2015).

Tietze, S. & Nadin, S. The psychological contract and the transition from office-based to home-based work. Hum. Resour. Manag. J. 21 , 318–334 (2011).

Orsini, C. & Rodrigues, V. Supporting motivation in teams working remotely: the role of basic psychological needs. Med. Teach. 42 , 828–829 (2020).

Ragu-Nathan, T. S., Tarafdar, M., Ragu-Nathan, B. S. & Tu, Q. The consequences of technostress for end users in organizations: conceptual development and empirical validation. Inf. Syst. Res. 19 , 417–433 (2008).

Lee, M. K. Understanding perception of algorithmic decisions: fairness, trust, and emotion in response to algorithmic management. Big Data Soc. 5 , 2053951718756684 (2018).

Gal, U., Jensen, T. B. & Stein, M.-K. Breaking the vicious cycle of algorithmic management: a virtue ethics approach to people analytics. Inf. Organ. 30 , 100301 (2020).

Rosenblat, A. Uberland: How Algorithms are Rewriting the Rules of Work (Univ. California Press, 2018).

Charbonneau, É. & Doberstein, C. An empirical assessment of the intrusiveness and reasonableness of emerging work surveillance technologies in the public sector. Public Adm. Rev. 80 , 780–791 (2020).

Levy, K. E. C. The contexts of control: information, power, and truck-driving work. Inf. Soc. 31 , 160–174 (2015).

Vargas, T. L. Consumer redlining and the reproduction of inequality at dollar general. Qual. Sociol. 44 , 205–229 (2021).

Stark, D. & Pais, I. Algorithmic management in the platform economy. Sociologica 14 , 47–72 (2020).

Schafheitle, S. et al. No stone left unturned? Toward a framework for the impact of datafication technologies on organizational control. Acad. Manag. Discov. 6 , 455–487 (2020).

Norlander, P., Jukic, N., Varma, A. & Nestorov, S. The effects of technological supervision on gig workers: organizational control and motivation of Uber, taxi, and limousine drivers. Int. J. Hum. Resour. Manag. 32 , 4053–4077 (2021).

Carayon, P. Effects of electronic performance monitoring on job design and worker stress: results of two studies. Int. J. Human–Computer Interact. 6 , 177–190 (1994).

Moore, S. & Hayes, L. J. B. in Humans and Machines At Work: Dynamics of Virtual Work (eds. Moore, P. V., Upchurch, M. & Whittaker, X.) 101–124 (Palgrave Macmillan, 2018).

De Cremer, D. Leadership by Algorithm (Harriman House, 2020).

Goods, C., Veen, A. & Barratt, T. “Is your gig any good?” Analysing job quality in the Australian platform-based food-delivery sector. J. Ind. Relat. 61 , 502–527 (2019).

Wood, A. J., Graham, M., Lehdonvirta, V. & Hjorth, I. Good gig, bad gig: autonomy and algorithmic control in the global gig economy. Work Employ. Soc. 33 , 56–75 (2019).

Duggan, J., Sherman, U., Carbery, R. & McDonnell, A. Algorithmic management and app-work in the gig economy: a research agenda for employment relations and HRM. Hum. Resour. Manag. J. 30 , 114–132 (2020).

Reid-Musson, E., MacEachen, E. & Bartel, E. ‘Don’t take a poo!’: worker misbehaviour in on-demand ride-hail carpooling. N. Technol. Work Employ. 35 , 145–161 (2020).

Anthony, C. When knowledge work and analytical technologies collide: the practices and consequences of black boxing algorithmic technologies. Adm. Sci. Q . 66 , 1173–1212 (2021).

Zednik, C. Solving the black box problem: a normative framework for explainable artificial intelligence. Phil. Technol. 34 , 265–288 (2021).

Schlicker, N. et al. What to expect from opening up ‘black boxes’? Comparing perceptions of justice between human and automated agents. Comput. Hum. Behav. 122 , 106837 (2021).

Terry, E., Marks, A., Dakessian, A. & Christopoulos, D. Emotional labour and the autonomy of dependent self-employed workers: the limitations of digital managerial control in the home credit sector. Work Employ. Soc . https://doi.org/10.1177/0950017020979504 (2021).

Gregory, K. ‘My life is more valuable than this’: understanding risk among on-demand food couriers in Edinburgh. Work Employ. Soc. 35 , 316–331 (2021).

Dweck, C. S. & Leggett, E. L. A social-cognitive approach to motivation and personality. Psychol. Rev. 25 , 109–116 (1988).

Wesche, J. S. & Sonderegger, A. When computers take the lead: the automation of leadership. Comput. Hum. Behav. 101 , 197–209 (2019).

Duggan, J., Sherman, U., Carbery, R. & McDonnell, A. Boundaryless careers and algorithmic constraints in the gig economy. Int. J. Hum. Resour. Manag . https://doi.org/10.1080/09585192.2021.1953565 (2021).

Timko, P. & van Melik, R. Being a Deliveroo rider: practices of platform labor in Nijmegen and Berlin. J. Contemp. Ethnogr. 50 , 497–523 (2021).

Leclercq-Vandelannoitte, A. An ethical perspective on emerging forms of ubiquitous IT-based control. J. Bus. Ethics 142 , 139–154 (2017).

Cai, Z., Parker, S. K., Chen, Z. & Lam, W. How does the social context fuel the proactive fire? A multilevel review and theoretical synthesis. J. Organ. Behav. 40 , 209–230 (2019).

Hetland, J., Hetland, H., Bakker, A. B. & Demerouti, E. Daily transformational leadership and employee job crafting: the role of promotion focus. Eur. Manag. J. 36 , 746–756 (2018).

Schmitt, A., Den Hartog, D. N. & Belschak, F. D. Transformational leadership and proactive work behaviour: a moderated mediation model including work engagement and job strain. J. Occup. Organ. Psychol. 89 , 588–610 (2016).

Lee, Y., Lee, J. & Hwang, Y. Relating motivation to information and communication technology acceptance: self-determination theory perspective. Comput. Hum. Behav. 51 , 418–428 (2015).

Nikou, S. A. & Economides, A. A. Mobile-based assessment: integrating acceptance and motivational factors into a combined model of self-determination theory and technology acceptance. Comput. Hum. Behav. 68 , 83–95 (2017).

Basch, J. M. et al. A good thing takes time: the role of preparation time in asynchronous video interviews. Int. J. Sel. Assess. 29 , 378–392 (2021).

Peters, D., Calvo, R. A. & Ryan, R. M. Designing for motivation, engagement and wellbeing in digital experience. Front. Psychol. 9 , 797 (2018).

Grote, G., Ryser, C., Wäfler, T., Windischer, A. & Weik, S. KOMPASS: a method for complementary function allocation in automated work systems. Int. J. Hum. Comput. Stud. 52 , 267–287 (2000).

Jungert, T., Van den Broeck, A., Schreurs, B. & Osterman, U. How colleagues can support each other’s needs and motivation: an intervention on employee work motivation. Appl. Psychol. 67 , 3–29 (2018).

Kirkman, B. L., Rosen, B., Tesluk, P. E. & Gibson, C. B. The impact of team empowerment on virtual team performance: the moderating role of face-to-face interaction. Acad. Manage. J. 47 , 175–192 (2004).

Klonek, F., Gerpott, F. H., Lehmann-Willenbrock, N. & Parker, S. K. Time to go wild: how to conceptualize and measure process dynamics in real teams with high-resolution. Organ. Psychol. Rev. 9 , 245–275 (2019).

Waller, M. J., Uitdewilligen, S., Rico, R. & Thommes, M. S. in The Emerald Handbook of Group and Team Communication Research (eds Beck, S. J., Keyton, J. & Poole, M. S.) 135–153 (Emerald, 2021).

Makarius, E. E., Mukherjee, D., Fox, J. D. & Fox, A. K. Rising with the machines: a sociotechnical framework for bringing artificial intelligence into the organization. J. Bus. Res. 120 , 262–273 (2020).

Lythreatis, S., Singh, S. K. & El-Kassar, A.-N. The digital divide: a review and future research agenda. Technol. Forecast. Soc. Change 175 , 121359 (2021).

Lai, J. & Widmar, N. O. Revisiting the digital divide in the COVID-19 era. Appl. Econ. Perspect. Policy 43 , 458–464 (2021).

Gran, A.-B., Booth, P. & Bucher, T. To be or not to be algorithm aware: a question of a new digital divide? Inf. Commun. Soc. 24 , 1779–1796 (2021).

Parker, S. K. & Andrei, D. M. Include, individualize, and integrate: organizational meta-strategies for mature workers. Work Aging Retire. 6 , 1–7 (2019).

Petery, G. A., Iles, L. J. & Parker, S. K. Putting successful aging into context. Ind. Organ. Psychol. 13 , 377–382 (2020).

Graf, N., Brown, A. & Patten, E. The narrowing, but persistent, gender gap in pay. Pew Research Center http://www.www.pewresearch.org/ft_18-04-06_wage_gap/ (2018).

Aksoy, C. G., Özcan, B. & Philipp, J. Robots and the gender pay gap in Europe. Eur. Econ. Rev. 134 , 103693 (2021).

Madgavkar, A., White, O., Krishnan, M., Mahajan, D. & Azcue, X. COVID-19 and gender equality: countering the regressive effects. McKinsey https://www.mckinsey.com/featured-insights/future-of-work/covid-19-and-gender-equality-countering-the-regressive-effects (2020).

Glass, J. Blessing or curse? Work–family policies and mother’s wage growth over time. Work Occup. 31 , 367–394 (2004).

Valletta, R. G. Declining job security. J. Labor. Econ. 17 , S170–S197 (1999).

Givord, P. & Maurin, E. Changes in job security and their causes: an empirical analysis for France, 1982–2002. Eur. Econ. Rev. 48 , 595–615 (2004).

Baruch, Y. & Vardi, Y. A fresh look at the dark side of contemporary careers: toward a realistic discourse. Br. J. Manag. 27 , 355–372 (2016).

Akkermans, J., Richardson, J. & Kraimer, M. L. The Covid-19 crisis as a career shock: implications for careers and vocational behavior. J. Vocat. Behav. 119 , 103434 (2020).

Gubler, M., Arnold, J. & Coombs, C. Reassessing the protean career concept: empirical findings, conceptual components, and measurement. J. Organ. Behav. 35 , S23–S40 (2014).

Hall, D. T. Careers in Organizations (Scott Foresman, 1976).

Hall, D. T. Careers In And Out Of Organizations (SAGE, 2002).

Hall, D. T. & Mirvis, P. H. in The Career Is Dead — Long Live The Career: A Relational Approach To Careers (ed. Hall, D. T.) 15–45 (Jossey-Bass, 1996).

Kernis, M. H. & Goldman, B. M. A Multicomponent Conceptualization of Authenticity: Theory and Research Vol. 38 (Zana, M. P.) 283–357 (Academic, 2006).

Ryan, W. S. & Ryan, R. M. Toward a social psychology of authenticity: exploring within-person variation in autonomy, congruence, and genuineness using self-determination theory. Rev. Gen. Psychol. 23 , 99–112 (2019).

Klotz, A. The COVID vaccine means a return to work. And a wave of resignations. NBC https://www.nbcnews.com/think/opinion/covid-vaccine-means-return-work-wave-resignations-ncna1269018 (2021).

Tharoor, I. The ‘great resignation’ goes global. Washington Post https://www.washingtonpost.com/world/2021/10/18/labor-great-resignation-global/ (2021).

Sheather, J. & Slattery, D. The great resignation — how do we support and retain staff already stretched to the limit? BJM Opinion https://blogs.bmj.com/bmj/2021/09/21/the-great-resignation-how-do-we-support-and-retain-staff-already-stretched-to-their-limit/ (2021).

Hirsch, P. B. The great discontent. J. Bus. Strategy 42 , 439–442 (2021).

Williamson, I. O. The ‘great resignation’ is a trend that began before the pandemic — and bosses need to get used to it. The Conversation https://theconversation.com/the-great-resignation-is-a-trend-that-began-before-the-pandemic-and-bosses-need-to-get-used-to-it-170197 (2021).

Hopkins, J. C. & Figaro, K. A. The great resignation: an argument for hybrid leadership. Int. J. Bus. Manag. Res. 9 , 393–400 (2021).

Gandhi, V. & Robison, J. The ‘great resignation’ is really the ‘great discontent’. Gallup https://www.gallup.com/workplace/351545/great-resignation-really-great-discontent.aspx (2021).

Warner, M. A. & Hausdorf, P. A. The positive interaction of work and family roles: using need theory to further understand the work–family interface. J. Manag. Psychol. 24 , 372–385 (2009).

Richer, S. F., Blanchard, C. & Vallerand, R. J. A motivational model of work turnover. J. Appl. Soc. Psychol. 32 , 2089–2113 (2002).

Gillet, N., Gagné, M., Sauvagère, S. & Fouquereau, E. The role of supervisor autonomy support, organizational support, and autonomous and controlled motivation in predicting employees’ satisfaction and turnover intentions. Eur. J. Work Organ. Psychol. 22 , 450–460 (2013).

Christian, A. How the great resignation is turning into the great reshuffle. BBC https://www.bbc.com/worklife/article/20211214-great-resignation-into-great-reshuffle (2021).

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Gagné, M., Parker, S.K., Griffin, M.A. et al. Understanding and shaping the future of work with self-determination theory. Nat Rev Psychol 1 , 378–392 (2022). https://doi.org/10.1038/s44159-022-00056-w

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The burden of anxiety, depression, and stress, along with the prevalence of symptoms of PTSD, and perceptions of the drivers of psychological harms, as perceived by doctors and nurses working in ICUs in Nepal during the COVID-19 pandemic; a mixed method evaluation

• Shirish KC 1 ,
• Tiffany E. Gooden 2 ,
• Diptesh Aryal 1 ,
• Kanchan Koirala 1 ,
• Subekshya Luitel 1 ,
• Rashan Haniffa 3 , 4 ,
• Abi Beane 3 , 4 on behalf of

Collaboration for Research, Implementation, and Training in Critical Care in Asia and Africa (CCAA)

BMC Health Services Research volume  24 , Article number:  450 ( 2024 ) Cite this article

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The COVID-19 pandemic resulted in significant physical and psychological impacts for survivors, and for the healthcare professionals caring for patients. Nurses and doctors in critical care faced longer working hours, increased burden of patients, and limited resources, all in the context of personal social isolation and uncertainties regarding cross-infection. We evaluated the burden of anxiety, depression, stress, post-traumatic stress disorder (PTSD), and alcohol dependence among doctors and nurses working in intensive care units (ICUs) in Nepal and explored the individual and social drivers for these impacts.

We conducted a mixed-methods study in Nepal, using an online survey to assess psychological well-being and semi-structured interviews to explore perceptions as to the drivers of anxiety, stress, and depression. Participants were recruited from existing national critical care professional organisations in Nepal and using a snowball technique. The online survey comprised of validated assessment tools for anxiety, depression, stress, PTSD, and alcohol dependence; all tools were analysed using published guidelines. Interviews were analysed using rapid appraisal techniques, and themes regarding the drivers for psychological distress were explored.

134 respondents (113 nurses, 21 doctors) completed the online survey. Twenty-eight (21%) participants experienced moderate to severe symptoms of depression; 67 (50%) experienced moderate or severe symptoms of anxiety; 114 (85%) had scores indicative of moderate to high levels of stress; 46 out of 100 reported symptoms of PTSD. Compared to doctors, nurses experienced more severe symptoms of depression, anxiety, and PTSD, whereas doctors experienced higher levels of stress than nurses. Most (95%) participants had scores indicative of low risk of alcohol dependence. Twenty participants were followed up in interviews. Social stigmatism, physical and emotional safety, enforced role change and the absence of organisational support were perceived drivers for poor psychological well-being.

Nurses and doctors working in ICU during the COVID-19 pandemic sustained psychological impacts, manifesting as stress, anxiety, and for some, symptoms of PTSD. Nurses were more vulnerable. Individual characteristics and professional inequalities in healthcare may be potential modifiable factors for policy makers seeking to mitigate risks for healthcare providers.

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Introduction

Between January 2020 and December 2021, the COVID-19 pandemic led to an estimated 18.2 million deaths [ 1 ]. Globally, healthcare systems were overwhelmed during the pandemic, with intensive care units (ICUs) receiving an unprecedented burden of patients [ 2 ]. In Nepal, the government first declared a lockdown on March 24, 2020, that lasted until July 21, 2020, and the second lockdown was announced on April 29, 2021, which was fully lifted on September 1, 2021 [ 3 ]. The first wave of the COVID-19 pandemic reached a peak of over 5000 cases a day in October 2020, and the second wave reached a peak of more than 9000 cases a day in May 2021, which was almost double [ 4 ]. Prior to the pandemic, Nepal reported a capacity of 1595 ICU beds across 194 hospitals and around 840 ventilators, equating to 2.8 ventilator-equipped ICU beds per 100,000 people [ 5 ]. To cope with the influx of COVID-19 patients, several existing postoperative wards and other high-dependency units of the hospitals were converted into improvised critical care units [ 6 ]. Globally, healthcare professionals (HCPs) and specifically those working in ICU and critical care services, arguably were at the frontline of the healthcare response. These HCPs faced the uncertainty of managing this new condition, extended working hours, limited personal protective equipment (PPE), and an increased risk of infection as they provide essential lifesaving interventions, including intubation and non-invasive respiratory management [ 7 , 8 ].

The impacts of the COVID-19 pandemic on the mental health and well-being of HCPs who worked during and after this global emergency are slowly becoming apparent. Research emerging from China, the USA, and Europe [ 9 ] describes a significant burden of psychological distress and symptoms synonymous with mental health conditions in HCPs. This is also evident from the limited studies that have been conducted in Nepal. For instance, one study conducted among 150 HCPs from outpatient clinics and inpatient wards caring for COVID-19 patients in Nepal reported that 38% of participants suffered from anxiety and/or depression [ 10 ]. Another Nepali study revealed that the prevalence of anxiety and depression among HCPs, including health assistants and support staff was 47% and 41%, respectively [ 11 ]. A larger online survey of 475 HCPs including pharmacists, paramedics and public health practitioners reported similar findings (42% had anxiety) and noted that nurses had a higher proportion of symptoms compared to other HCPs [ 12 ].. Whilst these studies, in conjunction with a meta-analysis, indicate that depression, anxiety, and post-traumatic disorder (PTSD) are highly prevalent among HCPs during the pandemic [ 9 , 10 , 11 , 12 , 13 ], fewer studies have explored the disparities between professionals’ roles, specifically among ICU workers, a group exposed to more advanced cases of COVID-19. Indeed a small study in Nepal comprising 96 nurses revealed that nurses who worked directly with COVID-19 patients experienced more severe symptoms of depression and anxiety [ 13 ]. The nature and characteristics of mental health symptoms appear to vary geographically, the HCPs’ role, their individual characteristics (age, gender) along with health system’s pre-existing resource capacity and ability to respond to increasing demand placed by events such as a pandemic. Understanding the mental health impact of ICU workers, any disparities between professional roles and drivers behind poor mental health in Nepal will help to identify what support is needed for ICU workers for pandemic preparedness; thus, providing important directions for investment in health systems strengthening.

We aimed to investigate the burden of anxiety, depression, stress, PTSD, and alcohol dependence among doctors and nurses in Nepal that worked in the ICU during the COVID-19 pandemic. We further sought to identify the factors driving the self-reported burden of psychological distress by exploring the lived experiences of these two different professional groups, and how these experiences impacted their psychological health and well-being.

Study design

We undertook a mixed-methods cross-sectional study [ 14 ] in Nepal with ICU doctors and nurses, combining an online questionnaire consisting of validated self-assessment tools combined with semi-structured interviews. The following self-reporting psychological assessment tools were used, given they have been used in previous studies in other settings and their widely validated in a variety of settings: Beck Anxiety Inventory (BAI) [ 15 ], Beck Depression Inventory (BDI) [ 16 ], Perceived Stress Scale (PSS) [ 17 ], PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5 (PCL-5) [ 18 ] and Alcohol Use Disorder identification Tool (AUDIT) [ 19 ]. BDI, BAI, and AUDIT have been validated in Nepal [ 20 , 21 , 22 ] and the PSS has been tested for reliability and correlation in Nepal [ 23 ]. Whilst the PCL-5 has not been validated in a Nepali setting, it was piloted (along with all other assessment tools used) with 20 people before the study commenced. Participants were given the flexibility to complete the questionnaire in either Nepali or English language. Despite this option, all participants opted to respond in English.

Ethics approval

was granted from the Nepal Health Research Council (approval number: 176/2021 P). All participants provided informed consent electronically before completing the online questionnaire. Participants from the qualitative component provided further informed verbal consent before the interview commenced.

In 2020, Nepal reported a capacity of 1595 ICU beds across 194 hospitals and around 840 ventilators, equating to 2.8 ventilator-equipped ICU beds per 100,000 people [ 5 ]. A year later, Nepal was under a state of health emergency, with patients being turned down due to a lack of ICU beds, oxygen, and ventilators [ 24 ].

Participants and recruitment

Doctors and nurses with experience in caring for COVID-19 patients in Nepalese ICUs were eligible for participation. Initially doctors registered with the Nepalese Society of Critical Care Medicine (NSCCM) [ 25 ] and nurses registered with the Critical Care Nurses Association of Nepal (CCNAN) [ 26 ] were contacted and invited to participate. Both organisations consist of voluntary memberships and represent the doctors and nurses working in a critical care setting in Nepal. At the time of recruitment, there were 187 doctors and 104 nurses registered at these organisations. This initial purposive sampling was augmented by snowballing techniques, whereby respondents were invited to forward the questionnaire link to other doctors or nurses working in ICUs [ 27 ]. Following completion of the questionnaire, respondents were invited to participate in a virtual interview. A convenience sample of 20 participants (a number which, based on the literature, was likely to provide saturation of findings [ 28 ]) was subsequently scheduled for an interview.

Study materials and data collection

The questionnaire was developed using an online survey platform (Google Forms) [ 29 ]. The questionnaire was piloted for readability and responder reliability with twenty HCPs based in Nepal, prior to roll out, who did not participate in the final analysis. Questionnaire content included socio-demographic information; age, sex, professional role and experience, degree of schooling, and home living arrangements; factors which had been identified as being important in the burden of psychological distress and impact on family life in similar research conducted during the previous SARS pandemic as well as the current COVID-19 event [ 30 ]. Participants could opt out of the study at any time. Participants could only complete the questionnaire once, and all survey responses were anonymous. Participants were signposted to healthcare services available to them should they be suffering from any distressing, mild, moderate or severe mental health symptoms. Invitations to participate in the questionnaire were sent out from 20th May 2021, and the questionnaire was closed to responses on 2nd October 2021.

The semi-structured interview topic guide was co-developed between doctors and nurses working in ICUs in Kathmandu. Co-design was used to ensure the sensitivity and appropriateness of the questions. None of the doctors and nurses involved in the codesign of the topic guide participated in the study proper. The qualitative component was aimed to augment the quantitative findings by providing an understanding of what social, organisational, and environmental factors were related to HCPs’ mental health. Topic guide questions focused on HCPs’ perceptions of their experiences of working during the pandemic and explored social, organisational, and environmental factors that may have influenced their self-reported burden and symptoms of psychological distress. These factors were selected from a review of the findings of the previously published meta-analysis and other studies conducted in Nepal [ 9 , 10 , 11 , 12 , 13 ]. The interview questions were piloted with five HCPs for interpretability and interviewer consistency. All interviews were conducted via video conferencing (Zoom) [ 31 ] between September 2021 and March 2022. Five ICU nurses with experience in conducting interviews and mixed methods research led the data collection following training on the topic guide. To ensure there was no prior relationship between the interviewer and the participant, interviewers were assigned to participants that worked in different ICUs than themselves and were not known to the interviewee. No one other than the interviewer and the participant was present for each interview, and interviews were conducted at the time chosen by the interviewee. Rapid assessment procedure (RAP) sheets were used for note-taking during the interviews [ 32 ]. Commonly used in rapid evaluations - designed to improve the rapidity and replicability of research during public health emergencies - RAP sheets help reduce the need for long-form transcription and encourage reflexivity for both interviewers and researchers, reduce interviewer bias, and enable validation of internal consistency with coding [ 33 ]. The RAP sheet contained the summary of questions from the topic guide, and the interviewers took notes of what the participants said regarding each question during the interview.

Data analysis

Descriptive statistics were used to describe participants’ demographics and professional profiles. Psychological health and well-being assessment tools from the questionnaire were analysed using published guidelines. For the BDI, each of the 21 items corresponding to a symptom of depression was summed for each participant to give a single total score [ 16 ]. With each item ranging from 0 to 3 points, a total score of 13 or less was considered minimal to no depression, 14 to 19 as mild depression, 20 to 28 as moderate depression, and 29 to 63 as severe depression [ 16 ]. Data is also presented separately for suicidality (question 9 from the BDI) whereby anyone that said they have thoughts about or plans to kill themselves is said to have experienced suicidality. The BAI scores reported included the 21 symptoms of anxiety that ranged between 0 and 63 points [ 15 ]. The values for each symptom were summed, and a total score of 0 to 7 was interpreted as a minimal level of anxiety, 8 to 15 as mild, 16 to 25 as moderate, and 26 to 63 as severe anxiety [ 15 ]. Scores on the PSS ranged from 0 to 40, with higher scores indicating higher perceptions of stress [ 17 ]: scores ranging from 0 to 13 were considered low descriptors of stress; 14 to 26 moderate; and 27 to 40 were considered higher levels of perceived stress. For alcohol use disorder reported using AUDIT [ 19 ], a score of 0 indicated no previous or current alcohol use; a score of 1 to 7 suggested low-risk consumption; 8 to 14 hazardous or harmful alcohol consumption; 15 or higher indicated the likelihood of alcohol dependence (moderate to severe alcohol use disorder). The PCL-5 included 20 items with a score range of 0 to 80 and a score of 33 or higher, indicating the presence of PTSD [ 18 ]. A sensitivity analysis was conducted for the BDI, BAI and AUDIT scores based on local validation studies whereby a score of 15 or lower from the BDI indicated no depression [ 20 ], 12 or lower from the BAI indicated no anxiety [ 21 ], and a score of 11 or above from the AUDIT indicated discriminate dependent drinkers [ 22 ].

RAP sheets, along with interviewer notes, were reviewed by the research team before analysis to ensure information was complete. SK, KK and AB used a constant comparative method, coding data following each round of interviews and then reflecting back on the summary of the codes together with the interviewers to promote the accuracy of findings and reduce recall and interviewer bias. In addition, emerging themes identified following each round of coding were used to guide subsequent interviews [ 34 ]. The broader research team met following each coding round to review the findings and reflexivity [ 35 ]. Categories and the subsequent themes (‘drivers’) were developed through the iterative process of interviewing, coding, analysing, and reviewing.

We invited 120 doctors and 341 nurses to participate. A total of 21 doctors and 113 nurses responded, all of which completed the BDI, BAI, PSS, and AUDIT questions; 100 completed the PCL-5 (16 doctors and 84 nurses). Nearly all nurses were female (99%, n  = 112), whereas most doctors were male (81%, n  = 17). The characteristics of respondents are described in Table  1 .

50% ( n  = 67) of respondents reported experiencing symptoms associated with moderate to severe anxiety, and a further 27% ( n  = 36) scored for mild anxiety as a result of working in the ICU during the COVID-19 pandemic (Table  2 ). Anxiety levels (and associated symptoms) were more pronounced in nurses than doctors, with 55% ( n  = 62) of the former scoring moderate to severe on the anxiety scale, compared to 24% ( n  = 6) of the latter. 21% ( n  = 28) of respondents described symptoms associated with moderate to severe depression, with a near-even split between nurses and doctors. Three-quarters of respondents ( n  = 114; 85%) had scores indicative of moderate to high levels of stress; this proportion was higher among doctors ( n  = 19; 91%) compared to nurses ( n  = 95; 84%). Of the 100 individuals that completed the PCL-5 assessment (16 doctors and 84 nurses), 45% ( n  = 46) reported a constellation of symptoms closely associated with PTSD, with a higher prevalence among nurses ( n  = 40; 47%) compared to doctors ( n  = 6; 38%).

Using cut-off scores from Nepali validation studies, 45 (34%) participants were experiencing mild, moderate or severe depressive symptoms, 80 (60%) were experiencing mild, moderate or severe anxiety symptoms, and 3 (2%) were considered discriminate dependent drinkers. These results are in line with our main analysis, including that a greater proportion of nurses were still found to suffer from depression and anxiety symptoms (supplementary Table 1 ).

Forty-six respondents to the online questionnaire volunteered to participate in the subsequent semi-structured interviews. Twenty participants were approached and consented to an interview: 16 were nurses (all female), and 4 were doctors (1 female, 3 male). On average, each interview resulted in 45 to 60 min of qualitative data. Saturation was met within the first 15 interviews, and findings were consistent between the coders and the research team. Analysis and synthesis of the interviews revealed nine themes, which, when codified, can be described as three key drivers of the psychological symptoms and impacts on mental well-being experienced by the interviewees: social stigmatism, physical and emotional safety, and organisational support. (Fig.  1 ). During the interviews, HCPs further described some of the coping strategies that they found helpful in mitigating the impacts experienced and may provide insights for future pandemic preparedness. These three themes, the drivers, and coping strategies, are explored below, along with quotes from the respondents.

Coding tree for the four main drivers for psychological distress

Social stigmatism

Interviewees described experiencing feelings of social stigmatisation as a result of interactions with their families, peers, as well as from the wider public. Examples of stigmatism experienced included physical avoidance from neighbours and community members when the HCP travelled to and from and around their home, especially when dwellings were in shared buildings and common areas.

“My house owner avoided talking and meeting me because I worked with COVID patients.” [N]. “I have an elderly family member, and I was afraid and worried [for them] when I came back from duty.” [N].

Interviewees described how rumours would spread within the community, notably related to concerns of risk of co-infection or cross-infection, either directly from parent to child or indirectly via friends and extended family. Some HCPs were asked or elected to stay away from their home so as to reduce the stigma to them and their family and in an attempt to reduce the risk of co-infection, particularly when they had vulnerable family members. Interviewees described how this self-selected or enforced separation and isolation resulted in feelings of rejection, physically and emotionally heightened feelings of stress and anxiety, alongside the threat to physical and emotional safety.

Physical and emotional safety

Increased workload and an enforced change in working pattern/ shift structures were experienced by all the HCPs interviewed. These longer overall working hours, increased duration of shift patterns, and enforced working rotas were perceived as resulting in a loss of physical and emotional safety by the interviewees. Feelings of loss of control, insomnia, or disruption to sleep patterns, alongside physical discomfort through sustained working in personal protective equipment, often in hot and humid temperatures. This physical and mental endurance contributed to feelings of emotional stress and anxiety.

“Shift frequency was increased, and I only got one night off in a week. Sometimes I had to work extra hours, which was very stressful.” [N]. “My sleep pattern had changed, I felt restless and was afraid about COVID” [D].

The change in shift structure and in working patterns meant for some HCPs enforced separation from family and friends whereby HCPs sought accommodation away from family or in temporary lodgings. This again resulted in isolation and additional strain on other family members so as to provide care for HCP’s dependents.

“I had to involve other family members to arrange for the medication and care of my grandmother” [N].

Increased working hours and changes in working patterns further had physical impacts; participants described skipping meals or having limited time to eat. The need to wear personal protective equipment (PPE), and indeed the risks to safety when PPE was not available, associated risks of non-availability of equipment, brought with it a risk to physical and emotional safety. HCPs interviewed reported skin lacerations, irritation, and discomfort whilst wearing equipment in hot, humid working environments.

“We had to frequently change the PPE and masks, which has caused skin problems that still exist.” [N].

Organisational support

Interviewees found the COVID-19 pandemic brought new and often enforced work responsibilities, some of which were associated with high levels of professional anxiety, stress, and uncertainty. A professionally challenging situation, even for those with many years of ICU working experience. HCPs faced emotionally challenging tasks such as dealing with end-of-life situations (particularly without relatives of the patient present) and having to comfort relatives over the phone, of which they received limited to no training or support on handling such situations.

“I went through an emotional breakdown while dealing with the end of the life situation of patients without the presence of family members in the COVID ICU… I felt sad when a young patient lost their lives” [D]. “Accommodation or isolation facilities should be provided by the hospital” [D]. “If incentives were provided in time and staff were provided with health insurance it would motivate us” [N].

Ever-changing role and responsibilities created anxiety for HCPs as to what care to deliver, and the rapidity and uncertainty of care were associated with feelings of vulnerability. Interviewees expressed how they wished there was a need for greater organisational support to better cope with the frequent updates and changes to practice. Furthermore, HCPs expressed concerns regarding a shortage of staff and the lack of mental health counselling and support, accommodation on-site at the hospital, and transportation to and from work.

“Mental health support or counselling facilities were not provided. It should be there… seniors and hospital staff should also talk to the staff to know the situation.” [N]. “Safety of healthcare workers should be the priority and nurse-patient ratio should be maintained to provide quality care to the patients… hospital should have recruited more staff.” [N].

Coping strategies

Participants described various ways in which they coped with the emotional, physical, social, and professional impacts of working through the pandemic. This included speaking with family and friends about the pressures they were under, taking up activities in their off time, such as gardening and reading, and using media entertainment such as music, movies, and shows. A few participants also mentioned that comparing the situation in Nepal to other countries (i.e., keeping up-to-date with the news) also helped them cope. Others mentioned that detachment from social media and more self-awareness through meditation helped.

“I ventilated my feelings with friends and family. Listening to soothing music also helped me cope with the stress.” [N]. “I coped by gardening with my sister in my home.” [N]. “I… watched the news that compared the death rates, which was low compared to others.” [D].

The COVID-19 pandemic’s impact on healthcare services and population health internationally is unprecedented in recent times. As healthcare professionals, policymakers, and researchers work to strengthen services in preparation for future pandemics now and mitigate the long-term impacts on individual and population health, understanding the impact on and perspectives of doctors and nurses at the frontline of care can provide important learning regarding the individuals characteristics and professional, social and economic drivers which may increase the risk of psychological impacts.

Mandated and enforced changes in role, specifically in working hours and shift patterns, were a key driver of psychological anxiety and distress. Within hospitals in Nepal, many departments were closed, and stay-at-home orders meant that outpatient or clinical services all but ceased. This resulted in an increased role and scope for critical care trained staff, and in contrast to other health systems (such as the UK) where healthcare staff were redeployed to ICU, there was a separation for ICU staff even from their professional peers working in other specialties. The increased scope and uncertainty of the HCP’s role, along with limited choice in redeployment in the ICU was another driver of poor mental health- and dominated nursing participants’ experiences. Interviewees described how these changes impacted not only themselves but the multigenerational families for whom many cared for. This enforcement of role change, and the related descriptions of the drivers for these impacts as experienced by participants in this study point not only to the differences in roles between nurses and doctors; but also highlights disparities in autonomy, advocacy for role change during international emergencies, and the implications of work on home and family life [ 36 ].

Giving staff choice to select shift patterns and ensuring the opportunity to have periods of rest to reconnect with family and have self-care is needed. Consultation and shared decision-making, even in times of restricted choice, are associated with improved perceptions of work from staff and may result in reducing psychological distress and promoting emotional safety, which is, in turn, associated with better outcomes for patients [ 37 , 38 ]. However, nurses in Nepal, as with many health systems, may have less opportunity for strategic and organisational decision making in response to public health emergencies. The impact of ongoing disparities between professionals and their agency to advocate for wellbeing and safety warrants further research.

Nurses were disproportionately burdened by both occurrence and severity of symptoms of anxiety and depression as a result of their work during the pandemic when compared to doctors.

Nearly half of all respondents had symptoms of anxiety and PTSD (again more prevalent in nurses), and the burden of anxiety symptoms was higher than the reported 22–33% from a recent umbrella review [ 39 ]. The burden of stress we report was also higher than a smaller study conducted in Nepal during the pandemic, which reported stress among 53.2% of healthcare professionals working in hospitals, primary health centres, pharmacies, and health posts in Nepal [ 40 ]; it was also higher than a meta-analysis of published studies exploring the incidence of both stress (57%) and PTSD (22%) among all cadres of healthcare workers [ 41 ]. One reason for the higher reported symptoms in our study may be the focus on ICU workers and their role in the management of end-of-life care. Indeed, our results for depression and anxiety are comparable to a study involving nurses working directly with COVID-19 in Nepal [ 13 ]. Studies conducted elsewhere in Asia have highlighted this positive relationship between ICU experiences and poor mental health [ 42 ].

Nurses in Nepal, as with many other countries, are more likely to be female, younger in age, and have less opportunity for graduate study; and have lower earning potential than physician colleagues [ 43 ]; all characteristics associated with increased risk of poorer mental health outcomes [ 44 ]. Exploration into the disparities of the psychological and health impacts of COVID-19 on different cadres of healthcare workers is emerging. A systematic review conducted in 2020, identified 27 studies which sought to explore the disparity in impacts of the pandemic on HCP’s psychological well-being. The findings from the review are in line with ours, indicating that the burden of symptoms for anxiety, depression, and PTSD is higher in nurses compared to doctors [ 45 ]. Notably only a few of these studies used validated tools for assessment of specific symptoms of anxiety, depression, or substance misuse [ 45 ]. Our study serves to strengthen the evidence of the vulnerability of nurses.

Nepal, like many other lower and middle-income countries in South and Southeast Asia, enforced large-scale lockdowns and restrictions of movement for all but essential healthcare and municipal staff [ 46 ]. As such, social stigmatism, physical and emotional safety, and organisational support were key drivers behind the elevated symptoms of psychological distress in ICU HCPs and may be a key determinant of differences between health systems internationally. Furthermore, the family responsibilities and social circumstances for nurses, contributed to their experiences of isolation, rejection, vulnerability, physical discomfort, and strain. These drivers mirrored those reported from Europe; and may reflect differences experienced by nurses as a result of their gender, and role norms of primary family carers within society [ 44 ].

Interviewees from both professional groups expressed concern at the absence of preparedness and support they felt from their employing institutions. This is notable given the ongoing investment in pandemic preparedness and the potential to make changes now to prepare for the next pandemic or public health emergency. Interventions such as resilience training, scenario-based simulation training, and group exercises based on psychoeducation and cognitive behavioural therapy (CBT) principles have proved effective in reducing anxiety, depression, stress, and PTSD among doctors and nurses while simultaneously improving their ability to work in unprecedented situations in other sectors [ 47 ]. Similar provisions may be valuable for ICU-based healthcare professionals and are deliverable online, making rollout potentially more feasible.

Strengths and limitations

A strength of this study is the exploration of participants’ perspectives on the drivers behind the burden of poor mental health described in ICU HCPs. This mixed methods approach offers insights into doctors’ and nurses’ unique individual, social and professional characteristics that may be associated with increased risk of distress. These differences and their potential for disparity in impacts on health and wellbeing should be of interest to policymakers and healthcare facility managers involved in future pandemic preparedness. However, the study has some limitations to acknowledge. Given the use of the snowball technique, we were able to ensure a high number of respondents, but as a consequence, we were unable to track the number of respondents that came from using this technique compared to those initially invited from the NSCCM and CCNAN. Therefore, a response rate and, subsequently, a non-response rate could not be reported. We did not collect information on the level of training in critical care that participants received; trained health professionals are likely to have additional skills in how to handle the potential stressful environment in critical care settings. Also, due to the lack of validation of the PCL-5 in Nepal, the results of this assessment tool should be interpreted with caution. The survey tools used for this study have not been validated in an online format. However, given these tools were self-reporting, and were piloted and administered in English, the online format is thought to have minimal impact on the results. Additionally, participants for the qualitative component were recruited based on convenience sampling; therefore, the diversity of the sample may not be optimised. We acknowledge that recall bias may be present in the participants during the interview, given they were recalling their experiences throughout the pandemic for up to 24 months prior to the interview; however, we hope the piloting of the interviews, the use of multiple researchers to code the data, and the constant comparative nature of the evaluation will mitigate this potential.

The COVID-19 pandemic negatively impacted the mental health of HCPs worldwide. This study strengthens existing evidence that nurses were (and may remain) at increased risk of both cross infection and may also be more vulnerable to psychological impacts including anxiety, depression and PTSD than their professional colleagues. In addition, critical care staff may be at even greater risk, due to the uniqueness of their role which includes prolonged periods of time with infected patients, frontline role in managing end of life care, and as described here, limited ability to advocate for changing role and working patterns during an emergency. Professional hierarchies, and social-economic and gender profiles unique to nurses, may be potential drivers for these disparities, and warrants further research. Learning from the ICU HCPs’ experiences during the COVID-19 pandemic may inform future preparedness strategies e to mitigate short and long-term mental illness among ICU HCPs in future pandemics.

Data availability

The interview guide is available in the Figshare repository,

https://doi.org/10.6084/m9.figshare.24247384.v1 .

The data supporting the conclusions of this article are available in the Figshare repository, https://doi.org/10.6084/m9.figshare.23999790.v1 .

Abbreviations

Coronavirus disease 2019

Intensive care unit

Healthcare professional

Personal protective equipment

Post-traumatic stress disorder

Nepalese Society of Critical Care Medicine

Critical Care Nurses Association of Nepal

Beck Anxiety Inventory

Beck Depression Inventory

Perceived Stress Scale

PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5

Alcohol Use Disorder Identification Tool

Rapid assessment procedure

Cognitive behavioural therapy

Wang H, Paulson KR, Pease SA, et al. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21. Lancet. 2022;399(10334):1513–36.

Article   CAS   Google Scholar  

Greco M, De Corte T, Ercole A et al. Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study. Intensive Care Med. 2022:1–16.

All Covid restrictions lifted in Valley [Internet]. kathmandupost.com. [Accessed 7 Feb 2024]. Available from: https://kathmandupost.com/valley/2022/03/05/all-covid-restrictions-lifted-in-valley .

Kharel P. Nepal’s fight against the second wave of COVID-19 pandemic. repositoryunescaporg [Internet]. 2021 [cited 2024 Feb 7]; Available from: https://hdl.handle.net/20.500.12870/5102 .

Neupane HC, Gauli B, Adhikari S, et al. Contextualizing critical care medicine in the face of COVID-19 pandemic. JNMA J Nepal Med Assoc. 2020;58(226):447.

PubMed   PubMed Central   Google Scholar  

Shrestha GS, Lamsal R, Tiwari P, Acharya SP. Anesthesiology and critical care response to COVID-19 in Resource-Limited settings. Anesthesiol Clin. 2021;39(2):285–92.

Article   PubMed   PubMed Central   Google Scholar  

Hölscher AH. Patient, surgeon, and health care worker safety during the COVID-19 pandemic. Ann Surg. 2021;274(5):681.

Article   PubMed   Google Scholar  

Gholami M, Fawad I, Shadan S, et al. COVID-19 and healthcare workers: a systematic review and meta-analysis. Int J Infect Dis. 2021;104:335–46.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Ghahramani S, Kasraei H, Hayati R et al. Health care workers’ mental health in the face of COVID-19: a systematic review and meta-analysis. Int J Psychiatry Clin Pract. 2022:1–10.

Gupta AK, Mehra A, Niraula A, et al. Prevalence of anxiety and depression among the healthcare workers in Nepal during the COVID-19 pandemic. Asian J Psychiatr. 2020;54:102260.

Adhikari SP, Rawal N, Shrestha DB et al. Prevalence of anxiety, depression, and perceived stigma in healthcare workers in Nepal during later phase of first wave of covid-19 pandemic: a web-based cross-sectional survey. Cureus. 2021, 13(6).

Khanal P, Devkota N, Dahal M, et al. Mental health impacts among health workers during COVID-19 in a low resource setting: a cross-sectional survey from Nepal. Global Health. 2020;16(1):1–12.

Google Scholar  

Tamrakar P, Pant SB, Acharya SP. Anxiety and depression among nurses in COVID and non-COVID intensive care units. Nurs Crit Care. 2021 Sep 28.

Fitzpatrick R, Boulton M. Qualitative methods for assessing health care. Qual Health Care. 1994;3(2):107.

Beck AT, Epstein N, Brown G, et al. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893.

Article   CAS   PubMed   Google Scholar  

Richter P, Werner J, Heerlein A, et al. On the validity of the Beck Depression Inventory. Psychopathology. 1998;31(3):160–8.

Cohen S, Kamarck T, Mermelstein R. Perceived stress scale. Measuring Stress: Guide Health Social Scientists. 1994;10(2):1–2.

Blevins CA, Weathers FW, Davis MT, et al. The posttraumatic stress disorder checklist for DSM-5 (PCL‐5): development and initial psychometric evaluation. J Trauma Stress. 2015;28(6):489–98.

Saunders JB, Aasland OG, Babor TF, et al. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791–804.

Kohrt B, Kunz RD, Koirala NR, Sharma VD, Nepal, Mahendra. Validation of a Nepali version of the Beck Depression Inventory. Nepal J Psychiatry. 2002;2:123–30.

Kohrt B, Kunz R, Koirala N, Campus M, Nepal. Validation of the Nepali version of beck anxiety inventory. Journal of Institute of Medicine [Internet]. 2007 Jan 21 [cited 2024 Feb 7]; Available from: https://www.semanticscholar.org/paper/Validation-of-the-Nepali-version-of-beck-anxiety-Kohrt-Kunz/148d 01852884f54d28967e105d57c177a3f0be36.

Pradhan B, Chappuis F, Baral D, Karki P, Rijal S, Hadengue A et al. The alcohol use disorders identification test (AUDIT): validation of a Nepali version for the detection of alcohol use disorders and hazardous drinking in medical settings. Substance Abuse Treatment, Prevention, and Policy [Internet]. 2012;7(1). Available from: https://substanceabusepolicy.biomedcentral.com/articles/ https://doi.org/10.1186/1747-597X-7-42 .

Sharma P, Devkota G. Mental health screening questionnaire: a study on reliability and correlation with perceived stress score. J Psychiatrists’ Association Nepal. 2019;8(2):4–8.

Article   Google Scholar  

Pandey BD, Morita K, Costello A. Twin crises in Nepal: covid-19 and climate change. 2022, 377.

Nepalese Society of Critical Care Medicine. NSCCM. 2022. [Accessed 16 August 2023]. Available from http://www.nsccm.org.np/ .

Critical Care Nurses Association of Nepal. Critical Care Nurses Association of Nepal. 2022. [Accessed 16 August 2023]. Available from https://ccnan.org.np/ .

Etikan I, Alkassim R, Abubakar S. Comparision of snowball sampling and sequential sampling technique. Biom Biostat Int J. 2016;3(1):55.

Saunders B, Sim J, Kingstone T, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893–907.

Google Inc. Google Forms. 2022. [Accessed 16 August 2023]. Available from https://www.google.co.uk/forms/about/ .

Zerbini G, Ebigbo A, Reicherts P et al. Psychosocial burden of healthcare professionals in times of COVID-19–a survey conducted at the University Hospital Augsburg. Ger Med Sci. 2020, 18.

Zoom Z. One platform to connect. 2022. [Accessed 16 August 2023]. Available from https://zoom.us/ .

Vindrola-Padros C, Chisnall G, Cooper S, et al. Carrying out rapid qualitative research during a pandemic: emerging lessons from COVID-19. Qual Health Res. 2020;30(14):2192–204.

Beebe J. Basic concepts and techniques of rapid appraisal. Hum Organ. 1995;54(1):42–51.

Althubaiti A. Information bias in health research: definition, pitfalls, and adjustment methods. J Multidiscip Healthc. 2016:211–7.

Macbeth D. On reflexivity in qualitative research: two readings, and a third. Qual Inq. 2001;7(1):35–68.

Jackson D, Anders R, Padula WV, et al. Vulnerability of nurse and physicians with COVID-19: monitoring and surveillance needed. J Clin Nurs. 2020;29(19–20):3584.

Bae SH. Intensive care nurse staffing and nurse outcomes: a systematic review. Nurs Crit Care. 2021;26(6):457–66.

Ejebu O-Z, Dall’Ora C, Griffiths P. Nurses’ experiences and preferences around shift patterns: a scoping review. PLoS ONE. 2021;16(8):e0256300.

Fernandez R, Sikhosana N, Green H, et al. Anxiety and depression among healthcare workers during the COVID-19 pandemic: a systematic umbrella review of the global evidence. BMJ Open. 2021;11(9):e054528.

Kafle K, Shrestha DB, Baniya A, et al. Psychological distress among health service providers during COVID-19 pandemic in Nepal. PLoS ONE. 2021;16(2):e0246784.

Marvaldi M, Mallet J, Dubertret C, et al. Anxiety, depression, trauma-related, and sleep disorders among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2021;126:252–64.

Thatrimontrichai A, Weber DJ, Apisarnthanarak A. Mental health among healthcare personnel during COVID-19 in Asia: a systematic review. J Formos Med Assoc. 2021;120(6):1296–304.

Prakash S, Yadav P, Yadav K. Perspectives of developing nursing education in Nepal. Nurs Care Open Access J. 2018;5(4):214–20.

Tiete J, Guatteri M, Lachaux A, et al. Mental health outcomes in healthcare workers in COVID-19 and non-COVID-19 care units: a cross-sectional survey in Belgium. Front Psychol. 2021;11:612241.

Kunz M, Strasser M, Hasan A. Impact of the coronavirus disease 2019 pandemic on healthcare workers: systematic comparison between nurses and medical doctors. Curr Opin Psychiatry. 2021;34(4):413.

Adhikari NK, Beane A, Devaprasad D et al. Impact of COVID-19 on non-COVID intensive care unit service utilization, case mix and outcomes: a registry-based analysis from India. Wellcome Open Res. 2021, 6.

Zaçe D, Hoxhaj I, Orfino A, et al. Interventions to address mental health issues in healthcare workers during infectious disease outbreaks: a systematic review. J Psychiatr Res. 2021;136:319–33.

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Acknowledgements

We thank the volunteers who took the time to interview the participants: Radhika Maharjan, Dipika Khadka, Anita Bashyal, Samina Amatya, and Roshani Kafle. We also want to thank Dr. Rohini Nepal and Jugmaya Chaudhary of Rhythm Neuropsychiatry Hospital and Research Centre for their contribution to advising and reviewing the self-reporting psychological assessment tools used in the questionnaire. We would also like to thank Transcultural Psychosocial Organisation (TPO) Nepal and Dr. Nabaraj Koirala for the permission to use the Nepali-validated version of BDI I and BAI for the study. We additionally thank Nilu Dullewe, who helped in coding the qualitative data. For the ongoing mutual support for improvements in ICU care, we would also like to acknowledge and thank members of the CCAA.

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Diptesh Aryal, Shirish KC, Kanchan Koirala, Subekshya Luitel, Rohini Nepal, Sushil Khanal, Hem R Paneru, Subha K Shreshta, Sanjay Lakhey, Samina Amatya, Kaveri Thapa, Radhika Maharjan, Roshani Kafle, Anita Bashyal, Reema Shrestha, Dipika Khadka and Nilu Dullewe.

This study was funded by a Wellcome Innovations Flagship Programme grant (Wellcome grant number: 215522/Z/19/Z). They had no role in the design, analysis, or reporting of this protocol.

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Shirish KC, Diptesh Aryal, Kanchan Koirala & Subekshya Luitel

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Tiffany E. Gooden

Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK

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• Diptesh Aryal
• , Shirish KC
• , Kanchan Koirala
• , Subekshya Luitel
• , Rohini Nepal
• , Sushil Khanal
• , Hem R Paneru
• , Subha K Shreshta
• , Sanjay Lakhey
• , Samina Amatya
• , Kaveri Thapa
• , Radhika Maharjan
• , Roshani Kafle
• , Anita Bashyal
• , Reema Shrestha
• , Dipika Khadka
•  & Nilu Dullewe

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All authors conceptualised this study. SK, DA, AB, RH, and SL developed the protocol, study methods, and materials. KK and SL facilitated the data collection, supervised by SK and DA. Data were analysed by SK, AB, KK, and TEG. SK and TEG wrote the drafts of the manuscript, and all authors reviewed the manuscript and consented to it being submitted. AB is the senior author.

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Correspondence to Diptesh Aryal .

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KC, S., Gooden, T.E., Aryal, D. et al. The burden of anxiety, depression, and stress, along with the prevalence of symptoms of PTSD, and perceptions of the drivers of psychological harms, as perceived by doctors and nurses working in ICUs in Nepal during the COVID-19 pandemic; a mixed method evaluation. BMC Health Serv Res 24 , 450 (2024). https://doi.org/10.1186/s12913-024-10724-7

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Psychological resilience and competence: key promoters of successful aging and flourishing in late life

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Many individuals, both in the public and within the field of psychology, often perceive aging as a burden that negatively impacts intellectual and mental health. Our present study aims to challenge this notion by identifying the crucial components of positive mental health in later life. These components not only promote positive mental health but also actively contribute to it, even under difficult circumstances. To accomplish this, we first offer a concise review of well-being and mental health models that highlight the psychological aspects of flourishing in late life. We then introduce a psychological competence-based model for positive mental health, which aligns with the concept of positive aging. Subsequently, we present a measurement tool suitable for practical applications. Finally, we provide a comprehensive overview of positive aging, drawing on methodological guidelines and existing research findings concerning sustainable positive mental health in later life. We examine the evidence indicating that psychological resilience (the capacity to adapt and recover from adversity or stress) and competence (skills and abilities to effectively cope with challenges across various life domains) significantly contribute to slowing down biological aging processes. Furthermore, we discuss insights into the relationship between psychological factors and aging derived from research on Blue Zones (regions characterized by a higher proportion of individuals experiencing longer, healthier lives).

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Resilience, Adapting to Change, and Healthy Aging

Conclusion: The Key to Successful Aging

Psychological resilience.

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Introduction

The population of the western world is aging at an unprecedented rate. This demographic shift is driven by several factors, including improvements in healthcare, resulting in increased life expectancy. As a result, the number of Americans ages 65 and older will more than double over the next 40 years, reaching 80 million in 2040 [ 1 ]. In the European Union, the proportion of people over 65 years old is expected to rise sharply until 2058, accounting for 30.3% of the population [ 2 ]. The Asia–Pacific region is projected to experience the fastest increase in older citizens, with one in four individuals being over 60 years old by 2050, resulting in 1.3 billion senior citizens [ 3 ]. According to the World Health Organization, the number of individuals aged 60 or older globally is expected to double by 2050, reaching an astounding two billion [ 4 ].

With the growing population of older adults, the concept of “successful aging” has become increasingly important. From a geroscience perspective, successful and healthy aging involves the optimization of biological aging processes over the course of a person’s lifetime. This can lead to a reduction in the rate of age-related functional decline, resulting in a delayed onset of age-related diseases and a longer maintenance of functional ability. This, in turn, enables well-being in older age, as defined by the World Health Organization’s concept of “healthy aging” [ 5 ]. To guide this study, we adopt the concept first introduced by Rowe and Kahn, which defines successful aging as the attainment of high levels of physical, psychological, and social functioning in old age, coupled with the absence of significant age-related diseases [ 6 , 7 , 8 ]. This concept emphasizes the importance of enabling older adults to remain active and productive members of society, rather than simply viewing aging as a period of decline and dependency.

There are multiple reasons why promoting successful aging is crucial. Firstly, it can improve the health and well-being of older individuals, resulting in a better quality of life and reduced pressure on healthcare systems. Secondly, it can be advantageous for society as a whole by enabling older adults to continue contributing to their communities, be it through paid or voluntary work, or supporting family members. Lastly, promoting successful aging can combat ageism and negative stereotypes about aging, which often restrict the opportunities available to older adults. Overall, given the demographic changes taking place, promoting successful aging is an important social and economical necessity for the communities. By supporting the health, well-being, and productivity of older adults, we can create a more inclusive and equitable society for all age.

To comprehensively understand successful aging, a multidisciplinary approach is necessary, as illustrated by the wide range of scientific fields covered in this journal. Here we focus on the physiological aspects of successful aging. Over the years, various cross-sectional and longitudinal psychological studies [ 9 , 10 , 11 , 12 , 13 , 14 ] have been conducted to investigate the nature of successful aging. These studies examine cognitive [ 15 ] and health [ 10 , 11 , 16 ] aspects, among others [ 11 ]. This approach has become increasingly important due to the growing elderly population resulting from increased life expectancy. As a result, promoting the well-being of older adults has become a key strategic goal for social and health policymakers worldwide, as highlighted by the World Health Organization [ 17 ].

Given the significant interest in investigating well-being in later life, understanding the factors that contribute to successful aging and complete physical and mental well-being of older adults is critical. Although “aging well” is a target state, it is surrounded by many concepts in addition to successful aging [ 18 , 19 ], such as active aging [ 20 , 21 ], productive aging [ 22 ], vital aging [ 23 ], optimal aging [ 18 ], healthy aging [ 24 ], harmonic aging [ 18 ], or simply good aging [ 9 ]. Despite the popularity of the successful aging construct in gerontology, there is no consensus regarding its definition.

While from a geroscience perspective it is an accurate and useful term, in the field of psychology the scientific construct of successful aging has often been criticized for its emphasis on values. The term “successful” is often associated with connotations such as fame or respect, which can create the perception that those who do not meet the criteria for successful aging are failures. As a result, the concept of positive aging has emerged as an alternative approach that encompasses the essence of successful aging while avoiding these negative associations. Positive aging focuses on the content of aging, emphasizing everything that constitutes a positive and fulfilling experience in later life. The concept of positive aging does not imply that certain achievements or values must be met in order to be considered successful. Instead, it highlights the importance of factors such as maintaining physical and mental health, maintaining social connections, and pursuing meaningful activities in later life. Overall, emphasizing the positive aspects of aging can help to combat ageism and negative stereotypes about aging, promoting a more positive and inclusive view of later life.

Positive psychology and aging

The concept of successful aging aligns closely with the mission statement of positive psychology, which is to study flourishing, optimal human functioning, and well-being [ 25 ]. Positive psychology places a strong emphasis on identifying indicators of mental health that contribute to long-term well-being, creativity, and flourishing, and developing theoretical frameworks to understand positive mental health. This approach differs from the traditional psychopathology-focused approach to mental health, as it prioritizes a person’s strengths and resources [ 25 ]. While positive psychology has been effective in examining the flourishing of healthy individuals, there has been a lack of focus on how it can apply to the life experiences of vulnerable individuals [ 26 ], such as older adults. The implication of this positive-focus model has significant potential in the field of gerontology, particularly in promoting late-life well-being and productivity. By seeking to identify, find, and enhance positive psychological changes and resources, instead of merely minimizing the negative effects of psychological frailty in aging [ 27 , 28 ], the positive psychology model can offer a more effective approach to aging.

While there are challenges in applying positive psychology to aging, such as theoretical and methodological difficulties, ongoing research in this field continues to expand our knowledge of well-being and mental health. Despite the multiple physical and social losses associated with aging, subjective well-being (SWB) is stable or even increasing in later life [ 29 ]. This highlights the importance of identifying the positive components of mental health in late life rather than conceptualizing mental health based solely on the absence or presence of psychopathology. However, while positive psychology has provided valuable insights into well-being and mental health, the field must still address theoretical and methodological challenges in developing new theories and measurement tools. These challenges include psychometric difficulties and the need for more empirical research to support the validity of positive psychology concepts in the context of aging [ 30 , 31 , 32 ].

Overall, positive psychology offers a valuable framework for promoting well-being in older adults by focusing on their strengths and resources rather than merely on their deficits and limitations. By emphasizing the positive aspects of aging, this approach can help individuals achieve optimal functioning and a fulfilling life in later years.

Previous models of well-being and mental health in late life

Previous models of well-being and mental health in late life have explored various conceptualizations, including (1) multidimensional well-being [ 33 , 34 , 35 , 36 ], (2) mirror opposite to the symptoms of mental disorders [ 37 , 38 , 39 ], (3) flourishing [ 34 ], (4) “hedo-eudemonic” well-being [ 33 , 38 , 40 , 41 , 42 , 43 ], (5) classical models of mental health [ 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ], (6) balanced models of mental health [ 52 , 53 , 54 , 55 ], and (7) the sum of the components of well-being [ 33 , 39 , 40 , 42 , 43 , 56 , 57 ]. While these models have focused on the components of well-being, they have not fully captured all aspects of mental health as defined by the World Health Organization (WHO) and classical theories of mental health. The WHO defines mental health as a dynamic state of internal equilibrium that enables individuals to use their abilities in harmony with universal values of society. Components of mental health include basic cognitive and social skills; the ability to recognize, express, and modulate emotions; empathy; flexibility; coping skills; social role functioning; and a harmonious relationship between body and mind, which contribute, to varying degrees, to the state of internal equilibrium [ 58 ]. Therefore, to fully capture mental health in late life, measurement tools should go beyond the operationalizations that define the concept with observable characteristics of well-being or as the mirror opposite of mental disorders. Incorporating the concept of successful aging can provide a more comprehensive approach to understanding and promoting mental health in late life.

Conceptual and methodological difficulties of well-being and mental health measurements

Measuring well-being and mental health presents significant conceptual and methodological challenges for positive psychology [ 59 ]. Inconsistent factor structures, varying internal consistency ranges, and differences in predictive ability across cultures have been found in different positive psychology measures [ 32 ]. Recent criticisms of positive psychology [ 30 , 32 ] have highlighted the fallibility of measuring instruments, directly affecting the credibility of the discipline and its underlying theories. Furthermore, the heterogeneity and multitude of psychological concepts and theories that fall under the umbrella of positive psychology make it difficult to compare research results based on constructs with different contents. Mixing predictor and indicator variables in cross-sectional and longitudinal studies on successful aging further confuses the methodology. Thus, there is a need to reconsider positive psychology models and to reconceptualize factors responsible for maintaining positive mental health in advanced age.

The concept of psychological immune competence and its role in the maintenance of positive mental health in late life

Just as our body has an immune system to defend against harmful biological agents, our mind also requires psychological immune competence for stress resistance and resilience [ 51 ]. Unlike the effects of vaccines, these psychological skills and competencies are deep-wired and long-lasting, acquired over time. Beside than using the concept of successful aging, which has a value-laden connotation, we also propose maintainable (moreover, promotable) positive mental health as a practical, measurable indicator of positive aging. According to the Maintainable Positive Mental Health Theory originally developed by Oláh [ 60 , 61 ], the level of well-being in later life depends on both the presence of psychological resources for positive mental health and the ability to utilize them effectively. This approach considers all theory-based but empirically identified components of well-being as features of mental health that reflect the presence and proper functioning of psychological capacities needed to maintain and promote positive psychological status and mental and physical health. This is in line with the World Health Organization’s definition of mental health as a dynamic state of internal equilibrium that enables individuals to use their abilities in harmony with universal values of society [ 58 ]. In addition to the components of well-being, resilience, accommodation to changes, and the development of efficient coping capacities such as savoring and establishing positive states while handling negative states are also major contributors to positive mental health. Therefore, our suggested definition of mental health in later life includes a high level of global well-being; psychological, social, and spiritual well-functioning; resilience; efficient creative and executive functioning; coping; and savoring capacities. These pillars ensure that individuals can flourish amidst the changes and challenges along with the age-related psychological frailty, including declines, losses, and negative events. The quality of these protective factors is decisive in strengthening an individual’s coping capacity and guaranteeing flourishing despite potential negative events, challenges, health issues, or losses during the aging process.

Mental Health Test — a comprehensive quantitative measure of psychological strengths and resources

The Mental Health Test [ 60 ] serves as the operationalized, comprehensive measurement of Maintainable Positive Mental Theory (MPMHT) [ 61 ]. The first pillar of MPMHT is Global Well-being, which integrates existing well-being theories and encompasses multi-component subjective well-being in emotional, psychological, social, and spiritual areas of life [ 43 , 62 , 63 ]. Table 1 outlines the pillars of Global Well-being and their relationship with self-regulation, savoring capacity, resilience, and creative and executive efficiency.

Savoring is the second pillar, referring to the ability to mentally relive joyful memories and experiences, generating mental well-being and extending it to future events [ 64 ]. Savoring is a necessary ability for MPMHT, as it contributes to achieving and maintaining positive mental health [ 65 ].

The third pillar is Creative and Executive Efficiency, which enables individuals to cope with difficulties and challenges by mobilizing their competencies in individual and social problem-solving [ 43 , 51 ].

The fourth pillar is Self-regulation, the ability to regulate and control temperament, emotions, and negative states while persisting in achieving a goal. This ability plays a critical role in mental health and represents one of the most adaptive variables of human behavior [ 66 , 67 , 68 ].

Finally, Resilience is the fifth pillar, referring to an individual’s psychological capacity to mobilize their resources and maintain positive mental health when facing unexpected, stressful situations. The higher the level of resilience, the more quickly the individual can recover from such situations [ 69 , 70 , 71 ].

According to MPMHT, these five pillars are responsible for an individual’s mental health. The competencies associated to the five pillars can be trained, improved, and strengthened. Thus, the pillars provide an easy-to-follow concept for the aging population. Firstly, it provides a structural model for assessing the individual capacities and resources (personal sources of resilience, the person’s own creativity, and his/her executive competencies as well as the sources of peer support and social connectedness). Secondly, based on this assessment the aging person can work up an equilibrium with their own physical and mental status as well as with the outside world, by promoting his/her development, creating a steady state for personal and social functioning (self-regulation), and an equilibrium of positive and negative emotions (coping, savoring). The mindful application of the five-pillar model and therefore the existence and efficient functioning of these elements may improve mental and physical well-being and social functioning, may increase the level of spiritual connectedness, and, through the preservation/promotion) of mental and physical help and global functioning, eventually might contribute to delay aging.

Psychological resilience, competence, and slowing biological aging processes: insights from Blue Zone studies

Research on the Blue Zones, regions where a higher proportion of individuals live longer and healthier lives, offers valuable insights into the connection between psychological factors and aging [ 72 ]. Blue Zones include five areas: Okinawa (Japan), Sardinia (Italy), Nicoya (Costa Rica), Icaria (Greece), and the Seventh-day Adventist community in Loma Linda (CA, USA) [ 73 , 74 , 75 , 76 , 77 ]. Studies conducted in these regions have identified several commonalities that contribute to longevity, including lifestyle, diet, and social factors [ 72 , 73 , 74 , 78 , 79 , 80 , 81 , 82 ]. These findings have been confirmed by subsequent studies in different populations [ 83 , 84 ]. Individuals living in the Blue Zones have been observed to exhibit a younger biological age compared to their chronological age [ 85 ]. This region-specific slowing down of aging processes is attributed to the unique lifestyle, dietary, and social factors prevalent in these regions.

Blue Zone populations are a valuable resource for the study of positive aspects of aging. Importantly, psychological resilience and competence likely play a significant role in slowing down biological aging processes, contributing to overall well-being and having a positive impact on physical health and longevity [ 77 , 86 , 87 ]. One key insight from Blue Zone research is the importance of a strong sense of purpose, known as “ikigai” [ 88 , 89 ] in Okinawa and “plan de vida” in Nicoya [ 73 ]. A well-defined purpose in life contributes to psychological resilience and competence, as it fosters motivation, determination, and a positive outlook. This sense of purpose is thought to reduce stress and anxiety and increase the sense of connectedness, which can help protect against the harmful effects of chronic stress on biological aging processes [ 83 , 84 ].

Drawing inspiration from lessons learned through Blue Zone research, individuals may benefit from a structured approach to discovering meaning in their lives, such as through targeted interventions. In this context, the concept of “life crafting” was introduced, a process grounded in positive psychology and the salutogenesis framework [ 90 , 91 , 92 , 93 ]. Life crafting typically begins with an intervention that incorporates a blend of self-reflection on values, passions, and objectives, envisioning one’s best possible self, developing goal attainment strategies, and employing other positive psychology techniques. Crucial components of such an intervention include identifying values and passions, examining current and desired abilities and habits, contemplating present and future social connections, outlining specific goal achievement, and committing to the established goals [ 92 ]. Previous research has demonstrated that personal goal setting and goal attainment strategies can provide individuals with direction and a sense of purpose [ 92 ]. By drawing from research findings in positive psychology, such as salutogenesis, sense of coherence, implementation intentions, value congruence, broaden-and-build, and goal-setting literature, a comprehensive, evidence-based life-crafting intervention program can be developed [ 92 ]. Informed by insights from the Blue Zones, this intervention can assist individuals in identifying their life purpose while concurrently ensuring that they create tangible plans to pursue it. The underlying premise is that life crafting empowers individuals to take charge of their lives, ultimately optimizing performance and happiness.

Another aspect highlighted in Blue Zone studies is the value of social connections and support networks [ 72 ]. Maintaining close relationships with family, friends, and community members can promote psychological resilience and competence by both accepting and providing emotional support, encouragement, and a sense of belonging. Social connections also facilitate the exchange of knowledge, resources, and coping strategies, which can further enhance an individual’s ability to deal with challenges and stressors.

Furthermore, the Blue Zones emphasize the role of regular physical activity and a predominantly plant-based diet [ 78 , 81 , 82 , 94 , 95 , 96 ], which have been linked to improved mental health, increased cognitive functioning, and reduced risk of age-related diseases. By maintaining a healthy lifestyle, individuals can foster their psychological resilience and competence while simultaneously mitigating the negative impact of biological aging.

Taken together, psychological resilience and competence are essential factors in slowing down biological aging processes, as demonstrated by the Blue Zone studies. Cultivating a sense of purpose, nurturing social connections, and adopting a healthy lifestyle can help enhance these psychological factors and contribute to a longer, healthier life.

Maintainable Positive Mental Health in late life

In this section we provide evidence and illustrate empirically proven strategies for the development of psychological immunocompetencies among the elderly. Emotional well-being can be improved in old age through various methods. Formal volunteering [ 97 ] is a low-cost and organic method that not only contributes to the more efficient functioning of a community but also gives older adults meaning and purpose while strengthening their commitment and social belonging. Another effective technique is to encourage older adults to be mindful of positive experiences regularly. For example, a study indicated that setting aside 5 min in the morning and 5 min in the evening each day for 1 week significantly increased the subjective well-being of participants [ 98 ]. Purposeful activity interventions, particularly those that involve taking on a functional role, can also improve well-being and quality-of-life outcomes in older adults aged 80 years and older [ 99 ].

Digital technology can play a crucial role in maintaining positive mental health in later stages of life. Recent studies have shown that the use of mobile fitness technology is associated with improved physical and psychological well-being, as measured by PERMA, among individuals aged 60 years or older [ 100 ]. Additionally, digital media can foster a sense of belonging and enhance communication among the elderly, leading to positive social outcomes [ 101 ].

Spiritual well-being is a crucial factor in maintaining positive mental health for older adults. Social innovation has been shown to contribute to enhancing the meaning and purpose of daily life for nursing home residents [ 102 ]. In a recent study, the process of spiritual care was found to involve identifying the spiritual needs and resources of older adults in healthcare, understanding their specific requirements, developing a personalized spiritual care treatment plan, and engaging relevant healthcare and spiritual care professionals to facilitate personal connections with meaning-making agents [ 103 ].

Other studies have demonstrated that mindfulness practices can have a positive impact on the happiness and resilience of adults aged 60 and over [ 98 ]. Practicing mindfulness by being aware of positive experiences and recognizing associated positive emotions twice a day for 5 min was found to improve well-being post-intervention, as well as 1 and 3 months later. Additionally, a 30-min mindfulness intervention, where participants were asked to savor positive emotions associated with connections with others, was found to enhance psychological agency in adults aged 60 to 90 years [ 104 ].

Research has shown that emotional intelligence-based interventions, including psychoeducation, can significantly improve the skills of older adults and increase their scores on resilience and life satisfaction [ 105 ]. Moreover, alternative interventions such as mindfulness and physical activity interventions have also been found to strengthen resilience in older adults [ 106 ].

Regular practice of moderately intense physical activity is a low-cost strategy that can help improve and maintain self-regulation. In one study, the mental well-being of 58 individuals aged 67 to 85 who participated in two moderately intense physical training programs was longitudinally evaluated [ 107 ]. The participants reported significantly more adaptive emotion regulation strategies after the intervention.

Additionally, self-efficacy can be improved among older adults through problem-solving therapy. An 8-week-long intervention was found to increase self-efficacy in elderly nursing home residents both at the end of the intervention and 3 months post-intervention [ 108 ].

These findings underscore the importance of early intervention, preventive community-based approaches, and the promotion of mental health for older adults. Public mental health conceptual frameworks, such as socioecological models, highlight the impact of individual, community, family/relational, and structural determinants [ 109 , 110 ]. Jopling’s model can be a promising framework for planning future interventions, identifying which levels and agents can contribute to the mental health of the elderly [ 111 ].

To help older individuals maintain their positive mental health status, it is crucial to establish sustainable prevention and protection strategies. One such strategy is to leverage modern technological developments customized for older adults, which can be a key element in innovation practices. With increasing interest and proficiency in digital media platforms and applications, older adults can stay healthy, independent, and socially connected. Digital media can broaden their social networks, enable communication with peers and younger generations, organize social and group events, promote diversity, and facilitate exchange of social support, ultimately bringing about a positive change in their social network, connectedness, and social inclusion. Therefore, short online cost-effective interventions should be more boldly applied among them.

Spirituality is an internal psychological resource that can be accessed anywhere, anytime, by the elderly regardless of their life situation, circumstances, cognitive status, or physical complaints. Spirituality can be experienced in many forms, from religious practice to simple sense of coherence and connectedness, and can also be manifested in secular frameworks. It is important to tailor spiritual practices to individual needs and implement them in social constructs that are personalized for older adults.

Nursing homes need to become more homelike and patient- and family-centered to enhance the quality of life, satisfaction, and autonomy of their residents. Empirical evidence has shown that cultural changes in nursing homes, such as individualized care, meaningful relationships, opportunities for participation in life roles, and a sense of belonging, have had positive effects on residents. Therefore, it is important to continue and strengthen this cultural shift in nursing homes.

In recent years, positive psychological interventions have faced significant scrutiny. The Best-Practice Guidelines for Positive Psychological Intervention Research Design offers comprehensive guidelines that address crucial aspects of intervention methodology, including (1) intervention design, (2) participant recruitment and retention, (3) adoption, (4) fidelity and implementation concerns, and (5) efficacy or effectiveness evaluation [ 112 ]. Additionally, the Intervention Mapping Approach and Theoretical Domains Framework deliver detailed insights into the scientific development process of mental health interventions [ 113 ]. By doing so, they demonstrate how utilizing these methodologies can enhance the reporting standards for intervention development.

Positive psychology approaches can play a crucial role in alleviating the psychological burden experienced by the elderly during the COVID-19 pandemic [ 114 ] as well. By promoting positive emotions, enhancing resilience, and fostering a sense of purpose and meaning, these interventions can help older adults cope with the challenges of the pandemic and maintain their mental well-being. In addition, it is important to note that the older adults are particularly vulnerable to COVID-19 mortality and morbidity [ 115 , 116 , 117 , 118 , 119 ], which can exacerbate existing psychological distress [ 120 , 121 , 122 ]. Therefore, positive psychology interventions are not only important for maintaining mental health but can also have potential benefits for physical health outcomes in this population.

Practical implications

The wider implementation MPMHT provides new perspectives for previous research on psychological immune competence and positive mental health [ 61 ] and a new conceptual and practical model for intervention programs aim to promote successful aging. Exploring and exploiting the existing (sometimes hidden) capacities of people previously focusing to age-related impairments not only help to shift their focus of attention. MPMHT not only helps to embrace the psychological frailty in aging as part of human experience but also provides purposeful practical strategies and techniques for promoting positive health and global functioning and, as a result, eventually may delay aging. The Mental Health Test (MHT) is the first test to have a five-dimensional complex structure covering a wide spectrum of mental health. The short completion time, the self-test design of the 18-item questionnaire, can provide the opportunity of measuring mental health competencies quickly and easily. It can be applied in epidemiological surveys, even in large-scale, representative survey programs, and also can serve as an everyday practical tool for the planning of the clients’ personalized health promotion interventions. Although various psychological measures are available, MHT’s unique structure comprehensively provides a panoramic view of the elderly’s mental health competencies, even among different kind of health care settings. Mental health institutions, nursing homes, social care institutions, and community-based services can adopt MHT into their daily practice. MHT serves for the comprehensive assessment of MPMHT but by the assessment of the resources of clients it also supports diagnostic work and the planning of personalized therapy. Beside therapy it can also help to improve the client’s level of global functioning when the goal is not primary symptom reduction but the restoration of daily functioning. Thus, MPMHT can propose a new paradigm for rehabilitation programs. The panoramic evaluation of resources and capacities with the structured assessment of the five pillars enables a more precise, personalized approach to promote the mental health of the elderly. The revealed personal resources can be used in counseling, therapy, and individual or group intervention programs. The prolonged maintenance of physical and mental functioning may have positive economic impact, since people living with mental disorders or other kind of disabilities may recover their functions more quickly, enabling them to maintain or improve their social productivity even in late life.

Conclusion and perspectives

In conclusion, this paper has shed light on the persistent obstacle that impedes progress in understanding the vulnerability of the elderly, which remains entrenched in society and the field of psychology. However, flourishing older adults continue to experience personal growth as they evolve and change. Our review has highlighted that mental health components have well-defined features and competencies that are modifiable and therefore can be trained and strengthened. Creative and executive efficiency, self-regulation, and resilience show positive correlations with age, indicating their potential for improvement. Savoring also implies a mental ability that can be enhanced with cognitive techniques, ultimately leading to greater subjective well-being, life satisfaction, and happiness.

It is important to note that, despite the psychological frailty in aging (e.g., increasing losses and higher prevalence of age-related diseases), strengthening these competencies can promote autonomy and a sense of self-coherence. Future research should focus to the elaboration of the concept of positive, maintainable mental health in the elderly. The development and implementation of strategies of increasing resilience and decrease frailty can demonstrate that along with embracing of vulnerability, aging can also be a human experience of flourishing, connectedness, and coherence. Incorporating the growing number of interventions based on positive psychology (a short outline is presented in Table 2 ) into multi-domain approaches is essential for promoting successful aging, as they synergistically enhance psychological resilience and competence, contributing to overall well-being and longevity [ 123 , 124 ].

Urban Institute: The US population is aging. https://www.urban.org/policy-centers/cross-center-initiatives/program-retirement-policy/projects/data-warehouse/what-future-holds/us-population-aging . Accessed 13 April 2023.

Asano M, Nomura Y, Hayakawa M, Ito KM, Ito K, Uyama Y, et al. Increased Ca 2+ influx in the resting state maintains the myogenic tone and activates charybdotoxin-sensitive K + channels in femoral arteries from young SHR. Clin Exp Pharmacol Physiol Suppl. 1995;1(7):S225–7.

Google Scholar  

World Economic Forum: Is Asia-Pacific ready to age gracefully? Age and longetivity. https://www.weforum.org/agenda/2021/10/is-asia-pacific-ready-to-be-the-world-s-most-rapidly-ageing-region/ . Accessed 13 April 2023.

World Health Organization: WHO: Number of people over 60 years set to double by 2050; major societal changes required. https://www.who.int/news/item/30-09-2015-who-number-of-people-over-60-years-set-to-double-by-2050-major-societal-changes-required . Accessed 13 April 2023.

World Health Organization. Decade of healthy ageing 2020–2030, Update 5, 2020.

Rowe JW, Kahn RL. Human aging: usual and successful. Science. 1987;237(4811):143–9.

Article   CAS   PubMed   Google Scholar  

Rowe JW, Kahn RL. Successful aging. Gerontologist. 1997;37(4):433–40.

Rowe JW, Kahn RL. Successful Aging 2.0: conceptual expansions for the 21st century. J Gerontol B Psychol Sci Soc Sci. 2015;70(4):593–6.

Article   PubMed   Google Scholar  

Enkvist A, Ekstrom H, Elmstahl S. Associations between cognitive abilities and life satisfaction in the oldest-old. Results from the longitudinal population study Good Aging in Skane. Clin Interv Aging. 2013;8:845–53.

Article   PubMed   PubMed Central   Google Scholar  

Kern ML, Hampson SE, Goldberg LR, Friedman HS. Integrating prospective longitudinal data: modeling personality and health in the Terman Life Cycle and Hawaii Longitudinal Studies. Dev Psychol. 2014;50(5):1390–406.

Netuveli G, Wiggins RD, Hildon Z, Montgomery SM, Blane D. Quality of life at older ages: evidence from the English longitudinal study of aging (wave 1). J Epidemiol Community Health. 2006;60(4):357–63.

Sperry L, McNeil C. Normal human aging today and tomorrow: insights from the batimore longitudinal study of aging 1. Aging in the Twenty-first Century: Routledge; 2021. p. 59–72.

Vaillant GE. Adaptation to life. Harvard University Press; 1995.

Vaillant GE. Aging well: surprising guideposts to a happier life from the landmark study of adult development. Hachette UK; 2008.

Seliger SL, Wendell CR, Waldstein SR, Ferrucci L, Zonderman AB. Renal function and long-term decline in cognitive function: the Baltimore Longitudinal Study of Aging. Am J Nephrol. 2015;4–5:305–12.

Article   Google Scholar  

Garner RE, Feeny DH, Thompson A, Bernier J, McFarland BH, Huguet N, et al. Bodyweight, gender, and quality of life: a population-based longitudinal study. Qual Life Res. 2012;21(5):813–25.

WHO’s work on the UN decade of healthy ageing (2021–2030). https://www.who.int/initiatives/decade-of-healthy-ageing . Accessed 15 March 2023.

Depp CA, Jeste DV. Definitions and predictors of successful aging: a comprehensive review of larger quantitative studies. Am J Geriatr Psychiatry. 2006;14(1):6–20.

Hr J. Successful aging. Gerontologist. 1961;1(1):8–13.

Ager CL, White LW, Mayberry WL, Crist PA, Conrad ME. Creative aging. Int J Aging Hum Dev. 1981;14(1):67–76.

Tromp C, Glăveanu VP. A Model of Creative Aging (MOCA): unlocking the potential of constraints for creativity in older adults. Psychol Aesthet Creat Arts. 2023. https://doi.org/10.1037/aca0000538 .

Morrow-Howell N, Hinterlong J, Sherraden M eds. Productive aging: concepts and challenges. JHU Press; 2001:260.

Caprara M, Molina MA, Schettini R, Santacreu M, Orosa T, Mendoza-Nunez VM, et al. Active aging promotion: results from the vital aging program. Curr Gerontol Geriatr Res. 2013;2013: 817813.

Aldwin CM, Spiro A III, Park CL. Health, behavior, and optimal aging: a life span developmental perspective. In: Birren J, Schaire KW, editors. Handbook of the psychology of aging. Elsevier; 2006. p. 85–104.

Seligman ME, Csikszentmihalyi M. Positive psychology. An introduction. Am Psychol. 2000;55(1):5–14.

Wehmeyer ML. The future of positive psychology and disability. Front Psychol. 2021;12: 790506.

Rockwood K, Mitnitski AB. Frailty in relation to the accumulation of deficits. J Gerontol. 2007;62:722–7.

Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, Schols JM. In search of an integral conceptual definition of frailty: opinions of experts. J Am Med Dir Assoc. 2010;11(5):338–43.

Hansen T, Slagsvold B. The age and subjective well-being paradox revisited: a multidimensional perspective. Norsk Epidemiologi. 2012;22(2). https://doi.org/10.5324/nje.v22i2.1565 .

Costantini A, De Beer LT, Klooster PMT, Zondervan-Zwijnenburg MAJ, Vera M, van Zyl LE. Editorial: positive psychological assessments: modern approaches, methodologies, models and guidelines: current perspectives. Front Psychol. 2022;13:1020653.

Linton MJ, Dieppe P, Medina-Lara A. Review of 99 self-report measures for assessing well-being in adults: exploring dimensions of well-being and developments over time. BMJ Open. 2016;6(7): e010641.

Costantini A, De Beer LT, Klooster PMT, Zondervan-Zwijnenburg MA, Vera M, van Zyl LE. Positive psychological assessments: Modern approaches, methodologies, models and guidelines: Current perspectives. Front Psychol. 2022;13:1020653.

Diener E, Wirtz D, Tov W, Kim-Prieto C, Choi DW, Oishi S, et al. New well-being measures: short scales to assess flourishing and positive and negative feelings. Soc Indic Res. 2009;97:143–56.

Keyes CL. Promoting and protecting mental health as flourishing: a complementary strategy for improving national mental health. Am Psychol. 2007;62(2):95–108.

Ryff CD. Psychological well-being in adult life. Curr Dir Psychol Sci. 1995;4:99–104.

Seligman M. PERMA and the building blocks of well-being. J Posit Psychol. 2018;13:333–5.

Caprara GV, Alessandri G, Caprara M. Associations of positive orientation with health and psychosocial adaptation: a review of findings and perspectives. Asian J Soc Psychol. 2019;22:126–32.

Oláh A. Positivity is an up-to-date predictor of well-functioning instead of a eudaemon. Asian J Soc Psychol. 2019;22:143–5.

Huppert FA, So TT. Flourishing across Europe: application of a new conceptual framework for defining well-being. Soc Indic Res. 2013;110(3):837–61.

Butler J, Kern ML. The PERMA-Profiler: a brief multidimensional measure of flourishing. Int J Wellbeing. 2016;6:1–48.

Joseph S, Maltby. Positive functioning inventory: initial validation of a 12-item self-report measure of well-being. Psychol Well-Being. 2014;4:1–13.

Lukat J, Margraf J, Lutz R, van der Veld WM, Becker ES. Psychometric properties of the Positive Mental Health Scale (PMH-scale). BMC Psychol. 2016;4:8.

Oláh A, Vargha A, Csengődi M, Bagdi B, Diósi T. Magyarország Boldogságtérképe. 2020 [Available from: http://boldogsagprogram.hu/magyarorszag-boldogsagterkepe-2020/ .

Antonovsky A. The structural sources of salutogenic strengths. In: Cooper CL, Payne R, editors. Personality and stress: individual differences in the stress process. John Wiley & Sons; 1991. p. 67–104.

Block J, Kremen AM. IQ and ego-resiliency: conceptual and empirical connections and separateness. J Pers Soc Psychol. 1996;70(2):349–61.

Block JH, Block J. The role of ego-control and ego-resiliency in the organization of behavior. In: Collins WA, editor. Development of cognition, affect, and social relations. Psychology Press; 2014. p. 49–112.

Jahoda M. Current concepts of positive mental health. Basic Books; 1958. https://psycnet.apa.org/doi/10.1037/11258-000 .

Vaillant GE. Mental health. Am J Psychiatry. 2003;160(8):1373–84.

Vaillant GE. Positive mental health: is there a cross-cultural definition? World Psychiatry. 2012;11(2):93–9.

Mayerson NH. The character strengths response: an urgent call to action. Front Psychol. 2020;11:2106.

Oláh A. Anxiety, coping and flow. Empirical studies in interactional perspective. Trefort Press; 2005:9789634463498.

Bohlmeijer ET, Westerhof GJ. A new model for sustainable mental health: integrating well-being into psychological treatment. In: Kirby JN, Gilbert P, editors. Making an impact on mental health: The applications of psychological research. Routledge/Taylor & Francis Group; 2020. p. 153–88.

Dodge R, Daly A, Huyton J, Sanders L. The challenge of defining wellbeing. Int J Wellbeing. 2012;2:222–35.

Lomas T. Life balance and harmony. Int J Wellbeing. 2021;11:50–68.

Walker M, Unterhalter E. Amartya Sen’s capability approach and social justice in education. Springer; 2007. p. 1–18.

Bech P, Gudex C, Johansen KS. The WHO (Ten) Well-Being Index: validation in diabetes. Psychother Psychosom. 1996;65(4):183–90.

Lamers SM, Westerhof GJ, ten Bohlmeijer ET, Klooster PM, Keyes CL. Evaluating the psychometric properties of the mental health continuum-short form (MHC-SF). J Clin Psychol. 2011;67:99–110.

Galderisi S, Heinz A, Kastrup M, Beezhold J, Sartorius N. Toward a new definition of mental health. World Psychiatry. 2015;14(2):231–3.

Van de Weijer M, Baselmans B, van der Deijl W, Bartels M. A growing sense of well-being: a literature review on the complex framework well-being. 2018. https://doi.org/10.31234/osf.io/3rmx9 .

Zabo V, Olah A, Vargha A. A new complex mental health test in a positive psychological framework. Front Psychol. 2022;13: 775622.

Oláh A. A Globális Jól-lét Modell kidolgozása és empirikus validitásának igazolása a személyiségtényezők figyelembe vételével. A K1A: 116965 számú kutatás zárójelentése. 2021.

Oláh A, Kapitány-Fövény M. Ten years of positive psychology. Magyar Pszichológiai Szemle. 2012;67:19–45.

Oláh ABAK, 55. A new model and a new inventory of well-being. 8th European Conference on Positive Psychology Budapest, Hungary: Akadémia Kiadó; 2016. p. 55.

Bryant FB, Veroff J. Savoring: a new model of positive experience. Lawrence Erlbaum Associates Publishers; 2007. https://doi.org/10.4324/9781315088426 .

Bryan MA, Mallik D, Cochran G, Lundahl B. Mindfulness and savoring: a commentary on savoring strategies and their implications for addiction treatment. Subst Use Misuse. 2022;57(5):822–6.

Baumeister RF, Vohs KD. Handbook of self-regulation: research, theory, and applications. The Guilford Press; 2004.

Elliot AJ, Thrash TM, Murayama K. A longitudinal analysis of self-regulation and well-being: avoidance personal goals, avoidance coping, stress generation, and subjective well-being. J Pers. 2011;79(3):643–74.

Singh S, Sharma NR. Self-regulation as a correlate of psychological well-being. Indian J Health Wellbeing. 2018;9:441–4.

Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76–82.

Southwick SM, Charney DS. Resilience: the science of mastering life’s greatest challenges. Cambridge University Press; 2018. https://doi.org/10.1017/78110849246 .

Verdolini N, Amoretti S, Montejo L, Garcia-Rizo C, Hogg B, Mezquida G, et al. Resilience and mental health during the COVID-19 pandemic. J Affect Disord. 2021;283:156–64.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Fastame MC, Mulas I, Pau M. Mental health and motor efficiency of older adults living in the Sardinia’s Blue Zone: a follow-up study. Int Psychogeriatr. 2021;33(12):1277–88.

Buettner D, Skemp S. Blue Zones: lessons from the world’s longest lived. Am J Lifestyle Med. 2016;10(5):318–21.

Poulain M, Herm A, Errigo A, Chrysohoou C, Legrand R, Passarino G, et al. Specific features of the oldest old from the Longevity Blue Zones in Ikaria and Sardinia. Mech Ageing Dev. 2021;198: 111543.

Poulain M, Pes GM, Grasland C, Carru C, Ferrucci L, Baggio G, et al. Identification of a geographic area characterized by extreme longevity in the Sardinia island: the AKEA study. Exp Gerontol. 2004;39(9):1423–9.

Legrand R, Manckoundia P, Nuemi G, Poulain M. Assessment of the health status of the oldest olds living on the Greek Island of Ikaria: a population based-study in a Blue Zone. Curr Gerontol Geriatr Res. 2019;2019:8194310.

Fastame MC, Hitchcott PK, Mulas I, Ruiu M, Penna MP. Resilience in elders of the Sardinian Blue Zone: an explorative study. Behav Sci (Basel). 2018;8(3):30.

Appel LJ. Dietary patterns and longevity: expanding the Blue Zones. Circulation. 2008;118(3):214–5.

Chrysohoou C, Pitsavos C, Lazaros G, Skoumas J, Tousoulis D, Stefanadis C, et al. Determinants of all-cause mortality and incidence of cardiovascular disease (2009 to 2013) in older adults: the Ikaria study of the Blue Zones. Angiology. 2016;67(6):541–8.

Heath C, Lopez NV, Seeton V, Sutliffe JT. Blue Zones-based worksite nutrition intervention: positive impact on employee wellbeing. Front Nutr. 2022;9: 795387.

Legrand R, Nuemi G, Poulain M, Manckoundia P. Description of lifestyle, including social life, diet and physical activity, of people >/=90 years living in Ikaria, a Longevity Blue Zone. Int J Environ Res Public Health. 2021;18(12).6602.

Pes GM, Poulain M, Errigo A, Dore MP. Evolution of the dietary patterns across nutrition transition in the Sardinian Longevity Blue Zone and association with health indicators in the oldest old. Nutrients. 2021;13(5):1495.

Tanno K, Sakata K, Ohsawa M, Onoda T, Itai K, Yaegashi Y, et al. Associations of ikigai as a positive psychological factor with all-cause mortality and cause-specific mortality among middle-aged and elderly Japanese people: findings from the Japan Collaborative Cohort Study. J Psychosom Res. 2009;67(1):67–75.

Tomioka K, Kurumatani N, Hosoi H. Relationship of having hobbies and a purpose in life with mortality, activities of daily living, and instrumental activities of daily living among community-dwelling elderly adults. J Epidemiol. 2016;26(7):361–70.

Engelbrecht HR, Merrill SM, Gladish N, MacIsaac JL, Lin DTS, Ecker S, et al. Sex differences in epigenetic age in Mediterranean high longevity regions. Front Aging. 2022;3:1007098.

Fastame MC, Hitchcott PK, Penna MP. The impact of leisure on mental health of Sardinian elderly from the ‘Blue Zone’: evidence for ageing well. Aging Clin Exp Res. 2018;30(2):169–80.

Fastame MC, Penna MP, Hitchcott PK. Psychological markers of longevity in Sardinian centenarians: the impact of developmental factors and social desirability. Aging Clin Exp Res. 2020;32(1):107–14.

Mori K, Kaiho Y, Tomata Y, Narita M, Tanji F, Sugiyama K, et al. Sense of life worth living (ikigai) and incident functional disability in elderly Japanese: the Tsurugaya Project. J Psychosom Res. 2017;95:62–7.

Nakanishi N. ‘Ikigai’ in older Japanese people. Age Ageing. 1999;28(3):323–4.

Chen S, van der Meij L, van Zyl LE, Demerouti E. The Life Crafting Scale: development and validation of a multi-dimensional meaning-making measure. Front Psychol. 2022;13: 795686.

de Jong EM, Ziegler N, Schippers MC. From shattered goals to meaning in life: life crafting in times of the COVID-19 pandemic. Front Psychol. 2020;11: 577708.

Schippers MC, Ziegler N. Life crafting as a way to find purpose and meaning in life. Front Psychol. 2019;10:2778.

Skrabski A, Kopp M, Rozsa S, Rethelyi J, Rahe RH. Life meaning: an important correlate of health in the Hungarian population. Int J Behav Med. 2005;12(2):78–85.

Lionetti V, Tuana BS, Casieri V, Parikh M, Pierce GN. Importance of functional food compounds in cardioprotection through action on the epigenome. Eur Heart J. 2019;40(7):575–82.

Reca IB, Lionetti V, Camardella L, D’Avino R, Giardina T, Cervone F, et al. A functional pectin methylesterase inhibitor protein (SolyPMEI) is expressed during tomato fruit ripening and interacts with PME-1. Plant Mol Biol. 2012;79(4–5):429–42.

Svezia B, Cabiati M, Matteucci M, Passino C, Pe ME, Lionetti V, et al. Tuscany Sangiovese grape juice imparts cardioprotection by regulating gene expression of cardioprotective C-type natriuretic peptide. Eur J Nutr. 2020;59(7):2953–68.

Greenfield EA, Marks NF. Formal volunteering as a protective factor for older adults’ psychological well-being. J Gerontol B Psychol Sci Soc Sci. 2004;59(5):S258–64.

Smith JL, Hanni AA. Effects of a savoring intervention on resilience and well-being of older adults. J Appl Gerontol. 2019;38(1):137–52.

Owen R, Berry K, Brown LJ. Enhancing older adults’ well-being and quality of life through purposeful activity: a systematic review of intervention studies. Gerontologist. 2022;62(6):e317–27.

Suh A, Li M. How the use of mobile fitness technology influences older adults’ physical and psychological well-being? Comput Hum Behav. 2022;131: 107205.

Sen K, Prybutok G, Prybutok V. The use of digital technology for social wellbeing reduces social isolation in older adults: a systematic review. SSM-population health. 2022;17: 101020.

Slettebo A, Skaar R, Brodtkorb K. Social innovation toward a meaningful everyday life for nursing home residents: an ethnographic study. Front Psychol. 2021;12: 666079.

Nissen RD, Viftrup DT, Hvidt NC. The process of spiritual care. Front Psychol. 2021;12: 674453.

Borelli JL, Bond DK, Fox S, Horn-Mallers M. Relational savoring reduces physiological reactivity and enhances psychological agency in older adults. J Appl Gerontol. 2020;39(3):332–42.

Delhom I, Satorres E, Meléndez JC. Can we improve emotional skills in older adults? Emotional intelligence, life satisfaction, and resilience. Psychosoc Interv. 2020;29(3):133–9.

Liu JJ, Ein N, Gervasio J, Battaion M, Reed M, Vickers K. Comprehensive meta-analysis of resilience interventions. Clin Psychol Rev. 2020;82: 101919.

Delle Fave A, Bassi M, Boccaletti ES, Roncaglione C, Bernardelli G, Mari D. Promoting well-being in old age: the psychological benefits of two training programs of adapted physical activity. Front Psychol. 2018;9:828.

Wu X, Li J, Zhang C, Zhou X, Dong X, Cao H, ..., Xie J. The effects of modified problem-solving therapy on depression, coping and self-efficacy in nursing homes elderly. Front Psychol. 2023;13:8404.

Bronfenbrenner U. The ecology of human development. Harvard University Press; 1979.

Göran D, Whitehead M. Policies and strategies to promote social equity in health. Background document to World Health Organisation – Strategy paper for Europe. Institute for Future Studies; 1991.

Jopling K. Promising approaches revisited: effective action on loneliness in later life. Age UK/Campaign to End Loneliness. 2020.

Zyl LE, Efendic E, Rothmann S, Shankland R. Best-practice guidelines for positive psychological intervention research design. In: Van Zyl LE, Rothmann S, editors. Positive Psychological Intervention Design and Protocols for Multi-Cultural Contexts. Springer; 2019. p. 1–32.

Van Agteren J, Iasiello M, Ali K, Fassnacht DB, Furber G, Woodyatt L, et al. Using the intervention mapping approach to develop a mental health intervention: a case study on improving the reporting standards for developing psychological interventions. Front Psychol. 2021;3773.

Lasota A, Mroz J. Positive psychology in times of pandemic—time perspective as a moderator of the relationship between resilience and meaning in life. Int J Environ Res Public Health. 2021;18(24):13340.

Nikolich-Zugich J, Knox KS, Rios CT, Natt B, Bhattacharya D, Fain MJ. SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. Geroscience. 2020;42(2):505–14.

Gado K, Kovacs AK, Domjan G, Nagy ZZ, Bednarik GD. COVID-19 and the elderly. Physiol Int. 2022. https://doi.org/10.1556/060.2022.0203 .

Peterfi A, Meszaros A, Szarvas Z, Penzes M, Fekete M, Feher A, et al. Comorbidities and increased mortality of COVID-19 among the elderly: a systematic review. Physiol Int. 2022. https://doi.org/10.1556/2060.2022.00206 .

Fekete M, Szarvas Z, Fazekas-Pongor V, Feher A, Dosa N, Lehoczki A, et al. COVID-19 infection in patients with chronic obstructive pulmonary disease: from pathophysiology to therapy. Mini-review Physiol Int. 2022;109(1):9–19.

Article   CAS   Google Scholar  

Moccia F, Gerbino A, Lionetti V, Miragoli M, Munaron LM, Pagliaro P, et al. COVID-19-associated cardiovascular morbidity in older adults: a position paper from the Italian Society of Cardiovascular Researches. Geroscience. 2020;42(4):1021–49.

Fountoulakis KN, Karakatsoulis G, Abraham S, Adorjan K, Ahmed HU, Alarcon RD, et al. Results of the COVID-19 mental health international for the general population (COMET-G) study. Eur Neuropsychopharmacol. 2022;54:21–40.

Fountoulakis KN, Karakatsoulis GN, Abraham S, Adorjan K, Ahmed HU, Alarcon RD, et al. The effect of different degrees of lockdown and self-identified gender on anxiety, depression and suicidality during the COVID-19 pandemic: data from the international COMET-G study. Psychiatry Res. 2022;315: 114702.

Fountoulakis KN, Karakatsoulis GN, Abraham S, Adorjan K, Ahmed HU, Alarcon RD, et al. Results of the COVID-19 mental health international for the health professionals (COMET-HP) study: depression, suicidal tendencies and conspiracism. Soc Psychiatry Psychiatr Epidemiol. 2023:1–24.

Lee C, Kuhn I, McGrath M, Remes O, Cowan A, Duncan F, ..., Niht Sphr. A systematic scoping review of community‐based interventions for the prevention of mental ill‐health and the promotion of mental health in older adults in the UK. Health Soc Care Community. 2022;30(1):27–57.

Saadeh M, Hu X, Dekhtyar S, Welmer AK, Vetrano DL, Xu W, et al. Profiles of behavioral, social and psychological well-being in old age and their association with mobility-limitation-free survival. Aging (Albany NY). 2022;14(15):5984–6005.

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Open access funding provided by Semmelweis University. Project no. TKP2021-NKTA-47 has been implemented with the support provided by the Ministry of Innovation and Technology of Hungary from the National Research, Development and Innovation Fund, financed under the TKP2021-NKTA funding scheme. Funding for the project through the National Cardiovascular Laboratory Program (RRF-2.3.1–21-2022–00003) was provided by the Ministry of Innovation and Technology of Hungary from the National Research, Development and Innovation Fund. This work was also supported by grants from the European University for Well-Being (EUniWell) program (grant agreement number: 101004093/EUniWell/EAC-A02-2019/EAC-A02-2019–1). The funding sources had no role in the writing of the article and in the decision to submit the article for publication.

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Virág Zábó & György Purebl

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Zábó, V., Csiszar, A., Ungvari, Z. et al. Psychological resilience and competence: key promoters of successful aging and flourishing in late life. GeroScience 45 , 3045–3058 (2023). https://doi.org/10.1007/s11357-023-00856-9

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Why Well-Being Is Foundational to Leading at Your Best

A new study suggests why it’s vital to prioritize leaders’ well-being..

Updated April 3, 2024 | Reviewed by Ray Parker

• When leaders maximize their well-being, they lead at their best and make a positive impact.
• The results of a recent study highlight a striking disparity between thriving and burned-out executives.
• Leaders can start with three strategies to connect the dots between leadership and well-being.

There is currently a disconnect between the demand to improve workforce well-being and the progress being made.

Unfortunately, workforce burnout is rising, and well-being is worsening. Specifically, according to Deloitte’s Well-being at Work 2023 survey, employee and leader well-being declined last year, and around 50% of employees and leaders are detrimentally impacted by workplace burnout. Symptoms include poor mental health, exhaustion, stress , and overwhelm.

Simultaneously, the demand for workforce well-being has been increasing for the past four years since the pandemic. And the majority of workers are taking a stand for their well-being: 60% of employees, 64% of managers, and 75% of executives are seriously considering quitting for a job that would better support their well-being, an increase from the prior year (Deloitte, 2023).

What’s contributing to this disconnect?

Based on my decade-plus of experience and research as a public company CEO coach and positive organizational psychologist, the key factor to making progress on workforce well-being is to prioritize the leaders’ own well-being. Wellbeing is broadly defined as human flourishing and wellness of mind and body (Diener et al., 2009).

However, this crucial factor is often overlooked. I frequently hear the misperception that leaders view meeting the demands of leadership as separate from their well-being. Leaders consider workforce well-being, which is commonly approached as a separate initiative or program, as a nice-to-have employee perk that doesn’t apply to them. Furthermore, leaders and executives are expected to lead efforts to improve workforce well-being and ensure that employees thrive, regardless of their own well-being.

In truth, when leaders maximize their well-being by serving themselves first, they lead at their best and positively impact themselves, their team, and their organization.

In a recent study , I interviewed 20 Fortune 1,000 CEOs to understand what leadership performance looks like when executives are thriving and when they are burned out . The results highlight a striking disparity that applies to all leaders.

On one end of the spectrum, I discovered that thriving CEOs create the highest leadership capacity, improve team performance, and help organizations thrive. Thriving CEOs consistently create positive and inclusive environments, energize and encourage others, make clear decisions, are visionary leaders, and retain the enthusiasm and mental agility to excel in their roles.

On the other end of the spectrum, I uncovered the damaging impacts of CEO burnout. CEO burnout is not only harmful to the individual; it is destructive to their teams and organizations. Burned-out CEOs consistently operate with reduced productivity , become closed off, create a negative environment, lack focus for decision-making , and act narrow-mindedly.

Additionally, the exhausting nature of everyday leadership adds pressure to overloaded executives. The results show leaders must routinely exhibit depleting behaviors, including repressing or deferring their own needs, acting in ways that do not necessarily reflect how they feel, and using their own energy to boost others.

These results highlight the high costs of leaders' disconnect from their well-being and what’s possible when leaders connect the dots between the two.

I hear from clients repeatedly that they want to build their visionary leadership capabilities. While this is an essential part of leadership, leaders must start by caring for themselves and cultivating their well-being to have the energy to expand their abilities to inspire.

Consider the metaphor of building a house: It’s the house’s strong foundation that supports the entire house and carries the weight. Without it, the house is prone to damage, and when it’s not addressed long-term, the house could crumble or sink.

When applied to leaders, those with a strong foundation of well-being not only have the stamina to meet the demands of their role, but they lead at their peak performance . As a result, they ultimately have an abundance of energy to inspire, energize, and motivate others positively. Those who don’t are more susceptible to burnout, which, as the study’s results illustrate, negatively impacts their leadership. Over time, from my experience, they are more likely to be crushed by the weight of the pressure.

Three Strategies to Connect the Dots Between Leadership and Well-being

1. Change your mindset

First, shift your awareness to reprioritize yourself and your well-being. Acknowledge that you won’t operate at your highest capacity without first focusing on your well-being. Embrace this mindset: Well-being is foundational to peak leadership performance.

2. Connect to your purpose

Envision what’s possible if you reach your full leadership potential. Check-in with your best self, focusing on the long-term big picture. Consider how to cultivate your well-being to lead at your best. Reflection: What’s important about taking care of my whole self?

3. Replenish your energy through "vital leadership"

Leaders have a lot of energy going out into the world. But what about energy going in? Through my research , I discovered vital leadership provides a foundation of energy resources for leaders to lead at their full capacity. By prioritizing your well-being, you build your vitality, giving you an abundance of energy.

With vital leadership, leaders can learn how to replenish their energy to have the inner physical, psychological, emotional, and spiritual resources to deliver on the outputs. This is an individual experience. It is up to you to determine what energizes you every day.

Reflection Questions:

• What brings you physical, psychological, emotional, and spiritual energy? Brainstorm to create a list, including things you are currently doing, used to do, or want to try.
• How could you integrate what gives you energy into your life more consistently?
• What’s one action you could take to refill your energy today?

What’s possible when leaders connect the dots between leadership and well-being?

What’s possible is that leaders thrive. They show up and lead as their best selves, creating a positive ripple effect throughout their team, organization, and communities. When leaders thrive, it creates an environment where employees can thrive, too.

Ultimately, when leaders embrace well-being as foundational to leadership, it transforms their leadership and lives. If we want leaders to lead at their highest capacity and have the greatest impact, then we must start including well-being in how we approach leadership.

https://www2.deloitte.com/us/en/insights/topics/talent/workplace-well-b…

Jamie Shapiro, Ph.D., is a CEO coach, positive organizational psychologist and the author of Brilliant: Be the Leader Who Shines Brightly Without Burning Out .

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Climate change-related concerns in psychotherapy: therapists’ experiences and views on addressing this topic in therapy

• Katharina Trost   ORCID: orcid.org/0009-0005-1865-1199 1 ,
• Verena Ertl 1 ,
• Julia König   ORCID: orcid.org/0000-0002-6267-337X 1 ,
• Rita Rosner   ORCID: orcid.org/0000-0002-7960-8398 1 &
• Hannah Comtesse   ORCID: orcid.org/0000-0003-4150-6107 1  

BMC Psychology volume  12 , Article number:  192 ( 2024 ) Cite this article

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While adverse impacts of climate change on physical health are well-known, research on its effects on mental health is still scarce. Thus, it is unclear whether potential impacts have already reached treatment practice. Our study aimed to quantify psychotherapists’ experiences with patients reporting climate change-related concerns and their views on dealing with this topic in psychotherapy.

In a nationwide online survey, responses were collected from 573 psychotherapists from Germany. Therapists reported on the presence of such patients, their socio-demographic characteristics, and climate change-related reactions. Psychotherapists’ views on dealing with this topic in psychotherapy were also assessed. Descriptive statistics were used to analyse the responses.

About 72% (410/573) of psychotherapists indicated having had patients expressing concerns about climate change during treatment. Out of these therapists, 41% (166/410) stated that at least one patient sought treatment deliberately because of such concerns. Patients were mainly young adults with higher education. Most frequent primary diagnoses were depression, adjustment disorder, and generalized anxiety disorder. Psychotherapists having encountered such patients differed from those without such encounters in their views on potential functional impairment and the necessity to target the concerns in treatment. Although 79% (326/415) of all respondents felt adequately prepared by their current therapeutic skills, 50% (209/414) reported a lack of information on how to deal with such concerns in therapy.

Conclusions

Results indicate that psychotherapists are frequently confronted with climate change-related concerns and regard the mental health impact of climate change on their patients as meaningful to psychotherapeutic care. Regular care could be improved by a continuous refinement of the conceptualization and knowledge of the mental health influences of climate change. This would allow providing tailored methods of assessing and addressing climate change-related concerns in practice.

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Introduction

Consequences of climate change are affecting an increasing number of people around the world [ 1 ]. While the ways in which climate change impacts physical health have been recognized for some time (e.g., 2), mental health outcomes have become a focus in recent years [ 3 ]. Results show that both acute and chronic (anticipated) consequences of climate change can affect mental health via diverse pathways [ 4 , 5 , 6 ]. Recent reviews on climate change impacts on mental health have highlighted a potential relation between acute climate change consequences and mental disorders [ 6 , 7 , 8 , 9 ]. It is well established that acute events, such as floods or wildfires, are associated with traumatic stress. For example, Kessler, Aguilar-Gaxiola [ 10 ] showed in a review that single event natural disasters were one of the 29 trauma event types with an increased risk of posttraumatic stress disorder (PTSD). Furthermore, Neria, Nandi [ 11 ] reported in a systematic review PTSD prevalence rates between 4% and 60% after natural disasters such as earthquakes, floods, hurricanes, and wildfires around the world from 1963 to 2005, depending on degree of exposure (e.g., proximity to epicenter, extent of disruption) and sample characteristics. While the association between acute events and PTSD is well established, reviews also proposed a relationship between acute weather events and an increase in anxiety disorders and depression [ 5 , 6 , 7 , 8 , 12 ]. Although not every weather extreme or disaster is caused by climate change, it is an established fact that natural disasters are becoming more frequent with climate change progressing [ 13 ]. Consequently, the possible negative effects of climate change on mental health are likely to increase.

The chronic effects of climate change (e.g., drought) on mental health are more difficult to operationalize, because impacts are mostly indirect and delayed, and factors interact in multiple ways (e.g., [ 14 ], for drought, [ 15 ]). However, recent (narrative) reviews on climate change impacts on mental health did focus on chronic influences (e.g., drought, increase in temperature and sea-level, deforestation) on mental health [ 5 , 6 , 7 , 12 , 16 ]. The review conducted by Palinkas and Wong [ 6 ], for example, assumed that subacute consequences of climate change (e.g., heat waves) can exacerbate existing mental disorders (e.g., substance abuse disorders due to diminished thermoregulation). Additionally, this review found that experiencing drought episodes (primarily studied in Australia) is associated with generalized anxiety disorder and depression, among other symptoms, due to factors such as economic effects and migration.

Furthermore, besides the exposure to climate change-related disasters and the perception of chronic climate change hazards, research has suggested that the awareness of the existential threat of climate change (e.g., ecological losses), evokes emotional reactions and may affect mental health (e.g., [ 5 ]). To capture these reactions, new concepts of climate/eco-emotions such as climate change anxiety [ 17 ] and ecological grief [ 18 ] have been introduced. However, these concepts have only recently been quantified [ 17 , 19 ], with first results indicating associations of severe levels of these concepts with functional impacts in daily life (e.g., [ 20 ]). At the general population level, several large-scale studies have shown that significant numbers of people in different countries are emotionally affected by worries, fears and sadness about environmental changes attributed to climate change [ 20 , 21 , 22 ]. For example, in a representative German survey conducted in 2022 more than a half of the participants (55%) indicated to be sad about natural destruction, around a quarter (23%) fully agreed with the statement “I am afraid of the consequences of climate change”, and almost a quarter of people (22%) felt psychologically stressed by climate change and environmental destruction, 5% of whom felt very stressed [ 22 ].

Taken together, these findings suggest that concerns about climate change seem to be widespread and may also become evident in clinical groups [ 23 , 24 , 25 ]. A recent study conducted in the USA investigated the experience, attitude, and knowledge of mental health professionals (MHP, N  = 517) with regard to the impact of climate change on mental health and its effect on treatment [ 24 ]. The majority of participants (57%) strongly agreed that the consequences of climate change influence mental health. Additionally, 54% of MHPs indicated that they had already seen clients who raised climate change-related concerns during treatment. MHPs reported that these concerns were related to symptoms of generalized anxiety, depression, grief reactions, and post-traumatic stress in these clients. Further, the majority of MHPs stated that they lacked tools for assessment and treatment as well as information on referral possibilities for these clients. Similar results were yielded in a sample of physicians and nurses in the USA [ 25 ]. However, it remains unclear whether and to what extent this is also the case in psychotherapeutic care in Europe.

The current study aimed at examining whether German psychotherapists are currently already encountering patients with climate change-related concerns in their practice. Therefore, we recruited a nationwide sample of psychotherapists working in different settings in Germany as possible for an online survey and queried them about these concerns as well as gathering information on patients’ demographics and clinical status. Further, we explored cognitive, emotional, physiological, and behavioral reactions of their patients regarding the respective climate change concerns. Finally, we examined psychotherapists’ views on dealing with climate change-related concerns during treatment. In this regard, we investigated whether psychotherapists who had encountered patients with concerns (therapists with experience) differed in their views from those who had not yet encountered such patients (therapists without experience).

Participants and procedure

The study was conducted as a nationwide cross-sectional online survey among psychotherapists, both licensed and in training, across all therapeutic approaches recognized in Germany. The therapeutic approaches in Germany are: cognitive behavioral therapy (CBT), psychoanalysis (PA), depth psychology (DP), systemic therapy (ST). Inclusion criteria were (a) being a licensed psychotherapist or psychotherapist in training and (b) giving informed consent to participate in the survey. The study was approved by the ethics committee of the Catholic University Eichstätt-Ingolstadt (number: 122–2022). Data collection took place between February and April 2023.

Our recruitment approach aimed to reflect the reality of the German psychotherapeutic care system as accurately as possible. Therefore, all regional Psychotherapists’ Chambers (“Psychotherapeutenkammern”), in which licensed psychotherapists need to be registered, were asked to forward the online survey link to their members. After a follow-up, commitments from eight out of 12 chambers were received. To include psychotherapists in training we used a random sampling approach. Training institutions in each of the 16 federal states were asked to forward the survey to their trainees. Given the absence of an official comprehensive list of all registered training institutions in Germany, we made a concerted effort to compile a thorough inventory of training institutes across the federal states (up to January 2023). This was achieved by utilizing the websites of psychotherapist chambers (Bavaria, Berlin, Bremen, Hessen, Niedersachsen, Nordrhein-Westfalen, Saarland, Schleswig-Holstein). In cases where lists were outdated or unavailable, additional searches were conducted on the official websites of states (Baden-Württemberg, Brandenburg, Hamburg, Mecklenburg-Vorpommern, Rheinland-Pfalz, Sachsen) as well as the German Association of Psychotherapists (DPtV, Sachsen-Anhalt. Thüringen). The final list comprised 271 institutions across all federal states and therapeutic approaches.

In each of the federal states, a random selection of 10% (in total, n  = 33) of the institutions was contacted to forward the survey to their trainees. In case an institution denied distributing the survey to their trainees, another institution for this federal state was randomly selected. At the end of the recruitment process, a sum of 45 training institutions was contacted, of which 27 distributed the survey link to their trainees. The 10% target could not be achieved in 5 federal states (Bavaria, Bremen, Hessen, Nordrhein-Westfalen, Rheinland-Pfalz). In addition, all regional associations of statutory health insurance physicians (“Kassenärztliche Vereinigungen”) and three professional associations of psychotherapists that operate across therapeutic approaches and throughout Germany (“Berufsverbände”, Association of Psychological Psychotherapists in the professional association of German psychologists, BDP-VPP; Federal Association of Contract Psychotherapists, BVVP; German Association of Psychotherapists, DPtV) were requested to distribute the survey. Two out of three requested professional associations published the survey link on their homepage and five out of 17 regional associations of statutory health insurance physicians (Bremen, Hamburg, Niedersachsen, Westfalen-Lippe, Thüringen) forwarded the survey to their members. Members of the national bodies could be licensed psychotherapists and psychotherapists in training. Members of associations of statutory health insurance physicians were licensed.

All contacted institutions received detailed information about the study by phone and e-mail and distributed the survey information, link, and QR-Code electronically via e-mail, internal newsletter, and/or a notice on their homepage and intranet. Four training institutions placed an announcement (printed version of the tender text) on their bulletin board.

A total of 624 psychotherapists clicked on the survey link, of whom 51 denied consent or did agree and dropped out before answering to the items for experience regarding patients with climate change-related concerns. Thus, we analyzed the responses of the remaining participants ( N  = 573). Dropouts after the consent page were not excluded from subsequent analyses as participants dropped out at different stages of the survey, and itemwise analyses were conducted (see 24, for a similar approach). To ensure the robustness of this approach, we contrasted participants with more and less than 10% missing values across the survey on all items. This yielded no significant differences in terms of therapists' characteristics, experiences with patients with climate change-related concerns, or views on the topic.

The survey comprised 37 items, of which 24 items administered to all participants and 13 items (focusing on climate change-specific reactions) presented only to those reporting that they had already treated patients with climate change-related concerns (i.e., therapists with experience). Items were newly developed for this study and based on a large-scale survey on experience, attitude, and knowledge of MHPs with climate change topics raised by their clients [ 24 ]. To ensure comprehensibility and relevance of all items, the survey was piloted by five psychotherapists in training before circulation. The survey was provided online using the survey tool Qualtrics. The complete survey is presented in Appendix A .

At the beginning of the survey, socio-demographic and work-related information about the participants was collected in ten items about: age (year of birth), gender (female/male/diverse), level of training (trainee vs. licensed), therapeutic approach (CBT, PA, DP, ST, other), work experience (number of years working as a therapist including time as trainee, number of weekly treatment sessions), and practice setting (private practice, hospital, outpatient clinic, other). Additionally, engagement in climate or pro-environmental advocacy groups was assessed dichotomously. The degree of pro-environmental behavior in everyday life was assessed on a 4-point scale (1 =  in no area of everyday life , 4 =  in almost all areas of everyday life). Thereafter, participants were assigned to one of two paths, depending on whether they had already encountered patients expressing climate change-related concerns. Path A (for therapists with experience) collected information about the number of such patients (seen in the last 12 months), the patients’ socio-demographic characteristics as well as their cognitive, emotional, physiological, and behavioral reactions. Predefined answer options for cognitive styles (e.g., rumination), physiological (e.g., racing heart) and behavioral reactions (e.g., crying) were formulated according to our current knowledge of human stress response and the recent literature on climate change-related emotions [ 17 , 19 , 26 ]. In addition, their expression of feelings related to climate change-related concerns were collected in free-text format. In path B, therapists without experience were asked whether they expected to encounter patients with climate change-related concerns in the future. In the first two parts, for most items multiple responses were allowed (therapists’ practice setting and therapeutic approach; patients’ age in years, educational degree, assumed family status, most frequent assigned diagnoses, cognitive styles, feelings, physiological and behavioral reactions). In the last part of the survey, all participants (therapists with and without experience) answered 12 questions regarding their views on climate change-related concerns (a) in relation to mental health, (b) on how to deal with them in therapy and (c) whether they felt well equipped or wished for additional training and resources on the topic. Therapists answered on a 4-point scale (1 =  I do not agree at all , 4 =  I fully agree).

Statistical analysis

All analyses were performed itemwise because the survey did not employ a forced choice format and participants dropped out at different stages of the survey. This means that we included the number of participants who had answered the respective items (indicated by n/N for all frequencies reported; see 24, for a similiar approach).

Descriptive statistics were used to describe items presented in the three parts of the survey, using frequencies or mean values. The free text answers related to the patients’ feelings were mostly given in one word per option (e.g., anxiety, fear, anger). The answers were categorized inductively [ 27 ] and analyzed descriptively.

For contrasting therapists with and without experience with regard to their views on climate change-related concerns in therapy, all items presented in the last part of the survey were dichotomized in 0 =  disagreement (on the 4-point scale: 1 =  I do not agree at all , 2 =  I rather disagree ) and 1 =  agreement (on the 4-point scale: 3 =  I rather agree , 4 =  I fully agree ). Group differences were computed using chi-square test, t-tests, and Mann-Whitney-U-test, depending on the type of data. All tests were two-tailed with α = 0.05. Bonferroni-Holm correction was performed within each thematic group of items asking about therapists’ views (i.e., views on consequences of climate change-related concerns for mental health, views on how to address climate change-related concerns in therapy and views on required resources for addressing climate change-related concerns in therapy). Data were analyzed using SPSS statistics, version 28.

Therapists’ socio-demographic information

Psychotherapists’ socio-demographic and work-related information is shown in Table  1 . Therapists were on average 49 years old and mostly female (75.6%, 433/571). The sample consisted predominantly of licensed therapists (87.1%, 499/573), who had been working with patients for an average of 15.2 years. Most therapists worked in private practices (79.0%, 453/573), while 11.0% (63/573) were employed in hospitals. Specialized on treating adults (73.6%, 422/573), therapists worked with an average of 19.1 treatment sessions per week over the last year. The most frequent approaches were CBT (56.5%, 324/573) and DP (40.7%, 233/573). Around 80% (450/570) of participants reported behaving climate change-conscious in many to almost all areas of everyday life . About 17% (99/568) reported being actively involved in “for future-” movements (e.g., “fridays for future”), or other climate or pro-environmental advocacy groups.

Therapists’ experience with patients with climate change-related concerns

Experience with patients with climate change-related concerns was reported by 71.6% (410/573) of the participants. Of the therapists without experience, 58.6% (95/163) expected to encounter more patients with climate change-related concerns in the future.

Of the therapists with experience ( n  = 410), 84.9% (348/410) reported having encountered a range of one to 30 of such patients, with 66.6% (273/410) indicating between one and 10 patients expressing climate change-related concerns. Of the therapists with experience ( n  = 410) 364 replied to the question whether. Around 40.5% (166/410) reported that at least one patient with climate change-related concerns had stated that such concerns were the explicit reason for seeking therapy.

Table  2 displays information provided by therapists with experience about socio-demographic characteristics of their patients with climate change-related concerns. Patients with such concerns were described as mainly young (19 to 24 years, 64.0%, 210/328) and early middle aged (25 to 34 years, 57.6%, 189/328) adults, as well as higher educated (higher education entrance qualification, 77.2%, 251/325; university degree, 66.8%, 217/325). Mostly, these patients were living in a relationship (62.3%, 197/316) and without children (53.4%, 171/320). Therapists indicated having diagnosed these patients with mostly depression (53.0%, 167/315), adjustment disorder (12.4%, 39/315), and generalized anxiety disorder (11.1%, 35/315) as the primary diagnoses for seeking treatment.

Therapists with experience reported a range of cognitive, emotional, physiological, and behavioral reactions of patients with climate change-related concerns. For the detailed list of patients’ reactions see Table A in Appendix B . Rumination was indicated as the most common cognitive style (73.1%, 231/316), besides catastrophic thoughts/ disaster thoughts (59.2%, 187/316). Within the “Other” category, 3.8% (12/316) of the therapists with experience reported effective solution- and action-oriented styles.

Furthermore, therapists with experience indicated that anxiety (88.6%, 194/219) with manifestations from worrying to panic, helplessness (60.7%, 133/219) with hopelessness and feelings of despair, anger (60.3%, 132/219) and grief (35.2%, 77/219) including disconsolateness and the feeling of senselessness were the four most frequent reported feelings in their patients.

More than two thirds of the therapists with experience who answered to the questions concerning physiological and behavioral reactions noticed physiological (68.2%, 176/258) and behavioral reactions (83.6%, 219/262). Around 60% (155/258) reported sleep disorders in their patients. Therapists indicated that avoidance (57.3%, 150/262), aggression (44.7%, 117/262), and crying (34.0%, 89/262) were the three most common behavioral reactions in their patients when climate change-related concerns were addressed in therapy.

Comparison of therapists with and without experience

Results of comparisons on socio-demographic and work-related characteristics between therapists with and without experience are summarized in Table  3 . Therapists with experience were significantly more often female and reported more climate friendly everyday behavior and engagement in climate change-related advocacy groups. They also indicated a significantly higher patient-load in the last 12 months. There were no differences in age and therapeutic approach.

Table  4 shows responses of therapists with and without experience regarding their views on (a) consequences of climate change-related concerns for mental health, (b) how to address climate change-related concerns in therapy and (c) required resources for addressing climate change-related concerns in therapy. For the full range of responses on the original 4-point scale (from 1 =  I do not agree at all to 4 =  I fully agree ) see Table B in Appendix B .

Therapists with experience approved significantly more often of all four statements regarding the potential consequences of climate change-related concerns to mental health. Around 80% (217/268) were convinced that climate change-related concerns can lead to serious functional impairment in everyday life. Whereby also more than half of the therapists without experience (58.0%, 91/157) agreed to this view. Therapists with experience (87.6%, 234/267) saw significantly more often relevant negative consequences to mental health, apart from traumatization e.g., due to extreme weather events. This opinion was also frequent in therapists without experience (64.5%, 100/155).

Regarding the views on how to address the topic in therapy, therapists with experience significantly more often agreed to the statement that climate change-related concerns should be taken up in a validating way (81.8%, 216/264). Additionally, therapists with experience are significantly more likely to approve of the statements that stress caused by climate change-related concerns (88.0%, 234/266) as well as motivation caused by climate change-related concerns (89.9%, 240/267) should be addressed in therapy. Both groups, therapists with (79.2%, 210/265) and without (77.3%, 116/150) experience reported having acquired adequate therapeutic skills to address climate change-related concerns in therapy and did not differ significantly in this regard. Around 30% (82/265) of therapists with experience stated concerns about their own potential overload from dealing with this topic in therapy. Also, nearly 20% (27/150) of therapists without experience stated the same concerns. There was a significant difference between the groups.

Regarding the views on required resources, therapists with experience significantly more often express an interest in educating and informing themselves. However, both groups of therapists reported difficulties in finding information or training on how to deal with patients expressing climate change-related concerns in therapy. Finally, therapists without experience significantly more frequently denied the importance of addressing the topic in therapy.

The current study investigated in a nationwide sample of psychotherapists in Germany whether they see patients with climate change-related concerns in their practice. We further examined characteristics of patients with such concerns and the therapists’ views on the topic of climate change in therapy. The results showed that the majority of therapists is already confronted with this topic in therapy. Although close to 80% of the therapists felt adequately prepared by applying their current therapeutic skills, half of them wished for more information and training on how to deal with such concerns in therapy.

The number of therapists (72%) indicating to see patients with climate change-related concerns in treatment found in this study is even higher than the number in the survey conducted with MHPs in the USA [ 24 ]. Hoppe, Prussia [ 24 ] reported that around 54% of MHPs stated to see clients with such concerns. However, since we exclusively sampled psychotherapists (opposed to the broader group of MHPs) who reported on their patients, it is likely that the patients discussed by the therapists in this study were heavily burdened. A review by Woodland, Ratwatte [ 9 ], comprising 31 studies, revealed an association between pre-existing mental health impacts and the exacerbation of mental health problems due to consequences of climate change (i.e., acute weather events). These findings may elucidate the higher proportion of therapists treating such patients, in contrast to the observations of Hoppe Hoppe, Prussia [ 24 ]. Furthermore, there is evidence suggestion an increased awareness of climate change in Germany in recent years [ 22 ] and compared to other nations [ 28 ]. The biennial Special Eurobarometer surveys on Climate Change conducted from 2009 to 2021 evaluated European perceptions of climate change, involving over 26,000 participants from the 27 EU member states and the UK. The results from 2019 indicated that more than eight out of ten respondents in Germany regarded climate change as a ‘very serious’ issue (81%), surpassing the EU average of 79% [ 28 ].

Further, 41% of the 410 therapists with experience stated that at least one patient with such concerns explicitly sought treatment because of these. This suggests that some patients seem to relate their functional impairment and distress to climate change and its consequences and seek treatment for this reason . This finding aligns with causal process diagram of Berry, Waite [ 4 ] to conceptualize relations between climate change and mental health. Climate change could influence mental health via various (in)direct paths. For example, the “loss of personal mental health resources” can be caused by an impaired capacity to cope with adversities and thus directly increase the risk of mental illness. Correspondingly, therapists in this study reported that their patients often experienced feelings of helplessness and frustration, which could be indicative of a reduced capacity to cope. In addition, climate change and its consequences could function as an additional stressor, increasing the mental health burden of patients. Together with other currently salient threats to the basis of existence, like the Ukraine war or sustained consequences of the Covid-19 pandemic [ 29 ] climate change-related concerns could add to pathology in a dose-effect manner.

The most frequently reported diagnoses of patients raising climate change-related concerns in this study were depression, adjustment disorder, and general anxiety disorder. According to available data of a Germany-wide research data platform (KODAP, short for the coordination of data collection and evaluation at research and training outpatient clinics for psychotherapy ) containing the diagnoses of 4266 adult patients treated in 2016, the most frequent diagnoses defined as treatment causes were affective disorders (39.4%), of these 36% were depressive episode/disorder diagnoses. Anxiety disorders accounted for 14.2% of the index diagnoses, whereby generalized anxiety disorder took 14th place under the 50 most frequent diagnoses with 2.3%. Frequent index diagnoses were also adjustment disorder with 4.5% (6th most frequent given diagnosis) [ 30 , 31 ]. Comparing the KODAP composition of diagnoses to our results implies that the three most frequent reported diagnoses are overrepresented in the present study. This could be related to differences in the settings. As KODAP provided data from patients in training outpatient clinics, we primarily surveyed psychotherapists about their patients in private practices. The current study cannot definitively determine whether these diagnoses occur more frequently in patients raising climate change-related concerns compared to other patients treated by the participants in their respective settings. Given the absence of comparative data, it is important to interpret these results with caution. Thus, it remains uncertain whether overrepresentation of these diagnoses in our study can be in any way linked to the presence of climate change-related concerns. Also, it needs to be stated that even strong emotional responses are part of an adequate reactions to the threat of climate change and can initiate an adaptive process [ 26 , 32 , 33 ]. However, climate change awareness could lead to extreme worrying, as several large-scale surveys have indicated [ 20 , 21 , 22 ]. The core symptom of generalized anxiety disorder is characterized by severe and persistent worrying [ 34 ] and thus concerns about consequences of climate change could act as such a core symptom. This is consistent with the results of the present study, as well as the survey of Hoppe, Prussia [ 24 ]. Both indicated that generalized anxiety disorder is frequently reported in relation to climate change mental health impacts. Yet, there is an ongoing debate about whether climate change-related symptoms are linked with established diagnoses (e.g., generalized anxiety disorder, as we considered above) or whether the broad range of climate change-related reactions indicates a need for an additional diagnostic category [ 4 , 8 , 32 ].

Furthermore, this study examined psychotherapists’ views on dealing with climate change-related concerns during treatment. Overall, both therapists with and without experience were convinced in the majority that climate change-related concerns have the potential to lead to serious functional impairment in patients and need to be taken up in a validating way in therapy. Therapists considered climate change-related concerns relevant for mental health, even when concerns were not related to traumatic experiences associated with climate change. This seems to indicate that psychotherapists have already consulted the currently existing literature on the acute and chronic effects of climate change consequences on mental health and is in line with our finding that more than the half of the participating psychotherapists undertake further information or training on these topics.

In addition, Budziszewska and Jonsson [ 23 ] conducted a qualitative study interviewing ten Swedish patients, who addressed climate change-related concerns within treatment. Results showed that an effective treatment (from the patients’ perspective) required psychotherapists’ knowledge about climate change and the competence to use this knowledge. This demands therapists to confront this topic themselves. In our study in more than 20% of the participating psychotherapists (more often with experience) worries occurred about a potential overload caused by treating patients with climate change-related concerns. This worry should be taken seriously in training and dissemination endeavors and indicates the need for self-care strategies and adequate supervision [ 8 , 35 , 36 ]. Nevertheless, almost 80% of respondents in this study felt well prepared to work with patients with climate change-related concerns using the therapeutic skills they had already acquired. The survey of Hoppe, Prussia [ 24 ] reported that less than a third of MHPs felt adequately prepared for this topic in treatment. As our study exclusively surveyed psychotherapists, our sample was likely to be trained more homogenously and specifically than the broad profession group (social workers, family and marriage counselors, psychologists) recruited by Hoppe, Prussia [ 24 ], which could explain the higher rate of preparedness found in our study. Nonetheless, our results are in line with findings of Gossmann, Rosner [ 37 ], who outlined in a German study surveying psychotherapists ( N  = 1358) about their work satisfaction, that psychotherapists in Germany felt efficacious, skillful, and able to deal with stressful situations in general.

There are several implications of the present findings for research and practice. Future studies are required to assess whether severe emotional reactions and high levels of functional impairment due to climate change-related concerns are related to specific established diagnoses or form climate change-specific pathologies. There is an increasing amount of literature seeking to comprehend psychological reactions to climate change consequences. More and more researchers aim to define and evaluate constructs and develop measures to get an exhaustive picture of climate change-related reactions and consequences for mental health [ 17 , 19 , 26 , 38 , 39 , 40 , 41 ]. Moreover, our results indicate a lack of information about how to address climate change-related concerns in psychotherapy. There is already some guideline literature that covers tasks and challenges in the areas of research and practice and provides initial therapeutic considerations [ 8 , 35 , 36 , 42 , 43 ]. However, material for psychoeducation, guidelines, and components for treatment of climate change-related concerns as well as strategies for psychotherapists’ self-care could be improved by a continuous refinement of the conceptualization and knowledge of mental health impacts of climate change.

Strengths and limitations

This study is - to the best of our knowledge - the first study assessing psychotherapists’ observations of patients raising climate change-related concerns and their views on dealing with this topic in therapy. A notable strength of this study lies in the composition of our sample of psychotherapists regarding the distribution of age, gender, practice setting and therapeutic approaches which was similar to the general population of psychotherapists practicing in Germany [ 44 ]. In the present study, approximately 60% of participating therapists fell within the age range of 36 to 61 years, with three-quarters being female. Official data for Germany indicated that 58% of employed psychotherapists fell within the age range of 35 to 60 years, with a female majority of 76.7% [ 44 ]. Furthermore, in our study, 79% of the psychotherapists practiced in private practice, while 11% were employed in hospital settings. Comparatively, official data reported that 71% worked in private practice and 15% were employed in hospitals [ 44 ]. Regarding therapeutic approaches, CBT was the most prevalent at 56.5%, followed by DP at 40.7%. PA at 16.3% and ST at 3.3%. Data from psychotherapists working with both adults and children/adolescents showed a similar distribution [ 45 ].”

However, there are several limitations. First, the presence of a self-selection bias cannot be discounted. It is plausible that therapists with a specific interest in climate change might have been more likely to participate in this study. Around 17% of respondents indicated involvement in advocacy groups, but the general level of involvement of German psychotherapists remains indeterminate due to a lack of comparative numbers. Secondly, the data on therapists’ diagnoses regarding climate change-related concerns are aggregated and retrospective estimates provided promptly during survey completion. The validity of these data needs to be treated with caution. Third, psychotherapists with the focus on adult patients were overrepresented in our study. This means that, this survey does not cover children and adolescents seeking treatment adequately. Further, it is important to note that the insights regarding patients’ and therapists’ awareness of climate change may not be generalized to other EU countries as Germany exhibits notably higher levels of climate change awareness compared to the EU average [ 46 ]. Final, the items were specifically developed for this study with no prior validation. Yet, the items were adapted from a large-scale survey with MHPs in the US [ 24 ] as we also aimed at descriptive results on the status quo on this topic in Europe.

This study provides first findings on the presence of patients with climate change-related concerns in therapy in Europe. Psychotherapists generally considered the impact of climate change on their patients’ mental health to be significant to psychotherapeutic care. Further research is needed to explore the associations between these concerns and psychological symptoms as well as to develop effective interventions to address these concerns.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Cognitive behavioral therapy

Depth psychology

Intergovernmental panel on climate change

Coordination of data collection and evaluation at research and training outpatient clinics for psychotherapy

Licensed psychotherapist

Mental health professionals

Psychoanalysis

Psychotherapist in training

Posttraumatic stress disorder

Systemic therapeutic approach

IPCC, editor. Climate Change 2022: impacts, adaptation and vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge: Cambridge University Press; 2022.

Google Scholar  

McMichael AJ, Woodruff RE, Hales S. Climate change and human health: present and future risks. Lancet. 2006;367(9513):859–69.

Article   PubMed   Google Scholar  

Hwong AR, Wang M, Khan H, Chagwedera DN, Grzenda A, Doty B, et al. Climate change and mental health research methods, gaps, and priorities: a scoping review. Lancet Planet Health. 2022;6(3):e281–91.

Berry HL, Waite TD, Dear KBG, Capon AG, Murray V. The case for systems thinking about climate change and mental health. Nat Clim Change. 2018;8(4):282–90.

Article   Google Scholar  

Lawrance EL, Thompson R, Le Newberry J, Page L, Jennings N. The Impact of Climate Change on Mental Health and emotional wellbeing: a narrative review of current evidence, and its implications. Int Rev Psychiatry. 2022;34(5):443–98.

Palinkas LA, Wong M. Global climate change and mental health. Curr Opin Psychol. 2020;32:12–6.

Cianconi P, Betrò S, Janiri L. The Impact of Climate Change on Mental Health: a systematic descriptive review. Front Psychiatry. 2020;11.

Crandon TJ, Dey C, Scott JG, Thomas HJ, Ali S, Charlson FJ. The clinical implications of climate change for mental health. Nat Hum Behav. 2022;6(11):1474–81.

Woodland L, Ratwatte P, Phalkey R, Gillingham EL. Investigating the Health impacts of Climate Change among people with Pre-existing Mental Health problems: a scoping review. Int J Environ Res Public Health. 2023;20(8).

Kessler RC, Aguilar-Gaxiola S, Alonso J, Benjet C, Bromet EJ, Cardoso G, et al. Trauma and PTSD in the WHO World Mental Health Surveys. Eur J Psychotraumatology. 2017;8:sup5.

Neria Y, Nandi A, Galea S. Post-traumatic stress disorder following disasters: a systematic review. Psychol Med. 2008;38(4):467–80.

Charlson F, Ali S, Benmarhnia T, Pearl M, Massazza A, Augustinavicius J et al. Climate Change and Mental Health: a scoping review. Int J Environ Res Public Health. 2021;18(9).

Seneviratne SI, Zhang X, Adnan M, Badi W, Dereczynski C, Di Luca A, et al. Weather and Climate Extreme events in a changing climate. In: Masson-Delmotte V, Zhai P, Pirani A, Connors SL, Péan C, Berger S, et al. editors. Climate Change 2021: the Physical Science Basis Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge: Cambridge University Press; 2021. pp. 1513–766.

Vins H, Bell J, Saha S, Hess JJ. The Mental Health outcomes of Drought: a systematic review and causal process Diagram. Int J Environ Res Public Health. 2015;12(10):13251–75.

Article   PubMed   PubMed Central   Google Scholar  

Hayes K, Poland B. Addressing Mental Health in a changing climate: incorporating Mental Health indicators into Climate Change and Health vulnerability and adaptation assessments. Int J Environ Res Public Health. 2018;15(9):1806.

Clayton S. Climate Change and Mental Health. Curr Environ Health Rep. 2021;8(1):1–6.

Clayton S, Karazsia BT. Development and validation of a measure of climate change anxiety. J Environ Psychol. 2020;69.

Cunsolo A, Ellis NR. Ecological grief as a mental health response to climate change-related loss. Nat Clim Change. 2018;8(4):275–81.

Ágoston C, Urbán R, Nagy B, Csaba B, Kőváry Z, Kovács K et al. The psychological consequences of the ecological crisis: three new questionnaires to assess eco-anxiety, eco-guilt, and ecological grief. Clim Risk Manage. 2022;37.

Hickman C, Marks E, Pihkala P, Clayton S, Lewandowski RE, Mayall EE, et al. Climate anxiety in children and young people and their beliefs about government responses to climate change: a global survey. Lancet Planet Health. 2021;5(12):e863–73.

Steentjes K, Pidgeon NF, Poortinga W, Corner AJ, Arnold A, Böhm G, et al. European perceptions of Climate Change: Topline findings of a survey conducted in four European countries in 2016. Cardiff: Cardiff University; 2017.

Grothmann T, Frick V, Harnisch R, Münsch M, Kettner SE, Thorun C. Umweltbewusstsein in Deutschland 2022 [Environmental awareness in Germany 2022]. Berlin: Bundesministerium für Umwelt, Naturschutz, nukleare Sicherheit und Verbraucherschutz (BMUV) Arbeitsgruppe Öffentlichkeitsarbeit, Online-Kommunikation, Trends & Analysen; 2023.

Budziszewska M, Jonsson SE. From climate anxiety to Climate Action: an existential perspective on climate change concerns within psychotherapy. J Humanistic Psychol. 2021.

Hoppe BO, Prussia L, Manning C, Raab KK, Jones-Casey KV. It’s hard to give Hope sometimes: Climate Change, Mental Health, and the challenges for Mental Health professionals. Ecopsychology. 2022;15(1):13–25.

Kircher M, Doheny B, Raab K, Onello E, Gingerich S, Potter T. Understanding the knowledge, attitudes, and practices of Healthcare professionals toward Climate Change and Health in Minnesota. Challenges. 2022;13(2).

Cunsolo A, Harper SL, Minor K, Hayes K, Williams KG, Howard C. Ecological grief and anxiety: the start of a healthy response to climate change? Lancet Planet Health. 2020;4(7):e261–3.

Mayring P. Qualitative inhaltsanalyse [Qualitative content analysis]. In: Böhm A, Mengel A, Muhr T, editors. Texte Verstehen: Konzepte, Methoden, Werkzeuge [Understanding texts: concepts, methods, tools]. Konstanz: Universitäts; 1994. pp. 159–76.

European Commission. Special Eurbarometer, 490: Climate Change: Factsheet Germany. 2019.

Weierstall-Pust R, Schnell T, Hessmann P, Feld M, Hofer M, Plate A, et al. Stressors related to the Covid-19 pandemic, climate change, and the Ukraine crisis, and their impact on stress symptoms in Germany: analysis of cross-sectional survey data. BMC Public Health. 2022;22(1):2233.

Velten J, Bräscher A-K, Fehm L, Fladung A-K, Fydrich T, Heider J, et al. Behandlungsdiagnosen in universitären Ambulanzen für psychologische Psychotherapie Im Jahr 2016 [Treatment diagnoses in university outpatient clinics for psychological psychotherapy in 2016]. Z für Klinische Psychologie Und Psychother. 2018;47(3):175–85.

Margraf J, Hoyer J, Fydrich T, In-Albon T, Lincoln T, Lutz W et al. The Cooperative Revolution reaches clinical psychology and psychotherapy: an Example from Germany. Clin Psychol Europe. 2021;3(1).

Bhullar N, Davis M, Kumar R, Nunn P, Rickwood D. Climate anxiety does not need a diagnosis of a mental health disorder. Lancet Planet Health. 2022;6(5):e383.

Clayton S, Manning CM, Speiser M, Hill AN. Mental Health and Our Changing Climate: Impacts, Inequities, Responses. Washington, D.C: American Psychological Association, and ecoAmerica2021.

Bassler M, Leidig S, Winelbach C. Generalisierte Angststörung [Generalized anxiety disorder]. In: Bassler M, Leidig S, editors. Psychotherapie Der Angsterkrankungen: Krankheitsmodelle Und Therapiepraxis - störungsspezifisch und schulenübergreifend [Psychotherapy for anxiety disorders: disease models and therapy practice - disorder-specific and across schools]. Stuttgart: Thieme; 2005. pp. 84–101.

van Bronswijk K, Hausmann CM, editors. Climate emotions: Klimakrise Und Psychische Gesundheit [Climate emotions: Climate Crisis and Mental Health]. Gießen: Psychosozial-; 2022.

Dohm L, Klar M. Klimakrise und Klimaresilienz: die Verantwortung Der Psychotherapie [Climate crisis and climate resilience: the responsibility of psychotherapy]. Psychosozial. 2020;43(3):99–114.

Gossmann K, Rosner R, Barke A. Work involvement and work satisfaction of psychotherapists-A nationwide online survey among psychotherapeutic practitioners in Germany. Clin Psychol Psychother. 2022.

Lutz PK, Zelenski JM, Newman DB. Eco-anxiety in daily life: relationships with well-being and pro-environmental behavior. Curr Res Ecol Social Psychol. 2023;4.

Helm SV, Pollitt A, Barnett MA, Curran MA, Craig ZR. Differentiating environmental concern in the context of psychological adaption to climate change. Glob Environ Change. 2018;48:158–67.

Comtesse H, Ertl V, Hengst SMC, Rosner R, Smid GE. Ecological grief as a response to environmental change: a Mental Health risk or functional response? Int J Environ Res Public Health. 2021;18(2).

Bright ML, Eames C. From apathy through anxiety to action: emotions as motivators for youth climate strike leaders. Australian J Environ Educ. 2021;38(1):13–25.

APA Task Force on Climate Change. Addressing the Climate Crisis: An Action Plan for Psychologists, Report of the APA Task Force on Climate Change. American Psychological Association;; 2022.

Doherty TJ, Clayton S. The psychological impacts of global climate change. Am Psychol. 2011;66(4):265–76.

Gesundheitsberichterstattung des Bundes [Federal Health Reporting]. Gesundheitsversorgung: Beschäftigte Psychologische Psychotherapeutinnen und -therapeuten und Kinder- und Jugendlichenpsychotherapeutinnen und -therapeuten [Health care: Employed psychological psychotherapists and child and adolescent psychotherapists] 2022 [Available from: https://www.gbe-bund.de/gbe/!pkg_olap_tables.prc_set_dim_values .

Deutsche Psychotherapeuten Vereinigung. [German psychotherapists’ Association]. Report Psychotherapie 2021 [Report psychotherapy. 2021] Wissenschaft und Forschung; 2021.

European Commission. Special Eurobarometer: Climate Change: Report Summary. 2021.

Hemmerich W, StatistikGuru. Rechner zur Adjustierung des α-Niveaus [StatisticsGuru: Calculator for adjusting the α level] 2016 [Available from: https://statistikguru.de/rechner/adjustierung-des-alphaniveaus.html .

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Acknowledgements

This research was funded by a doctoral scholarship of the Cusanuswerk foundation granted to Katharina Trost. The authors want to thank all those involved in the recruitment process (especially Theresa Neumann), including associations and institution distributing the online link, and all the therapists who took the time to complete the survey.

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KT, VE, and HC designed the study. KT collected the data and carried out the data analysis under supervision of HC. KT wrote the first draft of the manuscript. JK and RR critically reviewed the manuscript. All authors read and approved the final manuscript.

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The study was approved by the ethics committee of the Catholic University Eichstätt-Ingolstadt in December 2022 (ethics approval number: 122–2022). All participants gave digital informed consent to participate in the study and received no financial compensation. All methods were carried out in accordance with declaration of Helsinki.

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Supplementary Material 1: The complete survey is presented in Appendix A. The list of patients’ reaction is provided in Table A in appendix B and the full range responses of therapists’ views on the original 4-point scale (from 1 =  I do not agree at all to 4 =  I fully agree ) is provided in Table B in Appendix B

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Trost, K., Ertl, V., König, J. et al. Climate change-related concerns in psychotherapy: therapists’ experiences and views on addressing this topic in therapy. BMC Psychol 12 , 192 (2024). https://doi.org/10.1186/s40359-024-01677-x

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Psychological safety and the critical role of leadership development

When employees feel comfortable asking for help, sharing suggestions informally, or challenging the status quo without fear of negative social consequences, organizations are more likely to innovate quickly , unlock the benefits of diversity , and adapt well to change —all capabilities that have only grown in importance during the COVID-19 crisis. 1 Jonathan Emmett, Gunnar Schrah, Matt Schrimper, and Alexandra Wood, “ COVID-19 and the employee experience: How leaders can seize the moment ,” June 2020, McKinsey.com; Tera Allas, David Chinn, Pal Erik Sjatil, and Whitney Zimmerman, “ Well-being in Europe: Addressing the high cost of COVID-19 on life satisfaction ,” June 2020, McKinsey.com. Yet a McKinsey Global Survey conducted during the pandemic confirms that only a handful of business leaders often demonstrate the positive behaviors that can instill this climate, termed psychological safety , in their workforce. 2 The online survey was in the field from May 14–29, 2020, and garnered responses from 1,574 participants representing the full range of regions, industries, company sizes, functional specialties, and tenures. Of those respondents, we analyzed the results of 1,223 participants who said they were a member of a team that they did not lead, where a team is defined as two or more people who work together to achieve a common goal. CEOs were included in the findings if they said that a) their organization had a board of directors and b) they were not the board’s chair, so that they could think of their board when asked questions about their team.

As considerable prior research shows, psychological safety is a precursor to adaptive, innovative performance—which is needed in today’s rapidly changing environment—at the individual, team, and organization levels. 3 Amy C. Edmondson, The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth, first edition, Hoboken, NJ: John Wiley & Sons, November 2018; Shirley A. Ashauer and Therese Macan, “How can leaders foster team learning? Effects of leader-assigned mastery and performance goals and psychological safety,” Journal of Psychology, November–December 2013, Volume 147, Number 6, pp. 541–61, tandfonline.com; Anne Boon et al., “Team learning beliefs and behaviours in response teams,” European Journal of Training and Development, May 2013, Volume 37, Number 4, pp. 357–79, emerald.com; Daphna Brueller and Abraham Carmeli, “Linking capacities of high-quality relationships to team learning and performance in service organizations,” Human Resource Management, July–August 2011, Volume 50, Number 4, pp. 455–77, wileyonlinelibrary.com; M. Lance Frazier et al., “Psychological safety: A meta-analytic review and extension,” Personnel Psychology, February 2017, Volume 70, Number 1, pp. 113–65, onlinelibrary.wiley.com; Nikos Bozionelos and Konstantinos C. Kostopoulos, “Team exploratory and exploitative learning: Psychological safety, task conflict, and team performance,” Group & Organization Management, June 2011, Volume 36, Number 3, pp. 385–415, journals.sagepub.com; Rosario Ortega et al., “The emotional impact of bullying and cyberbullying on victims: A European cross-national study,” Aggressive Behavior, September–October 2012, Volume 38, Issue 5, pp. 342–56, onlinelibrary.wiley.com; Corinne Post, “Deep-level team composition and innovation: The mediating roles of psychological safety and cooperative learning,” Group & Organizational Management, October 2012, Volume 37, Number 5, pp. 555–88, journals.sagepub.com; Charles Duhigg, “What Google learned from its quest to build the perfect team,” New York Times, February 25, 2016, nytimes.com. Amy Edmondson’s 1999 research previously found—and our survey findings confirm—that higher psychological safety predicts a higher degree of boundary-spanning behavior, which is accessing and coordinating with those outside of an individual’s team to accomplish goals. For example, successfully creating a “ network of teams ”—an agile organizational structure that empowers teams to tackle problems quickly by operating outside of bureaucratic or siloed structures—requires a strong degree of psychological safety.

Fortunately, our newest research suggests how organizations can foster psychological safety. Doing so depends on leaders at all levels learning and demonstrating specific leadership behaviors that help their employees thrive. Investing in and scaling up leadership-development programs  can equip leaders to embody these behaviors and consequently cultivate psychological safety across the organization.

A recipe for leadership that promotes psychological safety

Leaders can build psychological safety by creating the right climate, mindsets, and behaviors within their teams. In our experience, those who do this best act as catalysts, empowering and enabling other leaders on the team—even those with no formal authority—to help cultivate psychological safety by role modeling and reinforcing the behaviors they expect from the rest of the team.

Our research finds that a positive team climate—in which team members value one another’s contributions, care about one another’s well-being, and have input into how the team carries out its work—is the most important driver of a team’s psychological safety. 4 Past research by Frazier et al. (2017) found three categories to be the main drivers of psychological safety: positive leader relations, work-design characteristics, and a positive team climate. We conducted multiple regression with relative-importance analysis to understand which category matters most, and our results show that a positive team climate has a significantly stronger direct effect on psychological safety than the other two. Based on these results, we tested a structural-equation model (SEM) in which the frequency with which team leaders displayed four leadership behaviors predicted psychological safety both directly and indirectly via positive team climate. Exploratory analyses were conducted to determine whether the effect of the leadership behaviors affected psychological safety at different levels of team climate. By setting the tone for the team climate through their own actions, team leaders have the strongest influence on a team’s psychological safety. Moreover, creating a positive team climate can pay additional dividends during a time of disruption. Our research finds that a positive team climate has a stronger effect on psychological safety in teams that experienced a greater degree of change in working remotely than in those that experienced less change during the COVID-19 pandemic. Yet just 43 percent of all respondents report a positive climate within their team.

Positive team climate is the most important driver of psychological safety and most likely to occur when leaders demonstrate supportive, consultative behaviors, then begin to challenge their teams.

During the pandemic, we have seen an accelerated shift away from the traditional command-and-control leadership style known as authoritative leadership, one of the four well-established styles of leadership behavior we examined to understand which ones encourage a positive team climate and psychological safety . The survey finds that team leaders’ authoritative-leadership behaviors are detrimental to psychological safety, while consultative- and supportive-leadership behaviors promote psychological safety.

The results also suggest that leaders can further enhance psychological safety by ensuring a positive team climate (Exhibit 1). Both consultative and supportive leadership help create a positive team climate, though to varying degrees and through different types of behaviors.

With consultative leadership, which has a direct and indirect effect on psychological safety, leaders consult their team members, solicit input, and consider the team’s views on issues that affect them. 5 The standardized regression coefficient between consultative leadership and psychological safety was 0.54. The survey measured consultative-leadership behaviors by asking respondents how frequently their team leaders demonstrate the following behaviors: ask the opinions of others before making important decisions, give team members the autonomy to make their own decisions, and try to achieve team consensus on decisions. Supportive leadership has an indirect but still significant effect on psychological safety by helping to create a positive team climate; it involves leaders demonstrating concern and support for team members not only as employees but also as individuals. 6 The survey measured supportive leadership behaviors by asking respondents how frequently their team leaders demonstrate the following behaviors: create a sense of teamwork and mutual support within the team, and demonstrate concern for the welfare of team members. These behaviors also can encourage team members to support one another.

Another set of leadership behaviors can sometimes strengthen psychological safety—but only when a positive team climate is in place. This set of behaviors, known as challenging leadership, encourages employees to do more than they initially think they can. A challenging leader asks team members to reexamine assumptions about their work and how it can be performed in order to exceed expectations and fulfill their potential. Challenging leadership has previously been linked with employees expressing creativity, feeling empowered to make work-related changes, and seeking to learn and improve. 7 Giles Hirst, Helen Shipton, and Qin Zhou, “Context matters: Combined influence of participation and intellectual stimulation on the promotion focus–employee creative relationship,” Journal of Organizational Behavior, October 2012, Volume 33, Number 7, pp. 894–909, onlinelibrary.wiley.com; Le Cong Thuan, “Motivating follower creativity by offering intellectual stimulation,” International Journal of Organizational Analysis, December 2019, Volume 28, Number 4, pp. 817–29, emerald.com; Jie Li et al., “Not all transformational leadership behaviors are equal: The impact of followers’ identification with leader and modernity on taking charge,” Journal of Leadership and Organizational Studies, August 2017, Volume 24, Number 3, pp. 318–34, journals.sagepub.com; Susana Llorens-Gumbau, Marisa Salanova Soria, and Israel Sánchez-Cardona, “Leadership intellectual stimulation and team learning: The mediating role of team positive affect,” Universitas Psychologica, March 2018, Volume 17, Number 1, pp. 1–16, revistas.javeriana.edu.co. However, the survey findings show that the highest likelihood of psychological safety occurs when a team leader first creates a positive team climate, through frequent supportive and consultative actions, and then challenges their team; without a foundation of positive climate, challenging behaviors have no significant effect. And employees’ experiences look very different depending on how their leaders behave, according to Amy Edmondson, the Novartis Professor of Leadership and Management at Harvard Business School (interactive).

What’s more, the survey results show that a climate conducive to psychological safety starts at the very top of an organization. We sought to understand the effects of senior-leader behavior on employees’ sense of safety and found that senior leaders can help create a culture of inclusiveness that promotes positive leadership behaviors throughout an organization by role-modeling these behaviors themselves. Team leaders are more likely to exhibit supportive, consultative, and challenging leadership if senior leaders demonstrate inclusiveness—for example, by seeking out opinions that might differ from their own and by treating others with respect.

The importance of developing leaders at all levels

Our findings show that investing in leadership development across an organization—for all leadership positions—is an effective method for cultivating the combination of leadership behaviors that enhance psychological safety. Employees who report that their organizations invest substantially in leadership development are more likely to also report that their team leaders frequently demonstrate consultative, supportive, and challenging leadership behaviors. They also are 64 percent more likely to rate senior leaders as more inclusive (Exhibit 2). 8 We measured investing in leadership development by asking about agreement with the following statements: “my organization places a great deal of importance on developing its leaders,” and “my organization devotes significant resources to developing its leaders.” However, the results suggest that the effectiveness of these programs varies depending upon the skills they address.

Reorient the skills developed in leadership programs

Organizations often attempt to cover many topics in their leadership-development programs . But our findings suggest that focusing on a handful of specific skills and behaviors in these learning programs can improve the likelihood of positive leadership behaviors that foster psychological safety and, ultimately, of strong team performance. Some of the most commonly taught skills at respondents’ organizations—such as open-dialogue skills, which allow leaders to explore disagreements and talk through tension in a team—are among the ones most associated with positive leadership behaviors. However, several relatively untapped skill areas also yield beneficial results (Exhibit 3).

Two of the less-commonly addressed skills in formal programs are predictive of positive leadership. Training in sponsorship—that is, enabling others’ success ahead of one’s own—supports both consultative- and challenging-leadership behaviors, yet just 26 percent of respondents say their organizations include the skill in development programs. And development of situational humility, which 36 percent of respondents say their organizations address, teaches leaders how to develop a personal-growth mindset and curiosity. Addressing this skill is predictive of leaders displaying consultative behaviors.

Development at the top is equally important

According to the data, fostering psychological safety at scale begins with companies’ most senior leaders developing and embodying the leadership behaviors they want to see across the organization. Many of the same skills that promote positive team-leader behaviors can also be developed among senior leaders to promote inclusiveness. For example, open-dialogue skills and development of social relationships within teams are also important skill sets for senior leaders.

In addition, several skills are more important at the very top of the organization. Situational and cultural awareness, or understanding how beliefs can be developed based on selective observations and the norms in different cultures, are both linked with senior leaders’ inclusiveness.

Looking ahead

Given the quickening pace of change and disruption and the need for creative, adaptive responses from teams at every level, psychological safety is more important than ever. The organizations that develop the leadership skills and positive work environment that help create psychological safety can reap many benefits, from improved innovation, experimentation, and agility to better overall organizational health and performance. 9 We define organizational health as an organization’s ability to align on a clear vision, strategy, and culture; to execute with excellence; and to renew the organization’s focus over time by responding to market trends.

As clear as this call to action may be, “How do we develop psychological safety?” and, more specifically, “Where do we start?” remain the most common questions we are asked. These survey findings show that there is no time to waste in creating and investing in leadership development at scale to help enhance psychological safety. Organizations can start doing so in the following ways:

• Go beyond one-off training programs and deploy an at-scale system of leadership development. Human behaviors aren’t easily shifted overnight. Yet too often we see companies try to do so by using targeted training programs alone. Shifting leadership behaviors within a complex system at the individual, team, and enterprise levels begins with defining a clear strategy aligned to the organization’s overall aspiration and a comprehensive set of capabilities that are required to achieve it. It’s critical to develop a taxonomy of skills (having an open dialogue, for example) that not only supports the realization of the organization’s overall identity but also fosters learning and growth and applies directly to people’s day-to-day work. Practically speaking, while the delivery of learning may be sequenced as a series of trainings—and rapidly codified and scaled for all leaders across a cohort or function of the organization—those trainings will be even more effective when combined with other building blocks of a broader learning system, such as behavioral reinforcements. While learning experiences look much different now than before the COVID-19 pandemic , digital learning provides large companies with more opportunities to break down silos and create new connections across an organization through learning.
• Invest in leadership-development experiences that are emotional, sensory, and create aha moments. Learning experiences that are immersive and engaging are remembered more clearly and for a longer time. Yet a common pitfall of learning programs is an outsize focus on the content—even though it is usually not a lack of knowledge that holds leaders back from realizing their full potential. Therefore, it’s critical that learning programs prompt leaders to engage with and shift their underlying beliefs, assumptions, and emotions to bring about lasting mindset changes. This requires a learning environment that is both conducive to the often vulnerable process of learning and also expertly designed. Companies can begin with facilitated experiences that push learners toward personal introspection through targeted reflection questions and small, intimate breakout conversations. These environments can help leaders achieve increased self-awareness, spark the desire for further growth, and, with the help of reflection and feedback, drive collective growth and performance.
• Build mechanisms to make development a part of leaders’ day-to-day work. Formal learning and skill development serve as springboards in the context of real work; the most successful learning journeys account for the rich learning that happens in day-to-day work and interactions. The use of learning nudges (that is, daily, targeted reminders for individuals) can help learners overcome obstacles and move from retention to application of their knowledge. In parallel, the organization’s most senior leaders need to be the first adopters of putting real work at the core of their development, which requires senior leaders to role model—publicly—their own processes of learning. In this context, the concept of role models has evolved; rather than role models serving as examples of the finished product, they become examples of the work in progress, high on self-belief but low on perfect answers. These examples become strong signals for leaders across the organization that it is safe to be practicing, failing, and developing on the job.

The contributors to the development and analysis of this survey include Aaron De Smet , a senior partner in McKinsey’s New Jersey office; Kim Rubenstein, a research-science specialist in the New York office; Gunnar Schrah, a director of research science in the Denver office; Mike Vierow, an associate partner in the Brisbane office; and Amy Edmondson , the Novartis Professor of Leadership and Management at Harvard Business School.

This article was edited by Heather Hanselman, an associate editor in the Atlanta office.

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Study: Meditation offers real benefits to seniors' psychological well-being

Dec. 1 (UPI) -- Meditating for 20 minutes daily for 18 months naturally boosted the psychological well-being of seniors, results from a new randomized controlled trial out Friday show.

The trial involving 130 otherwise healthy French speakers aged 65-84 in Caen, France, improved participants' awareness, connection to others and insight , according to the research conducted by a University College London-led consortium of European Universities and research centers and published in the journal PLOS ONE.

"As the global population ages, it is increasingly crucial to understand how we can support older adults in maintaining and deepening their psychological well-being. In our study, we tested whether long-term meditation training can enhance important dimensions of wellbeing," Marco Schlosser, a University College London psychiatry research fellow and University of Geneva doctoral candidate, said in a news release.

"Our findings suggest that meditation is a promising non-pharmacological approach to support human flourishing in late life."

The trial compared the test group, which followed an 18-month mediation program, 9 months' mindfulness training, a 9-month loving kindness and compassion module via weekly group sessions and a retreat day, with a group that received English lessons and a control group, which did neither.

The study found meditation training did no better than language classes in improving subjects' quality of life or one of the most commonly used measures of psychological well-being -- but the researchers suggest this may be due to limitations of existing tools for monitoring well-being.

The two conventional benchmarks, the researchers said, fail to encompass the qualities and depth of human flourishing that can be by fostered through longer-term meditation training, with the result that awareness, connection and insight benefits go unnoticed.

However, the longest randomized meditation training trial ever conducted did find meditation significantly boosted a global score of well-being dimensions of awareness, connection and insight, with awareness defined as "an undistracted and intimate attentiveness to one's thoughts, feelings and surroundings, which can support a sense of calm and deep satisfaction."

"Connection" relates to emotions including respect, gratitude and kinship that can help improve relationships with others. Insight refers to a self-knowledge and understanding of how thoughts and feelings participate in shaping our perception and how to switch-up negative thoughts about ourselves and the world around.

The worse a person's psychological state is, the greater the benefit the therapy confers. Positive outcomes were most significant among test participants reporting the lowest levels of mental well-being at the start of the trial who made the most progress, compared with those who entered the trial with high well-being scores.

The researchers say more research is needed to identify groups that might gain the greatest benefit from mediation training and to refine programs so that they deliver the maximum gains.

"By showing the potential of meditation programs, our findings pave the way for more targeted and effective programs that can help older adults flourish, as we seek to go beyond simply preventing disease or ill-health, and instead take a holistic approach to helping people across the full spectrum of human wellbeing, said senior author Antoine Lutz of the Lyon Neuroscience Research Center at Inserm.

The study was led by the European Union's Horizon 2020-funded Medit-Ageing research group which comprises UCL, Inserm, University of Geneva, Université de Caen Normandy, Lyon Neuroscience Research Center, University of Liege, Technische Universitat Dresden and Friedrich Schiller University Jena.

More From Forbes

2 mental health benefits of the 2024 solar eclipse, from a psychologist.

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Here’s why celestial events like the solar eclipse can improve mental well-being.

On April 8, 2024, parts of the United States, Mexico and Canada experienced a total solar eclipse. A 2022 study examining the social effects of the solar eclipse in 2017 found that such large-scale celestial events influence human behavior and mental well-being in intriguing ways.

Here are two mental health benefits of viewing solar eclipses, based on the study.

1. Eclipses Are Awe-Inspiring

Researchers found that those who were in the eclipse’s path of totality, rather than outside of it, experienced more awe.

Awe is an emotional response that involves feeling a sense of wonder, amazement and reverence when encountering something vast and extraordinary. It typically occurs when individuals are confronted with something larger than themselves or something that challenges their existing understanding of the world.

“Awe is perhaps the prototypical emotion triggered by rare, wholly immersive and visually arresting celestial events, such as a solar eclipse,” the researchers explain.

A 2022 study found that positive awe experiences such as connectedness to nature improve well-being. Experiencing awe can also significantly reduce stress and somatic health symptoms and encourage individuals to focus less on material concerns and more on meaningful experiences, leading to greater fulfillment.

Furthermore, awe-inducing experiences strongly anchor individuals to the present moment. This heightened state of mindfulness can reduce rumination and worrying about the past or future, leading to a calmer and more centered state of mind.

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Here are a few ways to make the most of these mental health benefits.

• Savor the moment. During the solar eclipse, those who mindfully experienced the moment benefited the most. Observing the changing light, the sounds around you and the reactions of others makes you feel like a part of a larger narrative. Engaging your senses can deepen the impact of the experience and enhance feelings of awe.
• Reflect on your experience. Take time to reflect on the personal significance of the solar eclipse. Consider the vastness of the universe, the beauty of nature and your place within it.
• Integrate awe into daily life. Seek out other opportunities for awe-inspiring experiences in your everyday life. Spend time in nature, visit art museums, attend concerts or explore new places.
• Practice gratitude. Take a moment to express gratitude for the opportunity to witness something extraordinary. Gratitude can amplify the positive effects of awe, contributing to a more optimistic outlook on life.

2. Eclipses Enhance Social Connection

Research shows that one in 10 Americans struggle with loneliness everyday. Researchers of the 2022 study suggest that fascinating events like a solar eclipse are vital reminders of the grandeur, complexity and interconnectedness of the universe and the human experience.

The authors found that participants who exhibited more awe in response to the solar eclipse became less self-focused and displayed more prosocial and affiliative behavior, humility and feelings of oneness with others compared to pre-eclipse levels.

Being in the presence of something larger or greater than oneself can create a diminished sense of self-importance and encourage us to tap into the power of shared experiences as a collective species, which aid in the fight against loneliness. Such events foster stronger connections with one’s community, humanity and the universe itself, creating a sense of interpersonal trust, shared meaning and social cooperation .

An event like the 2024 total solar eclipse tends to bring people together by enabling them to share ... [+] a unique moment. This can help people appreciate the value of community.

Research shows that awe-inspiring events also help individuals tap into their “ quiet ego state ,” where one can consider their own well-being as well as that of others, stay mindful of their emotional experiences without becoming overwhelmed, understand diverse viewpoints without judgment and prioritize an interconnected worldview and a mindset of personal growth.

The quiet ego state is in turn associated with optimal psychological well-being, greater resilience, authenticity and improved social relationships.

“Just as the moon aligned with the sun up in the heavens, people down on earth aligned with each other in awe of this spectacular celestial event,” the researchers reminisce.

Those who watched the solar eclipse with others—friends, family or fellow enthusiasts—were probably able to tap into these feelings of interconnectedness most deeply. Keep discussing your thoughts and feelings with others afterward to deepen the experience.

Solar eclipses are not only a visual spectacle of a rare cosmic event but an opportunity to pause, reflect and be humbled by the vastness and beauty of the universe.

Feeling like a whole new person since the solar eclipse? You might score high on this personality trait: Openness To Experience Scale

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Effects of Social Media Use on Psychological Well-Being: A Mediated Model

Dragana ostic.

1 School of Finance and Economics, Jiangsu University, Zhenjiang, China

Sikandar Ali Qalati

Belem barbosa.

2 Research Unit of Governance, Competitiveness, and Public Policies (GOVCOPP), Center for Economics and Finance (cef.up), School of Economics and Management, University of Porto, Porto, Portugal

Syed Mir Muhammad Shah

3 Department of Business Administration, Sukkur Institute of Business Administration (IBA) University, Sukkur, Pakistan

Esthela Galvan Vela

4 CETYS Universidad, Tijuana, Mexico

Ahmed Muhammad Herzallah

5 Department of Business Administration, Al-Quds University, Jerusalem, Israel

6 Business School, Shandong University, Weihai, China

Associated Data

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The growth in social media use has given rise to concerns about the impacts it may have on users' psychological well-being. This paper's main objective is to shed light on the effect of social media use on psychological well-being. Building on contributions from various fields in the literature, it provides a more comprehensive study of the phenomenon by considering a set of mediators, including social capital types (i.e., bonding social capital and bridging social capital), social isolation, and smartphone addiction. The paper includes a quantitative study of 940 social media users from Mexico, using structural equation modeling (SEM) to test the proposed hypotheses. The findings point to an overall positive indirect impact of social media usage on psychological well-being, mainly due to the positive effect of bonding and bridging social capital. The empirical model's explanatory power is 45.1%. This paper provides empirical evidence and robust statistical analysis that demonstrates both positive and negative effects coexist, helping to reconcile the inconsistencies found so far in the literature.

Introduction

The use of social media has grown substantially in recent years (Leong et al., 2019 ; Kemp, 2020 ). Social media refers to “the websites and online tools that facilitate interactions between users by providing them opportunities to share information, opinions, and interest” (Swar and Hameed, 2017 , p. 141). Individuals use social media for many reasons, including entertainment, communication, and searching for information. Notably, adolescents and young adults are spending an increasing amount of time on online networking sites, e-games, texting, and other social media (Twenge and Campbell, 2019 ). In fact, some authors (e.g., Dhir et al., 2018 ; Tateno et al., 2019 ) have suggested that social media has altered the forms of group interaction and its users' individual and collective behavior around the world.

Consequently, there are increased concerns regarding the possible negative impacts associated with social media usage addiction (Swar and Hameed, 2017 ; Kircaburun et al., 2020 ), particularly on psychological well-being (Chotpitayasunondh and Douglas, 2016 ; Jiao et al., 2017 ; Choi and Noh, 2019 ; Chatterjee, 2020 ). Smartphones sometimes distract their users from relationships and social interaction (Chotpitayasunondh and Douglas, 2016 ; Li et al., 2020a ), and several authors have stressed that the excessive use of social media may lead to smartphone addiction (Swar and Hameed, 2017 ; Leong et al., 2019 ), primarily because of the fear of missing out (Reer et al., 2019 ; Roberts and David, 2020 ). Social media usage has been associated with anxiety, loneliness, and depression (Dhir et al., 2018 ; Reer et al., 2019 ), social isolation (Van Den Eijnden et al., 2016 ; Whaite et al., 2018 ), and “phubbing,” which refers to the extent to which an individual uses, or is distracted by, their smartphone during face-to-face communication with others (Chotpitayasunondh and Douglas, 2016 ; Jiao et al., 2017 ; Choi and Noh, 2019 ; Chatterjee, 2020 ).

However, social media use also contributes to building a sense of connectedness with relevant others (Twenge and Campbell, 2019 ), which may reduce social isolation. Indeed, social media provides several ways to interact both with close ties, such as family, friends, and relatives, and weak ties, including coworkers, acquaintances, and strangers (Chen and Li, 2017 ), and plays a key role among people of all ages as they exploit their sense of belonging in different communities (Roberts and David, 2020 ). Consequently, despite the fears regarding the possible negative impacts of social media usage on well-being, there is also an increasing number of studies highlighting social media as a new communication channel (Twenge and Campbell, 2019 ; Barbosa et al., 2020 ), stressing that it can play a crucial role in developing one's presence, identity, and reputation, thus facilitating social interaction, forming and maintaining relationships, and sharing ideas (Carlson et al., 2016 ), which consequently may be significantly correlated to social support (Chen and Li, 2017 ; Holliman et al., 2021 ). Interestingly, recent studies (e.g., David et al., 2018 ; Bano et al., 2019 ; Barbosa et al., 2020 ) have suggested that the impact of smartphone usage on psychological well-being depends on the time spent on each type of application and the activities that users engage in.

Hence, the literature provides contradictory cues regarding the impacts of social media on users' well-being, highlighting both the possible negative impacts and the social enhancement it can potentially provide. In line with views on the need to further investigate social media usage (Karikari et al., 2017 ), particularly regarding its societal implications (Jiao et al., 2017 ), this paper argues that there is an urgent need to further understand the impact of the time spent on social media on users' psychological well-being, namely by considering other variables that mediate and further explain this effect.

One of the relevant perspectives worth considering is that provided by social capital theory, which is adopted in this paper. Social capital theory has previously been used to study how social media usage affects psychological well-being (e.g., Bano et al., 2019 ). However, extant literature has so far presented only partial models of associations that, although statistically acceptable and contributing to the understanding of the scope of social networks, do not provide as comprehensive a vision of the phenomenon as that proposed within this paper. Furthermore, the contradictory views, suggesting both negative (e.g., Chotpitayasunondh and Douglas, 2016 ; Van Den Eijnden et al., 2016 ; Jiao et al., 2017 ; Whaite et al., 2018 ; Choi and Noh, 2019 ; Chatterjee, 2020 ) and positive impacts (Carlson et al., 2016 ; Chen and Li, 2017 ; Twenge and Campbell, 2019 ) of social media on psychological well-being, have not been adequately explored.

Given this research gap, this paper's main objective is to shed light on the effect of social media use on psychological well-being. As explained in detail in the next section, this paper explores the mediating effect of bonding and bridging social capital. To provide a broad view of the phenomenon, it also considers several variables highlighted in the literature as affecting the relationship between social media usage and psychological well-being, namely smartphone addiction, social isolation, and phubbing. The paper utilizes a quantitative study conducted in Mexico, comprising 940 social media users, and uses structural equation modeling (SEM) to test a set of research hypotheses.

This article provides several contributions. First, it adds to existing literature regarding the effect of social media use on psychological well-being and explores the contradictory indications provided by different approaches. Second, it proposes a conceptual model that integrates complementary perspectives on the direct and indirect effects of social media use. Third, it offers empirical evidence and robust statistical analysis that demonstrates that both positive and negative effects coexist, helping resolve the inconsistencies found so far in the literature. Finally, this paper provides insights on how to help reduce the potential negative effects of social media use, as it demonstrates that, through bridging and bonding social capital, social media usage positively impacts psychological well-being. Overall, the article offers valuable insights for academics, practitioners, and society in general.

The remainder of this paper is organized as follows. Section Literature Review presents a literature review focusing on the factors that explain the impact of social media usage on psychological well-being. Based on the literature review, a set of hypotheses are defined, resulting in the proposed conceptual model, which includes both the direct and indirect effects of social media usage on psychological well-being. Section Research Methodology explains the methodological procedures of the research, followed by the presentation and discussion of the study's results in section Results. Section Discussion is dedicated to the conclusions and includes implications, limitations, and suggestions for future research.

Literature Review

Putnam ( 1995 , p. 664–665) defined social capital as “features of social life – networks, norms, and trust – that enable participants to act together more effectively to pursue shared objectives.” Li and Chen ( 2014 , p. 117) further explained that social capital encompasses “resources embedded in one's social network, which can be assessed and used for instrumental or expressive returns such as mutual support, reciprocity, and cooperation.”

Putnam ( 1995 , 2000 ) conceptualized social capital as comprising two dimensions, bridging and bonding, considering the different norms and networks in which they occur. Bridging social capital refers to the inclusive nature of social interaction and occurs when individuals from different origins establish connections through social networks. Hence, bridging social capital is typically provided by heterogeneous weak ties (Li and Chen, 2014 ). This dimension widens individual social horizons and perspectives and provides extended access to resources and information. Bonding social capital refers to the social and emotional support each individual receives from his or her social networks, particularly from close ties (e.g., family and friends).

Overall, social capital is expected to be positively associated with psychological well-being (Bano et al., 2019 ). Indeed, Williams ( 2006 ) stressed that interaction generates affective connections, resulting in positive impacts, such as emotional support. The following sub-sections use the lens of social capital theory to explore further the relationship between the use of social media and psychological well-being.

Social Media Use, Social Capital, and Psychological Well-Being

The effects of social media usage on social capital have gained increasing scholarly attention, and recent studies have highlighted a positive relationship between social media use and social capital (Brown and Michinov, 2019 ; Tefertiller et al., 2020 ). Li and Chen ( 2014 ) hypothesized that the intensity of Facebook use by Chinese international students in the United States was positively related to social capital forms. A longitudinal survey based on the quota sampling approach illustrated the positive effects of social media use on the two social capital dimensions (Chen and Li, 2017 ). Abbas and Mesch ( 2018 ) argued that, as Facebook usage increases, it will also increase users' social capital. Karikari et al. ( 2017 ) also found positive effects of social media use on social capital. Similarly, Pang ( 2018 ) studied Chinese students residing in Germany and found positive effects of social networking sites' use on social capital, which, in turn, was positively associated with psychological well-being. Bano et al. ( 2019 ) analyzed the 266 students' data and found positive effects of WhatsApp use on social capital forms and the positive effect of social capital on psychological well-being, emphasizing the role of social integration in mediating this positive effect.

Kim and Kim ( 2017 ) stressed the importance of having a heterogeneous network of contacts, which ultimately enhances the potential social capital. Overall, the manifest and social relations between people from close social circles (bonding social capital) and from distant social circles (bridging social capital) are strengthened when they promote communication, social support, and the sharing of interests, knowledge, and skills, which are shared with other members. This is linked to positive effects on interactions, such as acceptance, trust, and reciprocity, which are related to the individuals' health and psychological well-being (Bekalu et al., 2019 ), including when social media helps to maintain social capital between social circles that exist outside of virtual communities (Ellison et al., 2007 ).

Grounded on the above literature, this study proposes the following hypotheses:

• H1a: Social media use is positively associated with bonding social capital.
• H1b: Bonding social capital is positively associated with psychological well-being.
• H2a: Social media use is positively associated with bridging social capital.
• H2b: Bridging social capital is positively associated with psychological well-being.

Social Media Use, Social Isolation, and Psychological Well-Being

Social isolation is defined as “a deficit of personal relationships or being excluded from social networks” (Choi and Noh, 2019 , p. 4). The state that occurs when an individual lacks true engagement with others, a sense of social belonging, and a satisfying relationship is related to increased mortality and morbidity (Primack et al., 2017 ). Those who experience social isolation are deprived of social relationships and lack contact with others or involvement in social activities (Schinka et al., 2012 ). Social media usage has been associated with anxiety, loneliness, and depression (Dhir et al., 2018 ; Reer et al., 2019 ), and social isolation (Van Den Eijnden et al., 2016 ; Whaite et al., 2018 ). However, some recent studies have argued that social media use decreases social isolation (Primack et al., 2017 ; Meshi et al., 2020 ). Indeed, the increased use of social media platforms such as Facebook, WhatsApp, Instagram, and Twitter, among others, may provide opportunities for decreasing social isolation. For instance, the improved interpersonal connectivity achieved via videos and images on social media helps users evidence intimacy, attenuating social isolation (Whaite et al., 2018 ).

Chappell and Badger ( 1989 ) stated that social isolation leads to decreased psychological well-being, while Choi and Noh ( 2019 ) concluded that greater social isolation is linked to increased suicide risk. Schinka et al. ( 2012 ) further argued that, when individuals experience social isolation from siblings, friends, family, or society, their psychological well-being tends to decrease. Thus, based on the literature cited above, this study proposes the following hypotheses:

• H3a: Social media use is significantly associated with social isolation.
• H3b: Social isolation is negatively associated with psychological well-being.

Social Media Use, Smartphone Addiction, Phubbing, and Psychological Well-Being

Smartphone addiction refers to “an individuals' excessive use of a smartphone and its negative effects on his/her life as a result of his/her inability to control his behavior” (Gökçearslan et al., 2018 , p. 48). Regardless of its form, smartphone addiction results in social, medical, and psychological harm to people by limiting their ability to make their own choices (Chotpitayasunondh and Douglas, 2016 ). The rapid advancement of information and communication technologies has led to the concept of social media, e-games, and also to smartphone addiction (Chatterjee, 2020 ). The excessive use of smartphones for social media use, entertainment (watching videos, listening to music), and playing e-games is more common amongst people addicted to smartphones (Jeong et al., 2016 ). In fact, previous studies have evidenced the relationship between social use and smartphone addiction (Salehan and Negahban, 2013 ; Jeong et al., 2016 ; Swar and Hameed, 2017 ). In line with this, the following hypotheses are proposed:

• H4a: Social media use is positively associated with smartphone addiction.
• H4b: Smartphone addiction is negatively associated with psychological well-being.

While smartphones are bringing individuals closer, they are also, to some extent, pulling people apart (Tonacci et al., 2019 ). For instance, they can lead to individuals ignoring others with whom they have close ties or physical interactions; this situation normally occurs due to extreme smartphone use (i.e., at the dinner table, in meetings, at get-togethers and parties, and in other daily activities). This act of ignoring others is called phubbing and is considered a common phenomenon in communication activities (Guazzini et al., 2019 ; Chatterjee, 2020 ). Phubbing is also referred to as an act of snubbing others (Chatterjee, 2020 ). This term was initially used in May 2012 by an Australian advertising agency to describe the “growing phenomenon of individuals ignoring their families and friends who were called phubbee (a person who is a recipients of phubbing behavior) victim of phubber (a person who start phubbing her or his companion)” (Chotpitayasunondh and Douglas, 2018 ). Smartphone addiction has been found to be a determinant of phubbing (Kim et al., 2018 ). Other recent studies have also evidenced the association between smartphones and phubbing (Chotpitayasunondh and Douglas, 2016 ; Guazzini et al., 2019 ; Tonacci et al., 2019 ; Chatterjee, 2020 ). Vallespín et al. ( 2017 ) argued that phubbing behavior has a negative influence on psychological well-being and satisfaction. Furthermore, smartphone addiction is considered responsible for the development of new technologies. It may also negatively influence individual's psychological proximity (Chatterjee, 2020 ). Therefore, based on the above discussion and calls for the association between phubbing and psychological well-being to be further explored, this study proposes the following hypotheses:

• H5: Smartphone addiction is positively associated with phubbing.
• H6: Phubbing is negatively associated with psychological well-being.

Indirect Relationship Between Social Media Use and Psychological Well-Being

Beyond the direct hypotheses proposed above, this study investigates the indirect effects of social media use on psychological well-being mediated by social capital forms, social isolation, and phubbing. As described above, most prior studies have focused on the direct influence of social media use on social capital forms, social isolation, smartphone addiction, and phubbing, as well as the direct impact of social capital forms, social isolation, smartphone addiction, and phubbing on psychological well-being. Very few studies, however, have focused on and evidenced the mediating role of social capital forms, social isolation, smartphone addiction, and phubbing derived from social media use in improving psychological well-being (Chen and Li, 2017 ; Pang, 2018 ; Bano et al., 2019 ; Choi and Noh, 2019 ). Moreover, little is known about smartphone addiction's mediating role between social media use and psychological well-being. Therefore, this study aims to fill this gap in the existing literature by investigating the mediation of social capital forms, social isolation, and smartphone addiction. Further, examining the mediating influence will contribute to a more comprehensive understanding of social media use on psychological well-being via the mediating associations of smartphone addiction and psychological factors. Therefore, based on the above, we propose the following hypotheses (the conceptual model is presented in Figure 1 ):

Conceptual model.

• H7: (a) Bonding social capital; (b) bridging social capital; (c) social isolation; and (d) smartphone addiction mediate the relationship between social media use and psychological well-being.

Research Methodology

Sample procedure and online survey.

This study randomly selected students from universities in Mexico. We chose University students for the following reasons. First, students are considered the most appropriate sample for e-commerce studies, particularly in the social media context (Oghazi et al., 2018 ; Shi et al., 2018 ). Second, University students are considered to be frequent users and addicted to smartphones (Mou et al., 2017 ; Stouthuysen et al., 2018 ). Third, this study ensured that respondents were experienced, well-educated, and possessed sufficient knowledge of the drawbacks of social media and the extreme use of smartphones. A total sample size of 940 University students was ultimately achieved from the 1,500 students contacted, using a convenience random sampling approach, due both to the COVID-19 pandemic and budget and time constraints. Additionally, in order to test the model, a quantitative empirical study was conducted, using an online survey method to collect data. This study used a web-based survey distributed via social media platforms for two reasons: the COVID-19 pandemic; and to reach a large number of respondents (Qalati et al., 2021 ). Furthermore, online surveys are considered a powerful and authenticated tool for new research (Fan et al., 2021 ), while also representing a fast, simple, and less costly approach to collecting data (Dutot and Bergeron, 2016 ).

Data Collection Procedures and Respondent's Information

Data were collected by disseminating a link to the survey by e-mail and social network sites. Before presenting the closed-ended questionnaire, respondents were assured that their participation would remain voluntary, confidential, and anonymous. Data collection occurred from July 2020 to December 2020 (during the pandemic). It should be noted that, because data were collected during the pandemic, this may have had an influence on the results of the study. The reason for choosing a six-month lag time was to mitigate common method bias (CMB) (Li et al., 2020b ). In the present study, 1,500 students were contacted via University e-mail and social applications (Facebook, WhatsApp, and Instagram). We sent a reminder every month for 6 months (a total of six reminders), resulting in 940 valid responses. Thus, 940 (62.6% response rate) responses were used for hypotheses testing.

Table 1 reveals that, of the 940 participants, three-quarters were female (76.4%, n = 719) and nearly one-quarter (23.6%, n = 221) were male. Nearly half of the participants (48.8%, n = 459) were aged between 26 and 35 years, followed by 36 to 35 years (21.9%, n = 206), <26 (20.3%, n = 191), and over 45 (8.9%, n = 84). Approximately two-thirds (65%, n = 611) had a bachelor's degree or above, while one-third had up to 12 years of education. Regarding the daily frequency of using the Internet, nearly half (48.6%, n = 457) of the respondents reported between 5 and 8 h a day, and over one-quarter (27.2%) 9–12 h a day. Regarding the social media platforms used, over 38.5 and 39.6% reported Facebook and WhatsApp, respectively. Of the 940 respondents, only 22.1% reported Instagram (12.8%) and Twitter (9.2%). It should be noted, however, that the sample is predominantly female and well-educated.

Respondents' characteristics.

Measurement Items

The study used five-point Likert scales (1 = “strongly disagree;” 5 = “strongly agree”) to record responses.

Social Media Use

Social media use was assessed using four items adapted from Karikari et al. ( 2017 ). Sample items include “Social media is part of my everyday activity,” “Social media has become part of my daily life,” “I would be sorry if social media shut down,” and “I feel out of touch, when I have not logged onto social media for a while.” The adapted items had robust reliability and validity (CA = 783, CR = 0.857, AVE = 0.600).

Social Capital

Social capital was measured using a total of eight items, representing bonding social capital (four items) and bridging social capital (four items) adapted from Chan ( 2015 ). Sample construct items include: bonging social capital (“I am willing to spend time to support general community activities,” “I interact with people who are quite different from me”) and bridging social capital (“My social media community is a good place to be,” “Interacting with people on social media makes me want to try new things”). The adapted items had robust reliability and validity [bonding social capital (CA = 0.785, CR = 0.861, AVE = 0.608) and bridging social capital (CA = 0.834, CR = 0.883, AVE = 0.601)].

Social Isolation

Social isolation was assessed using three items from Choi and Noh ( 2019 ). Sample items include “I do not have anyone to play with,” “I feel alone from people,” and “I have no one I can trust.” This adapted scale had substantial reliability and validity (CA = 0.890, CR = 0.928, AVE = 0.811).

Smartphone Addiction

Smartphone addiction was assessed using five items taken from Salehan and Negahban ( 2013 ). Sample items include “I am always preoccupied with my mobile,” “Using my mobile phone keeps me relaxed,” and “I am not able to control myself from frequent use of mobile phones.” Again, these adapted items showed substantial reliability and validity (CA = 903, CR = 0.928, AVE = 0.809).

Phubbing was assessed using four items from Chotpitayasunondh and Douglas ( 2018 ). Sample items include: “I have conflicts with others because I am using my phone” and “I would rather pay attention to my phone than talk to others.” This construct also demonstrated significant reliability and validity (CA = 770, CR = 0.894, AVE = 0.809).

Psychological Well-Being

Psychological well-being was assessed using five items from Jiao et al. ( 2017 ). Sample items include “I lead a purposeful and meaningful life with the help of others,” “My social relationships are supportive and rewarding in social media,” and “I am engaged and interested in my daily on social media.” This study evidenced that this adapted scale had substantial reliability and validity (CA = 0.886, CR = 0.917, AVE = 0.688).

Data Analysis

Based on the complexity of the association between the proposed construct and the widespread use and acceptance of SmartPLS 3.0 in several fields (Hair et al., 2019 ), we utilized SEM, using SmartPLS 3.0, to examine the relationships between constructs. Structural equation modeling is a multivariate statistical analysis technique that is used to investigate relationships. Further, it is a combination of factor and multivariate regression analysis, and is employed to explore the relationship between observed and latent constructs.

SmartPLS 3.0 “is a more comprehensive software program with an intuitive graphical user interface to run partial least square SEM analysis, certainly has had a massive impact” (Sarstedt and Cheah, 2019 ). According to Ringle et al. ( 2015 ), this commercial software offers a wide range of algorithmic and modeling options, improved usability, and user-friendly and professional support. Furthermore, Sarstedt and Cheah ( 2019 ) suggested that structural equation models enable the specification of complex interrelationships between observed and latent constructs. Hair et al. ( 2019 ) argued that, in recent years, the number of articles published using partial least squares SEM has increased significantly in contrast to covariance-based SEM. In addition, partial least squares SEM using SmartPLS is more appealing for several scholars as it enables them to predict more complex models with several variables, indicator constructs, and structural paths, instead of imposing distributional assumptions on the data (Hair et al., 2019 ). Therefore, this study utilized the partial least squares SEM approach using SmartPLS 3.0.

Common Method Bias (CMB) Test

This study used the Kaiser–Meyer–Olkin (KMO) test to measure the sampling adequacy and ensure data suitability. The KMO test result was 0.874, which is greater than an acceptable threshold of 0.50 (Ali Qalati et al., 2021 ; Shrestha, 2021 ), and hence considered suitable for explanatory factor analysis. Moreover, Bartlett's test results demonstrated a significance level of 0.001, which is considered good as it is below the accepted threshold of 0.05.

The term CMB is associated with Campbell and Fiske ( 1959 ), who highlighted the importance of CMB and identified that a portion of variance in the research may be due to the methods employed. It occurs when all scales of the study are measured at the same time using a single questionnaire survey (Podsakoff and Organ, 1986 ); subsequently, estimates of the relationship among the variables might be distorted by the impacts of CMB. It is considered a serious issue that has a potential to “jeopardize” the validity of the study findings (Tehseen et al., 2017 ). There are several reasons for CMB: (1) it mainly occurs due to response “tendencies that raters can apply uniformity across the measures;” and (2) it also occurs due to similarities in the wording and structure of the survey items that produce similar results (Jordan and Troth, 2019 ). Harman's single factor test and a full collinearity approach were employed to ensure that the data was free from CMB (Tehseen et al., 2017 ; Jordan and Troth, 2019 ; Ali Qalati et al., 2021 ). Harman's single factor test showed a single factor explained only 22.8% of the total variance, which is far below the 50.0% acceptable threshold (Podsakoff et al., 2003 ).

Additionally, the variance inflation factor (VIF) was used, which is a measure of the amount of multicollinearity in a set of multiple regression constructs and also considered a way of detecting CMB (Hair et al., 2019 ). Hair et al. ( 2019 ) suggested that the acceptable threshold for the VIF is 3.0; as the computed VIFs for the present study ranged from 1.189 to 1.626, CMB is not a key concern (see Table 2 ). Bagozzi et al. ( 1991 ) suggested a correlation-matrix procedure to detect CMB. Common method bias is evident if correlation among the principle constructs is >0.9 (Tehseen et al., 2020 ); however, no values >0.9 were found in this study (see section Assessment of Measurement Model). This study used a two-step approach to evaluate the measurement model and the structural model.

Common method bias (full collinearity VIF).

Assessment of Measurement Model

Before conducting the SEM analysis, the measurement model was assessed to examine individual item reliability, internal consistency, and convergent and discriminant validity. Table 3 exhibits the values of outer loading used to measure an individual item's reliability (Hair et al., 2012 ). Hair et al. ( 2017 ) proposed that the value for each outer loading should be ≥0.7; following this principle, two items of phubbing (PHUB3—I get irritated if others ask me to get off my phone and talk to them; PHUB4—I use my phone even though I know it irritated others) were removed from the analysis Hair et al. ( 2019 ). According to Nunnally ( 1978 ), Cronbach's alpha values should exceed 0.7. The threshold values of constructs in this study ranged from 0.77 to 0.903. Regarding internal consistency, Bagozzi and Yi ( 1988 ) suggested that composite reliability (CR) should be ≥0.7. The coefficient value for CR in this study was between 0.857 and 0.928. Regarding convergent validity, Fornell and Larcker ( 1981 ) suggested that the average variance extracted (AVE) should be ≥0.5. Average variance extracted values in this study were between 0.60 and 0.811. Finally, regarding discriminant validity, according to Fornell and Larcker ( 1981 ), the square root of the AVE for each construct should exceed the inter-correlations of the construct with other model constructs. That was the case in this study, as shown in Table 4 .

Study measures, factor loading, and the constructs' reliability and convergent validity.

Discriminant validity and correlation.

Bold values are the square root of the AVE .

Hence, by analyzing the results of the measurement model, it can be concluded that the data are adequate for structural equation estimation.

Assessment of the Structural Model

This study used the PLS algorithm and a bootstrapping technique with 5,000 bootstraps as proposed by Hair et al. ( 2019 ) to generate the path coefficient values and their level of significance. The coefficient of determination ( R 2 ) is an important measure to assess the structural model and its explanatory power (Henseler et al., 2009 ; Hair et al., 2019 ). Table 5 and Figure 2 reveal that the R 2 value in the present study was 0.451 for psychological well-being, which means that 45.1% of changes in psychological well-being occurred due to social media use, social capital forms (i.e., bonding and bridging), social isolation, smartphone addiction, and phubbing. Cohen ( 1998 ) proposed that R 2 values of 0.60, 0.33, and 0.19 are considered substantial, moderate, and weak. Following Cohen's ( 1998 ) threshold values, this research demonstrates a moderate predicting power for psychological well-being among Mexican respondents ( Table 6 ).

Summary of path coefficients and hypothesis testing.

Structural model.

Strength of the model (Predictive relevance, coefficient of determination, and model fit indices).

Goodness of fit → SRMR = 0.063; d_ULS = 1.589; d_G = 0.512; chi-square = 2,910.744 .

Apart from the R 2 measure, the present study also used cross-validated redundancy measures, or effect sizes ( q 2 ), to assess the proposed model and validate the results (Ringle et al., 2012 ). Hair et al. ( 2019 ) suggested that a model exhibiting an effect size q 2 > 0 has predictive relevance ( Table 6 ). This study's results evidenced that it has a 0.15 <0.29 <0.35 (medium) predictive relevance, as 0.02, 0.15, and 0.35 are considered small, medium, and large, respectively (Cohen, 1998 ). Regarding the goodness-of-fit indices, Hair et al. ( 2019 ) suggested the standardized root mean square residual (SRMR) to evaluate the goodness of fit. Standardized root mean square is an absolute measure of fit: a value of zero indicates perfect fit and a value <0.08 is considered good fit (Hair et al., 2019 ). This study exhibits an adequate model fitness level with an SRMR value of 0.063 ( Table 6 ).

Table 5 reveals that all hypotheses of the study were accepted base on the criterion ( p -value < 0.05). H1a (β = 0.332, t = 10.283, p = 0.001) was confirmed, with the second most robust positive and significant relationship (between social media use and bonding social capital). In addition, this study evidenced a positive and significant relationship between bonding social capital and psychological well-being (β = 0.127, t = 4.077, p = 0.001); therefore, H1b was accepted. Regarding social media use and bridging social capital, the present study found the most robust positive and significant impact (β = 0.439, t = 15.543, p = 0.001); therefore, H2a was accepted. The study also evidenced a positive and significant association between bridging social capital and psychological well-being (β = 0.561, t = 20.953, p = 0.001); thus, H2b was accepted. The present study evidenced a significant effect of social media use on social isolation (β = 0.145, t = 4.985, p = 0.001); thus, H3a was accepted. In addition, this study accepted H3b (β = −0.051, t = 2.01, p = 0.044). Furthermore, this study evidenced a positive and significant effect of social media use on smartphone addiction (β = 0.223, t = 6.241, p = 0.001); therefore, H4a was accepted. Furthermore, the present study found that smartphone addiction has a negative significant influence on psychological well-being (β = −0.068, t = 2.387, p = 0.017); therefore, H4b was accepted. Regarding the relationship between smartphone addiction and phubbing, this study found a positive and significant effect of smartphone addiction on phubbing (β = 0.244, t = 7.555, p = 0.001); therefore, H5 was accepted. Furthermore, the present research evidenced a positive and significant influence of phubbing on psychological well-being (β = 0.137, t = 4.938, p = 0.001); therefore, H6 was accepted. Finally, the study provides interesting findings on the indirect effect of social media use on psychological well-being ( t -value > 1.96 and p -value < 0.05); therefore, H7a–d were accepted.

Furthermore, to test the mediating analysis, Preacher and Hayes's ( 2008 ) approach was used. The key characteristic of an indirect relationship is that it involves a third construct, which plays a mediating role in the relationship between the independent and dependent constructs. Logically, the effect of A (independent construct) on C (the dependent construct) is mediated by B (a third variable). Preacher and Hayes ( 2008 ) suggested the following: B is a construct acting as a mediator if A significantly influences B, A significantly accounts for variability in C, B significantly influences C when controlling for A, and the influence of A on C decreases significantly when B is added simultaneously with A as a predictor of C. According to Matthews et al. ( 2018 ), if the indirect effect is significant while the direct insignificant, full mediation has occurred, while if both direct and indirect effects are substantial, partial mediation has occurred. This study evidenced that there is partial mediation in the proposed construct ( Table 5 ). Following Preacher and Hayes ( 2008 ) this study evidenced that there is partial mediation in the proposed construct, because the relationship between independent variable (social media use) and dependent variable (psychological well-being) is significant ( p -value < 0.05) and indirect effect among them after introducing mediator (bonding social capital, bridging social capital, social isolation, and smartphone addiction) is also significant ( p -value < 0.05), therefore it is evidenced that when there is a significant effect both direct and indirect it's called partial mediation.

The present study reveals that the social and psychological impacts of social media use among University students is becoming more complex as there is continuing advancement in technology, offering a range of affordable interaction opportunities. Based on the 940 valid responses collected, all the hypotheses were accepted ( p < 0.05).

H1a finding suggests that social media use is a significant influencing factor of bonding social capital. This implies that, during a pandemic, social media use enables students to continue their close relationships with family members, friends, and those with whom they have close ties. This finding is in line with prior work of Chan ( 2015 ) and Ellison et al. ( 2007 ), who evidenced that social bonding capital is predicted by Facebook use and having a mobile phone. H1b findings suggest that, when individuals believe that social communication can help overcome obstacles to interaction and encourage more virtual self-disclosure, social media use can improve trust and promote the establishment of social associations, thereby enhancing well-being. These findings are in line with those of Gong et al. ( 2021 ), who also witnessed the significant effect of bonding social capital on immigrants' psychological well-being, subsequently calling for the further evidence to confirm the proposed relationship.

The findings of the present study related to H2a suggest that students are more likely to use social media platforms to receive more emotional support, increase their ability to mobilize others, and to build social networks, which leads to social belongingness. Furthermore, the findings suggest that social media platforms enable students to accumulate and maintain bridging social capital; further, online classes can benefit students who feel shy when participating in offline classes. This study supports the previous findings of Chan ( 2015 ) and Karikari et al. ( 2017 ). Notably, the present study is not limited to a single social networking platform, taking instead a holistic view of social media. The H2b findings are consistent with those of Bano et al. ( 2019 ), who also confirmed the link between bonding social capital and psychological well-being among University students using WhatsApp as social media platform, as well as those of Chen and Li ( 2017 ).

The H3a findings suggest that, during the COVID-19 pandemic when most people around the world have had limited offline or face-to-face interaction and have used social media to connect with families, friends, and social communities, they have often been unable to connect with them. This is due to many individuals avoiding using social media because of fake news, financial constraints, and a lack of trust in social media; thus, the lack both of offline and online interaction, coupled with negative experiences on social media use, enhances the level of social isolation (Hajek and König, 2021 ). These findings are consistent with those of Adnan and Anwar ( 2020 ). The H3b suggests that higher levels of social isolation have a negative impact on psychological well-being. These result indicating that, consistent with Choi and Noh ( 2019 ), social isolation is negatively and significantly related to psychological well-being.

The H4a results suggests that substantial use of social media use leads to an increase in smartphone addiction. These findings are in line with those of Jeong et al. ( 2016 ), who stated that the excessive use of smartphones for social media, entertainment (watching videos, listening to music), and playing e-games was more likely to lead to smartphone addiction. These findings also confirm the previous work of Jeong et al. ( 2016 ), Salehan and Negahban ( 2013 ), and Swar and Hameed ( 2017 ). The H4b results revealed that a single unit increase in smartphone addiction results in a 6.8% decrease in psychological well-being. These findings are in line with those of Tangmunkongvorakul et al. ( 2019 ), who showed that students with higher levels of smartphone addiction had lower psychological well-being scores. These findings also support those of Shoukat ( 2019 ), who showed that smartphone addiction inversely influences individuals' mental health.

This suggests that the greater the smartphone addiction, the greater the phubbing. The H5 findings are in line with those of Chatterjee ( 2020 ), Chotpitayasunondh and Douglas ( 2016 ), Guazzini et al. ( 2019 ), and Tonacci et al. ( 2019 ), who also evidenced a significant impact of smartphone addiction and phubbing. Similarly, Chotpitayasunondh and Douglas ( 2018 ) corroborated that smartphone addiction is the main predictor of phubbing behavior. However, these findings are inconsistent with those of Vallespín et al. ( 2017 ), who found a negative influence of phubbing.

The H6 results suggests that phubbing is one of the significant predictors of psychological well-being. Furthermore, these findings suggest that, when phubbers use a cellphone during interaction with someone, especially during the current pandemic, and they are connected with many family members, friends, and relatives; therefore, this kind of action gives them more satisfaction, which simultaneously results in increased relaxation and decreased depression (Chotpitayasunondh and Douglas, 2018 ). These findings support those of Davey et al. ( 2018 ), who evidenced that phubbing has a significant influence on adolescents and social health students in India.

The findings showed a significant and positive effect of social media use on psychological well-being both through bridging and bonding social capital. However, a significant and negative effect of social media use on psychological well-being through smartphone addiction and through social isolation was also found. Hence, this study provides evidence that could shed light on the contradictory contributions in the literature suggesting both positive (e.g., Chen and Li, 2017 ; Twenge and Campbell, 2019 ; Roberts and David, 2020 ) and negative (e.g., Chotpitayasunondh and Douglas, 2016 ; Jiao et al., 2017 ; Choi and Noh, 2019 ; Chatterjee, 2020 ) effects of social media use on psychological well-being. This study concludes that the overall impact is positive, despite some degree of negative indirect impact.

Theoretical Contributions

This study's findings contribute to the current literature, both by providing empirical evidence for the relationships suggested by extant literature and by demonstrating the relevance of adopting a more complex approach that considers, in particular, the indirect effect of social media on psychological well-being. As such, this study constitutes a basis for future research (Van Den Eijnden et al., 2016 ; Whaite et al., 2018 ) aiming to understand the impacts of social media use and to find ways to reduce its possible negative impacts.

In line with Kim and Kim ( 2017 ), who stressed the importance of heterogeneous social networks in improving social capital, this paper suggests that, to positively impact psychological well-being, social media usage should be associated both with strong and weak ties, as both are important in building social capital, and hence associated with its bonding and bridging facets. Interestingly, though, bridging capital was shown as having the greatest impact on psychological well-being. Thus, the importance of wider social horizons, the inclusion in different groups, and establishing new connections (Putnam, 1995 , 2000 ) with heterogeneous weak ties (Li and Chen, 2014 ) are highlighted in this paper.

Practical Contributions

These findings are significant for practitioners, particularly those interested in dealing with the possible negative impacts of social media use on psychological well-being. Although social media use is associated with factors that negatively impact psychological well-being, particularly smartphone addiction and social isolation, these negative impacts can be lessened if the connections with both strong and weak ties are facilitated and featured by social media. Indeed, social media platforms offer several features, from facilitating communication with family, friends, and acquaintances, to identifying and offering access to other people with shared interests. However, it is important to access heterogeneous weak ties (Li and Chen, 2014 ) so that social media offers access to wider sources of information and new resources, hence enhancing bridging social capital.

Limitations and Directions for Future Studies

This study is not without limitations. For example, this study used a convenience sampling approach to reach to a large number of respondents. Further, this study was conducted in Mexico only, limiting the generalizability of the results; future research should therefore use a cross-cultural approach to investigate the impacts of social media use on psychological well-being and the mediating role of proposed constructs (e.g., bonding and bridging social capital, social isolation, and smartphone addiction). The sample distribution may also be regarded as a limitation of the study because respondents were mainly well-educated and female. Moreover, although Internet channels represent a particularly suitable way to approach social media users, the fact that this study adopted an online survey does not guarantee a representative sample of the population. Hence, extrapolating the results requires caution, and study replication is recommended, particularly with social media users from other countries and cultures. The present study was conducted in the context of mainly University students, primarily well-educated females, via an online survey on in Mexico; therefore, the findings represent a snapshot at a particular time. Notably, however, the effect of social media use is increasing due to COVID-19 around the globe and is volatile over time.

Two of the proposed hypotheses of this study, namely the expected negative impacts of social media use on social isolation and of phubbing on psychological well-being, should be further explored. One possible approach is to consider the type of connections (i.e., weak and strong ties) to explain further the impact of social media usage on social isolation. Apparently, the prevalence of weak ties, although facilitating bridging social capital, may have an adverse impact in terms of social isolation. Regarding phubbing, the fact that the findings point to a possible positive impact on psychological well-being should be carefully addressed, specifically by psychology theorists and scholars, in order to identify factors that may help further understand this phenomenon. Other suggestions for future research include using mixed-method approaches, as qualitative studies could help further validate the results and provide complementary perspectives on the relationships between the considered variables.

Data Availability Statement

Ethics statement.

The studies involving human participants were reviewed and approved by Jiangsu University. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Funding. This study is supported by the National Statistics Research Project of China (2016LY96).

• Abbas R., Mesch G. (2018). Do rich teens get richer? Facebook use and the link between offline and online social capital among Palestinian youth in Israel . Inf. Commun. Soc. 21 , 63–79. 10.1080/1369118X.2016.1261168 [ CrossRef ] [ Google Scholar ]
• Adnan M., Anwar K. (2020). Online learning amid the COVID-19 pandemic: students' perspectives . J. Pedagog. Sociol. Psychol. 2 , 45–51. 10.33902/JPSP.2020261309 [ CrossRef ] [ Google Scholar ]
• Ali Qalati S., Li W., Ahmed N., Ali Mirani M., Khan A. (2021). Examining the factors affecting SME performance: the mediating role of social media adoption . Sustainability 13 :75. 10.3390/su13010075 [ CrossRef ] [ Google Scholar ]
• Bagozzi R. P., Yi Y. (1988). On the evaluation of structural equation models . J. Acad. Mark. Sci. 16 , 74–94. 10.1007/BF02723327 [ CrossRef ] [ Google Scholar ]
• Bagozzi R. P., Yi Y., Phillips L. W. (1991). Assessing construct validity in organizational research . Admin. Sci. Q. 36 , 421–458. 10.2307/2393203 [ CrossRef ] [ Google Scholar ]
• Bano S., Cisheng W., Khan A. N., Khan N. A. (2019). WhatsApp use and student's psychological well-being: role of social capital and social integration . Child. Youth Serv. Rev. 103 , 200–208. 10.1016/j.childyouth.2019.06.002 [ CrossRef ] [ Google Scholar ]
• Barbosa B., Chkoniya V., Simoes D., Filipe S., Santos C. A. (2020). Always connected: generation Y smartphone use and social capital . Rev. Ibérica Sist. Tecnol. Inf. E 35 , 152–166. [ Google Scholar ]
• Bekalu M. A., McCloud R. F., Viswanath K. (2019). Association of social media use with social well-being, positive mental health, and self-rated health: disentangling routine use from emotional connection to use . Health Educ. Behav. 46(2 Suppl), 69S−80S. 10.1177/1090198119863768 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Brown G., Michinov N. (2019). Measuring latent ties on Facebook: a novel approach to studying their prevalence and relationship with bridging social capital . Technol. Soc. 59 :101176. 10.1016/j.techsoc.2019.101176 [ CrossRef ] [ Google Scholar ]
• Campbell D. T., Fiske D. W. (1959). Convergent and discriminant validation by the multitrait-multimethod matrix . Psychol. Bull. 56 , 81–105. 10.1037/h0046016 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Carlson J. R., Zivnuska S., Harris R. B., Harris K. J., Carlson D. S. (2016). Social media use in the workplace: a study of dual effects . J. Org. End User Comput. 28 , 15–31. 10.4018/JOEUC.2016010102 [ CrossRef ] [ Google Scholar ]
• Chan M. (2015). Mobile phones and the good life: examining the relationships among mobile use, social capital and subjective well-being . New Media Soc. 17 , 96–113. 10.1177/1461444813516836 [ CrossRef ] [ Google Scholar ]
• Chappell N. L., Badger M. (1989). Social isolation and well-being . J. Gerontol. 44 , S169–S176. 10.1093/geronj/44.5.s169 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Chatterjee S. (2020). Antecedents of phubbing: from technological and psychological perspectives . J. Syst. Inf. Technol. 22 , 161–118. 10.1108/JSIT-05-2019-0089 [ CrossRef ] [ Google Scholar ]
• Chen H.-T., Li X. (2017). The contribution of mobile social media to social capital and psychological well-being: examining the role of communicative use, friending and self-disclosure . Comput. Hum. Behav. 75 , 958–965. 10.1016/j.chb.2017.06.011 [ CrossRef ] [ Google Scholar ]
• Choi D.-H., Noh G.-Y. (2019). The influence of social media use on attitude toward suicide through psychological well-being, social isolation, and social support . Inf. Commun. Soc. 23 , 1–17. 10.1080/1369118X.2019.1574860 [ CrossRef ] [ Google Scholar ]
• Chotpitayasunondh V., Douglas K. M. (2016). How phubbing becomes the norm: the antecedents and consequences of snubbing via smartphone . Comput. Hum. Behav. 63 , 9–18. 10.1016/j.chb.2016.05.018 [ CrossRef ] [ Google Scholar ]
• Chotpitayasunondh V., Douglas K. M. (2018). The effects of phubbing on social interaction . J. Appl. Soc. Psychol. 48 , 304–316. 10.1111/jasp.12506 [ CrossRef ] [ Google Scholar ]
• Cohen J. (1998). Statistical Power Analysis for the Behavioural Sciences . Hillsdale, NJ: Lawrence Erlbaum Associates. [ Google Scholar ]
• Davey S., Davey A., Raghav S. K., Singh J. V., Singh N., Blachnio A., et al.. (2018). Predictors and consequences of phubbing among adolescents and youth in India: an impact evaluation study . J. Fam. Community Med. 25 , 35–42. 10.4103/jfcm.JFCM_71_17 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• David M. E., Roberts J. A., Christenson B. (2018). Too much of a good thing: investigating the association between actual smartphone use and individual well-being . Int. J. Hum. Comput. Interact. 34 , 265–275. 10.1080/10447318.2017.1349250 [ CrossRef ] [ Google Scholar ]
• Dhir A., Yossatorn Y., Kaur P., Chen S. (2018). Online social media fatigue and psychological wellbeing—a study of compulsive use, fear of missing out, fatigue, anxiety and depression . Int. J. Inf. Manag. 40 , 141–152. 10.1016/j.ijinfomgt.2018.01.012 [ CrossRef ] [ Google Scholar ]
• Dutot V., Bergeron F. (2016). From strategic orientation to social media orientation: improving SMEs' performance on social media . J. Small Bus. Enterp. Dev. 23 , 1165–1190. 10.1108/JSBED-11-2015-0160 [ CrossRef ] [ Google Scholar ]
• Ellison N. B., Steinfield C., Lampe C. (2007). The benefits of Facebook friends: Social capital and college students' use of online social network sites . J. Comput. Mediat. Commun. 12 , 1143–1168. 10.1111/j.1083-6101.2007.00367.x [ CrossRef ] [ Google Scholar ]
• Fan M., Huang Y., Qalati S. A., Shah S. M. M., Ostic D., Pu Z. (2021). Effects of information overload, communication overload, and inequality on digital distrust: a cyber-violence behavior mechanism . Front. Psychol. 12 :643981. 10.3389/fpsyg.2021.643981 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Fornell C., Larcker D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error . J. Market. Res. 18 , 39–50. 10.1177/002224378101800104 [ CrossRef ] [ Google Scholar ]
• Gökçearslan S., Uluyol Ç., Sahin S. (2018). Smartphone addiction, cyberloafing, stress and social support among University students: a path analysis . Child. Youth Serv. Rev. 91 , 47–54. 10.1016/j.childyouth.2018.05.036 [ CrossRef ] [ Google Scholar ]
• Gong S., Xu P., Wang S. (2021). Social capital and psychological well-being of Chinese immigrants in Japan . Int. J. Environ. Res. Public Health 18 :547. 10.3390/ijerph18020547 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Guazzini A., Duradoni M., Capelli A., Meringolo P. (2019). An explorative model to assess individuals' phubbing risk . Fut. Internet 11 :21. 10.3390/fi11010021 [ CrossRef ] [ Google Scholar ]
• Hair J. F., Risher J. J., Sarstedt M., Ringle C. M. (2019). When to use and how to report the results of PLS-SEM . Eur. Bus. Rev. 31 , 2–24. 10.1108/EBR-11-2018-0203 [ CrossRef ] [ Google Scholar ]
• Hair J. F., Sarstedt M., Pieper T. M., Ringle C. M. (2012). The use of partial least squares structural equation modeling in strategic management research: a review of past practices and recommendations for future applications . Long Range Plann. 45 , 320–340. 10.1016/j.lrp.2012.09.008 [ CrossRef ] [ Google Scholar ]
• Hair J. F., Sarstedt M., Ringle C. M., Gudergan S. P. (2017). Advanced Issues in Partial Least Squares Structural Equation Modeling. Thousand Oaks, CA: Sage. [ Google Scholar ]
• Hajek A., König H.-H. (2021). Social isolation and loneliness of older adults in times of the CoViD-19 pandemic: can use of online social media sites and video chats assist in mitigating social isolation and loneliness? Gerontology 67 , 121–123. 10.1159/000512793 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Henseler J., Ringle C. M., Sinkovics R. R. (2009). The use of partial least squares path modeling in international marketing, in New Challenges to International Marketing , Vol. 20, eds R.R. Sinkovics and P.N. Ghauri (Bigley: Emerald; ), 277–319. [ Google Scholar ]
• Holliman A. J., Waldeck D., Jay B., Murphy S., Atkinson E., Collie R. J., et al.. (2021). Adaptability and social support: examining links with psychological wellbeing among UK students and non-students . Fron. Psychol. 12 :636520. 10.3389/fpsyg.2021.636520 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jeong S.-H., Kim H., Yum J.-Y., Hwang Y. (2016). What type of content are smartphone users addicted to? SNS vs. games . Comput. Hum. Behav. 54 , 10–17. 10.1016/j.chb.2015.07.035 [ CrossRef ] [ Google Scholar ]
• Jiao Y., Jo M.-S., Sarigöllü E. (2017). Social value and content value in social media: two paths to psychological well-being . J. Org. Comput. Electr. Commer. 27 , 3–24. 10.1080/10919392.2016.1264762 [ CrossRef ] [ Google Scholar ]
• Jordan P. J., Troth A. C. (2019). Common method bias in applied settings: the dilemma of researching in organizations . Austr. J. Manag. 45 , 3–14. 10.1177/0312896219871976 [ CrossRef ] [ Google Scholar ]
• Karikari S., Osei-Frimpong K., Owusu-Frimpong N. (2017). Evaluating individual level antecedents and consequences of social media use in Ghana . Technol. Forecast. Soc. Change 123 , 68–79. 10.1016/j.techfore.2017.06.023 [ CrossRef ] [ Google Scholar ]
• Kemp S. (January 30, 2020). Digital 2020: 3.8 billion people use social media. We Are Social . Available online at: https://wearesocial.com/blog/2020/01/digital-2020-3-8-billion-people-use-social-media .
• Kim B., Kim Y. (2017). College students' social media use and communication network heterogeneity: implications for social capital and subjective well-being . Comput. Hum. Behav. 73 , 620–628. 10.1016/j.chb.2017.03.033 [ CrossRef ] [ Google Scholar ]
• Kim K., Milne G. R., Bahl S. (2018). Smart phone addiction and mindfulness: an intergenerational comparison . Int. J. Pharmaceut. Healthcare Market. 12 , 25–43. 10.1108/IJPHM-08-2016-0044 [ CrossRef ] [ Google Scholar ]
• Kircaburun K., Alhabash S., Tosuntaş S. B., Griffiths M. D. (2020). Uses and gratifications of problematic social media use among University students: a simultaneous examination of the big five of personality traits, social media platforms, and social media use motives . Int. J. Mental Health Addict. 18 , 525–547. 10.1007/s11469-018-9940-6 [ CrossRef ] [ Google Scholar ]
• Leong L.-Y., Hew T.-S., Ooi K.-B., Lee V.-H., Hew J.-J. (2019). A hybrid SEM-neural network analysis of social media addiction . Expert Syst. Appl. 133 , 296–316. 10.1016/j.eswa.2019.05.024 [ CrossRef ] [ Google Scholar ]
• Li L., Griffiths M. D., Mei S., Niu Z. (2020a). Fear of missing out and smartphone addiction mediates the relationship between positive and negative affect and sleep quality among Chinese University students . Front. Psychiatr. 11 :877. 10.3389/fpsyt.2020.00877 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Li W., Qalati S. A., Khan M. A. S., Kwabena G. Y., Erusalkina D., Anwar F. (2020b). Value co-creation and growth of social enterprises in developing countries: moderating role of environmental dynamics . Entrep. Res. J. 2020 :20190359. 10.1515/erj-2019-0359 [ CrossRef ] [ Google Scholar ]
• Li X., Chen W. (2014). Facebook or Renren? A comparative study of social networking site use and social capital among Chinese international students in the United States . Comput. Hum. Behav . 35 , 116–123. 10.1016/j.chb.2014.02.012 [ CrossRef ] [ Google Scholar ]
• Matthews L., Hair J. F., Matthews R. (2018). PLS-SEM: the holy grail for advanced analysis . Mark. Manag. J. 28 , 1–13. [ Google Scholar ]
• Meshi D., Cotten S. R., Bender A. R. (2020). Problematic social media use and perceived social isolation in older adults: a cross-sectional study . Gerontology 66 , 160–168. 10.1159/000502577 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mou J., Shin D.-H., Cohen J. (2017). Understanding trust and perceived usefulness in the consumer acceptance of an e-service: a longitudinal investigation . Behav. Inf. Technol. 36 , 125–139. 10.1080/0144929X.2016.1203024 [ CrossRef ] [ Google Scholar ]
• Nunnally J. (1978). Psychometric Methods . New York, NY: McGraw-Hill. [ Google Scholar ]
• Oghazi P., Karlsson S., Hellström D., Hjort K. (2018). Online purchase return policy leniency and purchase decision: mediating role of consumer trust . J. Retail. Consumer Serv. 41 , 190–200. [ Google Scholar ]
• Pang H. (2018). Exploring the beneficial effects of social networking site use on Chinese students' perceptions of social capital and psychological well-being in Germany . Int. J. Intercult. Relat. 67 , 1–11. 10.1016/j.ijintrel.2018.08.002 [ CrossRef ] [ Google Scholar ]
• Podsakoff P. M., MacKenzie S. B., Lee J.-Y., Podsakoff N. P. (2003). Common method biases in behavioral research: a critical review of the literature and recommended remedies . J. Appl. Psychol. 88 , 879–903. 10.1037/0021-9010.88.5.879 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Podsakoff P. M., Organ D. W. (1986). Self-reports in organizational research: problems and prospects . J. Manag. 12 , 531–544. 10.1177/014920638601200408 [ CrossRef ] [ Google Scholar ]
• Preacher K. J., Hayes A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models . Behav Res. Methods 40 , 879–891. 10.3758/brm.40.3.879 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Primack B. A., Shensa A., Sidani J. E., Whaite E. O., yi Lin L., Rosen D., et al.. (2017). Social media use and perceived social isolation among young adults in the US . Am. J. Prev. Med. 53 , 1–8. 10.1016/j.amepre.2017.01.010 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Putnam R. D. (1995). Tuning in, tuning out: the strange disappearance of social capital in America . Polit. Sci. Polit. 28 , 664–684. 10.2307/420517 [ CrossRef ] [ Google Scholar ]
• Putnam R. D. (2000). Bowling Alone: The Collapse and Revival of American Community . New York, NY: Simon and Schuster. [ Google Scholar ]
• Qalati S. A., Ostic D., Fan M., Dakhan S. A., Vela E. G., Zufar Z., et al.. (2021). The general public knowledge, attitude, and practices regarding COVID-19 during the lockdown in Asian developing countries . Int. Q. Commun. Health Educ. 2021 :272684X211004945. 10.1177/0272684X211004945 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Reer F., Tang W. Y., Quandt T. (2019). Psychosocial well-being and social media engagement: the mediating roles of social comparison orientation and fear of missing out . New Media Soc. 21 , 1486–1505. 10.1177/1461444818823719 [ CrossRef ] [ Google Scholar ]
• Ringle C., Wende S., Becker J. (2015). SmartPLS 3 [software] . Bönningstedt: SmartPLS. [ Google Scholar ]
• Ringle C. M., Sarstedt M., Straub D. (2012). A critical look at the use of PLS-SEM in MIS Quarterly. MIS Q . 36, iii–xiv. 10.2307/41410402 [ CrossRef ] [ Google Scholar ]
• Roberts J. A., David M. E. (2020). The social media party: fear of missing out (FoMO), social media intensity, connection, and well-being . Int. J. Hum. Comput. Interact. 36 , 386–392. 10.1080/10447318.2019.1646517 [ CrossRef ] [ Google Scholar ]
• Salehan M., Negahban A. (2013). Social networking on smartphones: when mobile phones become addictive . Comput. Hum. Behav. 29 , 2632–2639. 10.1016/j.chb.2013.07.003 [ CrossRef ] [ Google Scholar ]
• Sarstedt M., Cheah J.-H. (2019). Partial least squares structural equation modeling using SmartPLS: a software review . J. Mark. Anal. 7 , 196–202. 10.1057/s41270-019-00058-3 [ CrossRef ] [ Google Scholar ]
• Schinka K. C., VanDulmen M. H., Bossarte R., Swahn M. (2012). Association between loneliness and suicidality during middle childhood and adolescence: longitudinal effects and the role of demographic characteristics . J. Psychol. Interdiscipl. Appl. 146 , 105–118. 10.1080/00223980.2011.584084 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Shi S., Mu R., Lin L., Chen Y., Kou G., Chen X.-J. (2018). The impact of perceived online service quality on swift guanxi . Internet Res. 28 , 432–455. 10.1108/IntR-12-2016-0389 [ CrossRef ] [ Google Scholar ]
• Shoukat S. (2019). Cell phone addiction and psychological and physiological health in adolescents . EXCLI J. 18 , 47–50. 10.17179/excli2018-2006 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Shrestha N. (2021). Factor analysis as a tool for survey analysis . Am. J. Appl. Math. Stat. 9 , 4–11. 10.12691/ajams-9-1-2 [ CrossRef ] [ Google Scholar ]
• Stouthuysen K., Teunis I., Reusen E., Slabbinck H. (2018). Initial trust and intentions to buy: The effect of vendor-specific guarantees, customer reviews and the role of online shopping experience . Electr. Commer. Res. Appl. 27 , 23–38. 10.1016/j.elerap.2017.11.002 [ CrossRef ] [ Google Scholar ]
• Swar B., Hameed T. (2017). Fear of missing out, social media engagement, smartphone addiction and distraction: moderating role of self-help mobile apps-based interventions in the youth , Paper presented at the 10th International Conference on Health Informatics (Porto). [ Google Scholar ]
• Tangmunkongvorakul A., Musumari P. M., Thongpibul K., Srithanaviboonchai K., Techasrivichien T., Suguimoto S. P., et al.. (2019). Association of excessive smartphone use with psychological well-being among University students in Chiang Mai, Thailand . PLoS ONE 14 :e0210294. 10.1371/journal.pone.0210294 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Tateno M., Teo A. R., Ukai W., Kanazawa J., Katsuki R., Kubo H., et al.. (2019). Internet addiction, smartphone addiction, and hikikomori trait in Japanese young adult: social isolation and social network . Front. Psychiatry 10 :455. 10.3389/fpsyt.2019.00455 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Tefertiller A. C., Maxwell L. C., Morris D. L. (2020). Social media goes to the movies: fear of missing out, social capital, and social motivations of cinema attendance . Mass Commun. Soc. 23 , 378–399. 10.1080/15205436.2019.1653468 [ CrossRef ] [ Google Scholar ]
• Tehseen S., Qureshi Z. H., Johara F., Ramayah T. (2020). Assessing dimensions of entrepreneurial competencies: a type II (reflective-formative) measurement approach using PLS-SEM . J. Sustain. Sci. Manage. 15 , 108–145. [ Google Scholar ]
• Tehseen S., Ramayah T., Sajilan S. (2017). Testing and controlling for common method variance: a review of available methods . J. Manag. Sci. 4 , 146–165. 10.20547/jms.2014.1704202 [ CrossRef ] [ Google Scholar ]
• Tonacci A., Billeci L., Sansone F., Masci A., Pala A. P., Domenici C., et al.. (2019). An innovative, unobtrusive approach to investigate smartphone interaction in nonaddicted subjects based on wearable sensors: a pilot study . Medicina (Kaunas) 55 :37. 10.3390/medicina55020037 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Twenge J. M., Campbell W. K. (2019). Media use is linked to lower psychological well-being: evidence from three datasets . Psychiatr. Q. 90 , 311–331. 10.1007/s11126-019-09630-7 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Vallespín M., Molinillo S., Muñoz-Leiva F. (2017). Segmentation and explanation of smartphone use for travel planning based on socio-demographic and behavioral variables . Ind. Manag. Data Syst. 117 , 605–619. 10.1108/IMDS-03-2016-0089 [ CrossRef ] [ Google Scholar ]
• Van Den Eijnden R. J., Lemmens J. S., Valkenburg P. M. (2016). The social media disorder scale . Comput. Hum. Behav. 61 , 478–487. 10.1016/j.chb.2016.03.038 [ CrossRef ] [ Google Scholar ]
• Whaite E. O., Shensa A., Sidani J. E., Colditz J. B., Primack B. A. (2018). Social media use, personality characteristics, and social isolation among young adults in the United States . Pers. Indiv. Differ. 124 , 45–50. 10.1016/j.paid.2017.10.030 [ CrossRef ] [ Google Scholar ]
• Williams D. (2006). On and off the'net: scales for social capital in an online era . J. Comput. Mediat. Commun. 11 , 593–628. 10.1016/j.1083-6101.2006.00029.x [ CrossRef ] [ Google Scholar ]