mental health in life essay

16 Personal Essays About Mental Health Worth Reading

Here are some of the most moving and illuminating essays published on BuzzFeed about mental illness, wellness, and the way our minds work.

BuzzFeed Staff

1. My Best Friend Saved Me When I Attempted Suicide, But I Didn’t Save Her — Drusilla Moorhouse

"I was serious about killing myself. My best friend wasn’t — but she’s the one who’s dead."

2. Life Is What Happens While You’re Googling Symptoms Of Cancer — Ramona Emerson

"After a lifetime of hypochondria, I was finally diagnosed with my very own medical condition. And maybe, in a weird way, it’s made me less afraid to die."

3. How I Learned To Be OK With Feeling Sad — Mac McClelland

"It wasn’t easy, or cheap."

4. Who Gets To Be The “Good Schizophrenic”? — Esmé Weijun Wang

"When you’re labeled as crazy, the “right” kind of diagnosis could mean the difference between a productive life and a life sentence."

5. Why Do I Miss Being Bipolar? — Sasha Chapin

"The medication I take to treat my bipolar disorder works perfectly. Sometimes I wish it didn’t."

6. What My Best Friend And I Didn’t Learn About Loss — Zan Romanoff

"When my closest friend’s first baby was stillborn, we navigated through depression and grief together."

7. I Can’t Live Without Fear, But I Can Learn To Be OK With It — Arianna Rebolini

"I’ve become obsessively afraid that the people I love will die. Now I have to teach myself how to be OK with that."

8. What It’s Like Having PPD As A Black Woman — Tyrese Coleman

"It took me two years to even acknowledge I’d been depressed after the birth of my twin sons. I wonder how much it had to do with the way I had been taught to be strong."

9. Notes On An Eating Disorder — Larissa Pham

"I still tell my friends I am in recovery so they will hold me accountable."

10. What Comedy Taught Me About My Mental Illness — Kate Lindstedt

"I didn’t expect it, but stand-up comedy has given me the freedom to talk about depression and anxiety on my own terms."

11. The Night I Spoke Up About My #BlackSuicide — Terrell J. Starr

"My entire life was shaped by violence, so I wanted to end it violently. But I didn’t — thanks to overcoming the stigma surrounding African-Americans and depression, and to building a community on Twitter."

12. Knitting Myself Back Together — Alanna Okun

"The best way I’ve found to fight my anxiety is with a pair of knitting needles."

13. I Started Therapy So I Could Take Better Care Of Myself — Matt Ortile

"I’d known for a while that I needed to see a therapist. It wasn’t until I felt like I could do without help that I finally sought it."

14. I’m Mending My Broken Relationship With Food — Anita Badejo

"After a lifetime struggling with disordered eating, I’m still figuring out how to have a healthy relationship with my body and what I feed it."

15. I Found Love In A Hopeless Mess — Kate Conger

"Dehoarding my partner’s childhood home gave me a way to understand his mother, but I’m still not sure how to live with the habit he’s inherited."

16. When Taking Anxiety Medication Is A Revolutionary Act — Tracy Clayton

"I had to learn how to love myself enough to take care of myself. It wasn’t easy."

Topics in this article

• Mental Health

• Bipolar Disorder
• Therapy Center
• When To See a Therapist
• Types of Therapy
• Best Online Therapy
• Best Couples Therapy
• Best Family Therapy
• Managing Stress
• Sleep and Dreaming
• Understanding Emotions
• Self-Improvement
• Healthy Relationships
• Student Resources
• Personality Types
• Verywell Mind Insights
• 2023 Verywell Mind 25
• Mental Health in the Classroom
• Editorial Process
• Meet Our Review Board
• Crisis Support

The Importance of Mental Health

Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

Akeem Marsh, MD, is a board-certified child, adolescent, and adult psychiatrist who has dedicated his career to working with medically underserved communities.

Westend61 / Getty Images

Risk Factors for Poor Mental Health

Signs of mental health problems, benefits of good mental health, how to maintain mental health and well-being.

Your mental health is an important part of your well-being. This aspect of your welfare determines how you’re able to operate psychologically, emotionally, and socially among others.

Considering how much of a role your mental health plays in each aspect of your life, it's important to guard and improve psychological wellness using appropriate measures.

Because different circumstances can affect your mental health, we’ll be highlighting risk factors and signs that may indicate mental distress. But most importantly, we’ll dive into all of the benefits of having your mental health in its best shape.

Mental health is described as a state of well-being where a person is able to cope with the normal stresses of life. This state permits productive work output and allows for meaningful contributions to society.

However, different circumstances exist that may affect the ability to handle life’s curveballs. These factors may also disrupt daily activities, and the capacity to manage these changes. 

The following factors, listed below, may affect mental well-being and could increase the risk of developing psychological disorders .

Childhood Abuse

When a child is subjected to physical assault, sexual violence, emotional abuse, or neglect while growing up, it can lead to severe mental and emotional distress.

Abuse increases the risk of developing mental disorders like depression, anxiety, post-traumatic stress disorder, or personality disorders.

Children who have been abused may eventually deal with alcohol and substance use issues. But beyond mental health challenges, child abuse may also lead to medical complications such as diabetes, stroke, and other forms of heart disease.

The Environment

A strong contributor to mental well-being is the state of a person’s usual environment . Adverse environmental circumstances can cause negative effects on psychological wellness.

For instance, weather conditions may influence an increase in suicide cases. Likewise, experiencing natural disasters firsthand can increase the chances of developing PTSD. In certain cases, air pollution may produce negative effects on depression symptoms.  

In contrast, living in a positive social environment can provide protection against mental challenges.

Your biological makeup could determine the state of your well-being. A number of mental health disorders have been found to run in families and may be passed down to members.

These include conditions such as autism , attention deficit hyperactivity disorder , bipolar disorder , depression , and schizophrenia .

Your lifestyle can also impact your mental health. Smoking, a poor diet , alcohol consumption , substance use , and risky sexual behavior may cause psychological harm. These behaviors have been linked to depression.

When mental health is compromised, it isn’t always apparent to the individual or those around them. However, there are certain warning signs to look out for, that may signify negative changes for the well-being. These include:

• A switch in eating habits, whether over or undereating
• A noticeable reduction in energy levels
• Being more reclusive and shying away from others
• Feeling persistent despair
• Indulging in alcohol, tobacco, or other substances more than usual
• Experiencing unexplained confusion, anger, guilt, or worry
• Severe mood swings
• Picking fights with family and friends
• Hearing voices with no identifiable source
• Thinking of self-harm or causing harm to others
• Being unable to perform daily tasks with ease

Whether young or old, the importance of mental health for total well-being cannot be overstated. When psychological wellness is affected, it can cause negative behaviors that may not only affect personal health but can also compromise relationships with others. 

Below are some of the benefits of good mental health.

A Stronger Ability to Cope With Life’s Stressors

When mental and emotional states are at peak levels, the challenges of life can be easier to overcome.

Where alcohol/drugs, isolation, tantrums, or fighting may have been adopted to manage relationship disputes, financial woes, work challenges, and other life issues—a stable mental state can encourage healthier coping mechanisms.

A Positive Self-Image

Mental health greatly correlates with personal feelings about oneself. Overall mental wellness plays a part in your self-esteem . Confidence can often be a good indicator of a healthy mental state.

A person whose mental health is flourishing is more likely to focus on the good in themselves. They will hone in on these qualities, and will generally have ambitions that strive for a healthy, happy life.

Healthier Relationships

If your mental health is in good standing, you might be more capable of providing your friends and family with quality time , affection , and support. When you're not in emotional distress, it can be easier to show up and support the people you care about.

Better Productivity

Dealing with depression or other mental health disorders can impact your productivity levels. If you feel mentally strong , it's more likely that you will be able to work more efficiently and provide higher quality work.

Higher Quality of Life

When mental well-being thrives, your quality of life may improve. This can give room for greater participation in community building. For example, you may begin volunteering in soup kitchens, at food drives, shelters, etc.

You might also pick up new hobbies , and make new acquaintances , and travel to new cities.

Because mental health is so important to general wellness, it’s important that you take care of your mental health.

To keep mental health in shape, a few introductions to and changes to lifestyle practices may be required. These include:

• Taking up regular exercise
• Prioritizing rest and sleep on a daily basis
• Trying meditation
• Learning coping skills for life challenges
• Keeping in touch with loved ones
• Maintaining a positive outlook on life

Another proven way to improve and maintain mental well-being is through the guidance of a professional. Talk therapy can teach you healthier ways to interact with others and coping mechanisms to try during difficult times.

Therapy can also help you address some of your own negative behaviors and provide you with the tools to make some changes in your own life.

A Word From Verywell

Your mental health state can have a profound impact on all areas of your life. If you're finding it difficult to address mental health concerns on your own, don't hesitate to seek help from a licensed therapist .

World Health Organization. Mental Health: Strengthening our Response .

Lippard ETC, Nemeroff CB. The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders . Am J Psychiatry . 2020;177(1):20-36. doi:10.1176/appi.ajp.2019.19010020

 Helbich M. Mental Health and Environmental Exposures: An Editorial. Int J Environ Res Public Health . 2018;15(10):2207. Published 2018 Oct 10. doi:10.3390/ijerph15102207

Helbich M. Mental Health and Environmental Exposures: An Editorial. Int J Environ Res Public Health . 2018;15(10):2207. Published 2018 Oct 10. doi:10.3390/ijerph15102207

National Institutes of Health. Common Genetic Factors Found in 5 Mental Disorders .

Zaman R, Hankir A, Jemni M. Lifestyle Factors and Mental Health . Psychiatr Danub . 2019;31(Suppl 3):217-220.

Medline Plus. What Is mental health? .

National Alliance on Mental Health. Why Self-Esteem Is Important for Mental Health .

By Elizabeth Plumptre Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

Talk to our experts

1800-120-456-456

• Mental Health Essay

Essay on Mental Health

According to WHO, there is no single 'official' definition of mental health. Mental health refers to a person's psychological, emotional, and social well-being; it influences what they feel and how they think, and behave. The state of cognitive and behavioural well-being is referred to as mental health. The term 'mental health' is also used to refer to the absence of mental disease. 

Mental health means keeping our minds healthy. Mankind generally is more focused on keeping their physical body healthy. People tend to ignore the state of their minds. Human superiority over other animals lies in his superior mind. Man has been able to control life due to his highly developed brain. So, it becomes very important for a man to keep both his body and mind fit and healthy. Both physical and mental health are equally important for better performance and results.

Importance of Mental Health 

An emotionally fit and stable person always feels vibrant and truly alive and can easily manage emotionally difficult situations. To be emotionally strong, one has to be physically fit too. Although mental health is a personal issue, what affects one person may or may not affect another; yet, several key elements lead to mental health issues.

Many emotional factors have a significant effect on our fitness level like depression, aggression, negative thinking, frustration, and fear, etc. A physically fit person is always in a good mood and can easily cope up with situations of distress and depression resulting in regular training contributing to a good physical fitness standard. 

Mental fitness implies a state of psychological well-being. It denotes having a positive sense of how we feel, think, and act, which improves one’s ability to enjoy life. It contributes to one’s inner ability to be self-determined. It is a proactive, positive term and forsakes negative thoughts that may come to mind. The term mental fitness is increasingly being used by psychologists, mental health practitioners, schools, organisations, and the general population to denote logical thinking, clear comprehension, and reasoning ability.

 Negative Impact of Mental Health

The way we physically fall sick, we can also fall sick mentally. Mental illness is the instability of one’s health, which includes changes in emotion, thinking, and behaviour. Mental illness can be caused due to stress or reaction to a certain incident. It could also arise due to genetic factors, biochemical imbalances, child abuse or trauma, social disadvantage, poor physical health condition, etc. Mental illness is curable. One can seek help from the experts in this particular area or can overcome this illness by positive thinking and changing their lifestyle.

Regular fitness exercises like morning walks, yoga, and meditation have proved to be great medicine for curing mental health. Besides this, it is imperative to have a good diet and enough sleep. A person needs 7 to 9 hours of sleep every night on average. When someone is tired yet still can't sleep, it's a symptom that their mental health is unstable. Overworking oneself can sometimes result in not just physical tiredness but also significant mental exhaustion. As a result, people get insomnia (the inability to fall asleep). Anxiety is another indicator. 

There are many symptoms of mental health issues that differ from person to person and among the different kinds of issues as well. For instance, panic attacks and racing thoughts are common side effects. As a result of this mental strain, a person may experience chest aches and breathing difficulties. Another sign of poor mental health is a lack of focus. It occurs when you have too much going on in your life at once, and you begin to make thoughtless mistakes, resulting in a loss of capacity to focus effectively. Another element is being on edge all of the time.

It's noticeable when you're quickly irritated by minor events or statements, become offended, and argue with your family, friends, or co-workers. It occurs as a result of a build-up of internal irritation. A sense of alienation from your loved ones might have a negative influence on your mental health. It makes you feel lonely and might even put you in a state of despair. You can prevent mental illness by taking care of yourself like calming your mind by listening to soft music, being more social, setting realistic goals for yourself, and taking care of your body. 

Surround yourself with individuals who understand your circumstances and respect you as the unique individual that you are. This practice will assist you in dealing with the sickness successfully.  Improve your mental health knowledge to receive the help you need to deal with the problem. To gain emotional support, connect with other people, family, and friends.  Always remember to be grateful in life.  Pursue a hobby or any other creative activity that you enjoy.

What does Experts say

Many health experts have stated that mental, social, and emotional health is an important part of overall fitness. Physical fitness is a combination of physical, emotional, and mental fitness. Emotional fitness has been recognized as the state in which the mind is capable of staying away from negative thoughts and can focus on creative and constructive tasks. 

He should not overreact to situations. He should not get upset or disturbed by setbacks, which are parts of life. Those who do so are not emotionally fit though they may be physically strong and healthy. There are no gyms to set this right but yoga, meditation, and reading books, which tell us how to be emotionally strong, help to acquire emotional fitness. 

Stress and depression can lead to a variety of serious health problems, including suicide in extreme situations. Being mentally healthy extends your life by allowing you to experience more joy and happiness. Mental health also improves our ability to think clearly and boosts our self-esteem. We may also connect spiritually with ourselves and serve as role models for others. We'd also be able to serve people without being a mental drain on them. 

Mental sickness is becoming a growing issue in the 21st century. Not everyone receives the help that they need. Even though mental illness is common these days and can affect anyone, there is still a stigma attached to it. People are still reluctant to accept the illness of mind because of this stigma. They feel shame to acknowledge it and seek help from the doctors. It's important to remember that "mental health" and "mental sickness" are not interchangeable.

Mental health and mental illness are inextricably linked. Individuals with good mental health can develop mental illness, while those with no mental disease can have poor mental health. Mental illness does not imply that someone is insane, and it is not anything to be embarrassed by. Our society's perception of mental disease or disorder must shift. Mental health cannot be separated from physical health. They both are equally important for a person. 

Our society needs to change its perception of mental illness or disorder. People have to remove the stigma attached to this illness and educate themselves about it. Only about 20% of adolescents and children with diagnosable mental health issues receive the therapy they need. 

According to research conducted on adults, mental illness affects 19% of the adult population. Nearly one in every five children and adolescents on the globe has a mental illness. Depression, which affects 246 million people worldwide, is one of the leading causes of disability. If  mental illness is not treated at the correct time then the consequences can be grave.

One of the essential roles of school and education is to protect boys’ and girls' mental health as teenagers are at a high risk of mental health issues. It can also impair the proper growth and development of various emotional and social skills in teenagers. Many factors can cause such problems in children. Feelings of inferiority and insecurity are the two key factors that have the greatest impact. As a result, they lose their independence and confidence, which can be avoided by encouraging the children to believe in themselves at all times. 

To make people more aware of mental health, 10th October is observed as World Mental Health. The object of this day is to spread awareness about mental health issues around the world and make all efforts in the support of mental health.

The mind is one of the most powerful organs in the body, regulating the functioning of all other organs. When our minds are unstable, they affect the whole functioning of our bodies. Being both physically and emotionally fit is the key to success in all aspects of life. People should be aware of the consequences of mental illness and must give utmost importance to keeping the mind healthy like the way the physical body is kept healthy. Mental and physical health cannot be separated from each other. And only when both are balanced can we call a person perfectly healthy and well. So, it is crucial for everyone to work towards achieving a balance between mental and physical wellbeing and get the necessary help when either of them falters.

Mental Health Essay for Students and Children

500+ words essay on mental health.

Every year world mental health day is observed on October 10. It was started as an annual activity by the world federation for mental health by deputy secretary-general of UNO at that time. Mental health resources differ significantly from one country to another. While the developed countries in the western world provide mental health programs for all age groups. Also, there are third world countries they struggle to find the basic needs of the families. Thus, it becomes prudent that we are asked to focus on mental health importance for one day. The mental health essay is an insight into the importance of mental health in everyone’s life. 

Mental Health

In the formidable years, this had no specific theme planned. The main aim was to promote and advocate the public on important issues. Also, in the first three years, one of the central activities done to help the day become special was the 2-hour telecast by the US information agency satellite system. 

Mental health is not just a concept that refers to an individual’s psychological and emotional well being. Rather it’s a state of psychological and emotional well being where an individual is able to use their cognitive and emotional capabilities, meet the ordinary demand and functions in the society. According to WHO, there is no single ‘official’ definition of mental health.

Thus, there are many factors like cultural differences, competing professional theories, and subjective assessments that affect how mental health is defined. Also, there are many experts that agree that mental illness and mental health are not antonyms. So, in other words, when the recognized mental disorder is absent, it is not necessarily a sign of mental health. 

Get the huge list of more than 500 Essay Topics and Ideas

One way to think about mental health is to look at how effectively and successfully does a person acts. So, there are factors such as feeling competent, capable, able to handle the normal stress levels, maintaining satisfying relationships and also leading an independent life. Also, this includes recovering from difficult situations and being able to bounce back.  

Important Benefits of Good Mental Health

Mental health is related to the personality as a whole of that person. Thus, the most important function of school and education is to safeguard the mental health of boys and girls. Physical fitness is not the only measure of good health alone. Rather it’s just a means of promoting mental as well as moral health of the child. The two main factors that affect the most are feeling of inferiority and insecurity. Thus, it affects the child the most. So, they lose self-initiative and confidence. This should be avoided and children should be constantly encouraged to believe in themselves.

Customize your course in 30 seconds

Which class are you in.

• Travelling Essay
• Picnic Essay
• Our Country Essay
• My Parents Essay
• Essay on Favourite Personality
• Essay on Memorable Day of My Life
• Essay on Knowledge is Power
• Essay on Gurpurab
• Essay on My Favourite Season
• Essay on Types of Sports

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Download the App

How to Start an Essay About Mental Health

Mental health is a topic that is gaining increasing attention in contemporary society. As societal awareness of mental health issues grows, so does the need for thoughtful and well-researched essays on this subject.

If you are looking to start an essay about mental health, it is important to approach the topic with sensitivity, knowledge, and a clear understanding of its significance. In this article, we will explore the key steps to successfully begin your essay on mental health.

Understanding the Importance of Mental Health

Mental health is an integral part of our overall well-being. It encompasses our emotional, psychological, and social well-being, affecting how we think, feel, and act. Despite its importance, mental health has historically been stigmatized and overlooked.

However, with growing awareness, the significance of mental health in our daily lives is increasingly recognized.

When we talk about mental health, we are referring to more than just the absence of mental illness. It is a state of well-being in which an individual can cope with the normal stresses of life, work productively, and contribute to their community.

Mental health encompasses various aspects such as emotional stability, psychological resilience, and the ability to form and maintain meaningful relationships.

Understanding the complexities of mental health is crucial for promoting overall well-being. It is not a one-size-fits-all concept, as each person may experience mental health differently. Factors such as genetics, upbringing, life experiences, and social support systems all play a role in shaping an individual’s mental health.

Defining Mental Health

Before delving into the complexities of mental health, it is crucial to have a clear understanding of what it entails. Mental health refers to a state of well-being in which an individual can cope with the normal stresses of life, work productively, and contribute to their community.

It encompasses various aspects such as emotional stability, psychological resilience, and the ability to form and maintain meaningful relationships.

Emotional stability is an essential component of mental health. It involves being able to recognize and manage our emotions effectively. This includes understanding our feelings, expressing them appropriately, and regulating our emotional responses to different situations.

Emotional stability allows us to navigate through life’s ups and downs with resilience and adaptability.

Psychological resilience is another crucial aspect of mental health. It refers to our ability to bounce back from adversity and cope with challenges effectively.

Resilience is not about avoiding difficulties but rather about developing the skills and mindset to navigate through them. It involves having a positive outlook, seeking support when needed, and finding healthy ways to cope with stress.

The ability to form and maintain meaningful relationships is also closely tied to mental health. Healthy relationships provide us with support, love, and a sense of belonging. They contribute to our overall well-being and help us navigate through life’s challenges. Building and nurturing relationships requires effective communication, empathy, and the ability to establish boundaries.

The Impact of Mental Health on Daily Life

It is important to highlight the profound impact mental health has on our daily lives. Untreated mental health conditions can hinder our ability to manage stress, maintain relationships, and perform well in our personal and professional endeavors.

Understanding how mental health affects individuals and society as a whole is crucial for raising awareness and fostering support for those experiencing mental health challenges.

When our mental health is compromised, it can affect our ability to cope with everyday stressors. Simple tasks may become overwhelming, and we may struggle to find joy and fulfillment in our daily lives. Mental health conditions can manifest in various ways, including anxiety, depression, mood swings, and difficulty concentrating.

Furthermore, mental health plays a significant role in our relationships. When we are struggling with our mental well-being, it can impact our ability to connect with others, communicate effectively, and maintain healthy boundaries. This can lead to strained relationships, feelings of isolation, and a decreased sense of belonging.

In the workplace, mental health is a crucial factor in our productivity and overall job satisfaction. When we are mentally healthy, we are better able to focus, make decisions, and handle stress effectively.

On the other hand, untreated mental health conditions can lead to decreased productivity, absenteeism, and difficulties in maintaining professional relationships.

Recognizing the impact of mental health on daily life is essential for promoting a supportive and inclusive society.

Preparing to Write Your Essay

Before you begin writing, it is essential to adequately prepare yourself. This involves choosing an appropriate topic and conducting preliminary research to establish a solid foundation for your essay.

Writing an essay on mental health can be a rewarding experience that allows you to delve into a topic that is both important and relevant in today’s society.

When selecting a topic, consider exploring areas such as the impact of mental health on different demographics, the role of stigma in mental health treatment, or the effectiveness of various therapeutic approaches.

Choosing Your Topic

When selecting a topic for your essay on mental health, consider areas that interest you or resonate with your personal experiences. This will ensure your essay reflects your passion and authenticity, making it a compelling read. It is also wise to choose a topic that is relevant and addresses current issues or trends in the field of mental health.

One possible topic could be exploring the impact of social media on mental health. In today’s digital age, social media has become an integral part of our lives, but it also has its drawbacks. By examining the potential negative effects of excessive social media use on mental well-being, you can shed light on an important issue that affects many individuals.

Another topic worth considering is the intersection of mental health and cultural diversity. By exploring how different cultural backgrounds and beliefs influence the perception and treatment of mental health, you can contribute to a more inclusive and comprehensive understanding of this complex field.

Conducting Preliminary Research

Once you have chosen your topic, conduct preliminary research to familiarize yourself with the existing literature and perspectives in the field of mental health.

This will enable you to develop a well-informed and comprehensive essay. Utilize reputable sources such as scholarly articles, books, and reputable websites to gather accurate information and insights on your chosen topic.

Start by exploring academic databases that specialize in psychology and mental health research. These databases provide access to a wide range of scholarly articles and studies conducted by experts in the field. By reviewing the latest research findings, you can stay up-to-date with the current advancements and debates in mental health.

In addition to academic sources, consider consulting books written by renowned psychologists or mental health professionals. These books often provide a deeper understanding of specific topics and offer valuable insights based on years of research and clinical experience.

Furthermore, reputable websites such as government health agencies or mental health organizations can provide reliable information and resources. These organizations often publish reports, guidelines, and statistics that can support your arguments and provide a broader context for your essay.

Remember to critically evaluate the sources you come across during your research. Look for peer-reviewed articles, check the credentials of the authors, and consider the methodology used in the studies. By ensuring the credibility of your sources, you can strengthen the validity and reliability of your essay.

Crafting Your Thesis Statement

A strong thesis statement is the backbone of every effective essay. It serves as a concise and well-articulated summary of the main argument or point you will be addressing throughout the essay.

When crafting your thesis statement, ensure that it is specific, arguable, and supported by evidence. A well-crafted thesis statement sets the tone for your essay and provides a roadmap for the reader.

Importance of a Strong Thesis

A strong thesis statement is essential as it condenses the main focus of your essay into a single sentence. It allows your readers to understand the purpose and direction of your essay from the outset.

A well-defined thesis also helps you maintain coherence and clarity throughout your writing, ensuring you stay on track and deliver a well-structured essay.

Tips for Writing a Compelling Thesis

When formulating your thesis statement, consider the following tips:

• Be specific and concise
• Avoid vague language
• Ensure your thesis is arguable
• Use strong language and avoid hedging
• Assert the main argument or point of your essay
• Support your thesis statement with evidence and examples

Outlining Your Essay

An essay outline serves as a roadmap for your writing and helps you organize your thoughts coherently. It provides structure and clarity, making the writing process smoother and increasing the overall coherence of your essay.

The Benefits of an Essay Outline

By creating an outline, you can:

• Organize your ideas logically
• Ensure a smooth flow of information
• Maintain coherence throughout your essay
• Identify any gaps or missing information
• Stay focused on your main argument or point

How to Create an Effective Outline

When creating an essay outline, break your essay into logical sections or paragraphs. Each section should focus on a particular aspect of mental health, supporting your thesis statement. Arrange your main points and supporting evidence in a logical and coherent manner, ensuring smooth transitions between paragraphs. A well-structured outline will serve as a guide throughout your writing process.

Writing the Introduction

The introduction is a crucial part of any essay as it sets the tone and captivates the reader’s attention. A compelling introduction encourages readers to engage with your essay and establishes the significance of mental health as a topic of discussion.

Grabbing the Reader’s Attention

Hook your readers from the beginning by using an attention-grabbing opening sentence or anecdote. This could be a startling statistic, a thought-provoking quote, or a short personal story. By immediately piquing your readers’ interest, you create a compelling reason for them to continue reading and delve further into your essay.

Introducing Your Thesis

After capturing the readers’ attention, smoothly transition into introducing your thesis statement. Clearly state your main argument or point and briefly outline the main components you will be discussing in your essay.

This will give the readers a sense of what to expect and ensure they understand the focus of your essay from the outset.In conclusion, starting an essay about mental health requires careful consideration and preparation.

In conclusion, starting an essay about mental health requires careful consideration and preparation. By understanding the importance of mental health, conducting preliminary research, crafting a strong thesis statement, outlining your essay, and writing a captivating introduction, you will set a solid foundation for a thoughtful and impactful essay on mental health.

👋 Hi! I’m your smart assistant Amy!

Don’t know where to start? Type your requirements and I’ll connect you to an academic expert within 3 minutes.

• Open access
• Published: 22 November 2012

Quality of life of people with mental health problems: a synthesis of qualitative research

• Janice Connell 1 ,
• John Brazier 2 ,
• Alicia O’Cathain 1 ,
• Myfanwy Lloyd-Jones 2 &
• Suzy Paisley 3  

Health and Quality of Life Outcomes volume  10 , Article number:  138 ( 2012 ) Cite this article

93k Accesses

159 Citations

37 Altmetric

Metrics details

To identify the domains of quality of life important to people with mental health problems.

A systematic review of qualitative research undertaken with people with mental health problems using a framework synthesis.

We identified six domains: well-being and ill-being; control, autonomy and choice; self-perception; belonging; activity; and hope and hopelessness. Firstly, symptoms or ‘ill-being’ were an intrinsic aspect of quality of life for people with severe mental health problems. Additionally, a good quality of life was characterised by the feeling of being in control (particularly of distressing symptoms), autonomy and choice; a positive self-image; a sense of belonging; engagement in meaningful and enjoyable activities; and feelings of hope and optimism. Conversely, a poor quality life, often experienced by those with severe mental health difficulties, was characterized by feelings of distress; lack of control, choice and autonomy; low self-esteem and confidence; a sense of not being part of society; diminished activity; and a sense of hopelessness and demoralization.

Conclusions

Generic measures fail to address the complexity of quality of life measurement and the broad range of domains important to people with mental health problems.

Introduction

There has been a shift in mental health services from an emphasis on treatment focused on reducing symptoms, based on a narrow notion of health and disease, to a more holistic approach which takes into consideration both well-being and functioning [ 1 ]. Mental health services in the United Kingdom, for example, are now being planned and commissioned based on psychological formulations addressing a person’s wider well-being, need, and functional outcome alongside, or sometimes in place of, diagnostic categories and clinical ideas of cure and outcome [ 2 ]. At the same time, there has been an increasing use of generic measures of health related quality of life like EQ-5D and SF-36 in assessing the benefits of health care interventions in order to inform decisions about provision and reimbursement (eg National Institute for Health and Clinical Excellence) [ 3 ] and for assessing patient reported outcomes [ 4 ]. It is claimed these generic measures are appropriate for both physical and mental health conditions; however some argue they are not suitable for people with severe mental health problems, particularly psychosis [ 5 , 6 ].

One of the challenges of using the concept ‘quality of life’ as a basis for outcome measurement is that it can be defined, and therefore measured, in innumerable ways. The assumptions underlying such measurement can be influenced by both academic discipline and ideological perspective [ 7 ]. As a result there are many different overlapping models of quality of life including objective and subjective indicators, needs satisfaction, psychological and subjective well-being models, health, functioning and social models [ 8 ]. One on-going tension is whether a measure should have a subjective or objective orientation. A subjective orientation may emphasise the importance of ‘being’, which in turn can be viewed either in hedonistic terms as the experience of current happiness or pleasure, or as a more eudemonic approach which considers the more pervading attributes of self-fulfilment, realisation or actualization [ 9 , 10 ]. A subjective evaluative approach may also be taken which asks people to rate how satisfied they are with their lives and aspects of it [ 11 ]. On the other hand, a more objective approach used in social policy places its emphasis on meeting needs, whether they are healthy, have sufficient income for food and satisfactory living conditions, are well educated and have access to resources [ 9 , 12 ]. A review of eleven instruments for measuring quality of life for people with severe mental illness identified that the most commonly assessed domains are employment or work, health, leisure, living situation, and relationships [ 13 ]. These measures combine an objective with a subjective approach that establishes levels of satisfaction with these different objective life domains. However, concerns have been raised regarding the limited coverage of domains assessed in such instruments [ 14 , 15 ]. Furthermore, it is criticised that measures have primarily been generated from the perspective of mental health professionals or other experts using a top-down approach rather than by an assessment of what individuals with mental health problems perceive to be important to their quality of life [ 15 ]. These are also important potential criticisms of the generic measures of health related quality of life like the EQ-5D and SF-36 [ 5 ].

The aim of this literature review was to examine the quality of life domains that are important from the perspective of an individual with mental health problems. This research was part of a larger project considering the applicability and suitability of generic health related quality of life measures for people with mental health problems (MRC project number G0801394).

We sought to identify all primary qualitative research studies (involving methods such as interviews and focus groups) which explicitly asked adults with mental health problems what they considered to be important to their quality of life or how their quality of life had been affected by their mental health problems.

A range of approaches is available for synthesizing qualitative research [ 16 ]. Paterson et al. [ 17 ] recommend that the choice is made on the basis of the nature of the research question and design, the prevailing paradigm, and the researcher’s personal preference. In this review, framework synthesis was used. This is based on the ‘framework’ approach for the analysis of primary data [ 18 ] and is a highly structured approach to organizing and analyzing data which permits the expansion and refinement of an a priori framework to incorporate new themes emerging from the data [ 16 ]. It is appropriate here because the aim of our wider study was to identify whether existing outcomes measures are useful for measuring quality of life for people with mental health problems.

Search methods

Systematic reviews of clinical effectiveness evidence require extensive searching based on a clearly focussed search question. Defining a focussed question was neither possible nor appropriate here because a pre-specified search question would have imposed on the search process an a priori conceptual understanding of the topic under review. Given the abstract nature of the relevant concepts and associated search vocabulary, and given the exploratory and inductive nature of the review process, we needed to use an iterative approach to searching. This incorporated a number of different search techniques including keyword searching, taking advice from experts, hand searching and citation searching of relevant references and world-wide-web searching. The iterative approach provided a means of accommodating within the search process new themes emerging from the review as the scope of our conceptual understanding developed. The identification of relevant search terms was an evolving process. Four search iterations were undertaken. The choice of search terms used in earlier iterations was based on our initial understanding of the review topic and on papers identified by experts at the outset of the review. The choice of search terms used in later iterations was informed by the review of evidence identified by earlier search iterations. Key terms included mental health; mental illness; mental disorder; quality of life; well-being; well being; life satisfaction; life functioning; life change; recovery; subjective experience; lived experience; lifestyle; coping; adaptation; qualitative; qualitative research. For a full list of search terms and details of the evolving search iterations see Additional file 1 : Appendix 1 and Additional file 2: Appendix 2. Database searches were undertaken between October 2009 and April 2010 and included Medline, ASSIA, CINAHL, PsycINFO, and Web of Science. The searches were not restricted by date, language or country.

Inclusion and exclusion criteria

• Quality of life

The search started from a premise of not imposing a pre-conceived definition or model of ‘quality of life’. Whilst some studies retrieved had an explicit aim to explore quality of life we found other studies with very similar findings to those which explicitly examined the concept of quality of life even though quality of life was not the subject of investigation. These studies examined the concepts of: recovery, lived experience, subjective experience, psychosocial issues, health needs, and strategies for living. Complexities thus arose in deciding whether the studies were about the same substantive concept of quality of life or were tapping into a separate but overlapping concept. As Sandelowski [ 19 ] states ‘often research purposes and questions are so broadly stated it is only by looking at the kinds of findings produced that topical similarity can be determined’. We were aware of the danger that the inclusion of these studies could introduce themes that were not central to the concept of quality of life but were rather allied to a separate but related concept. A pragmatic decision was made to examine the research aims and interview questions of those studies which did not directly investigate the concept of quality of life and only include those which asked broad open-ended questions about how participants’ mental health affected their lives, what was important to or would improve their lives, or equated their findings with quality of life in some way. We excluded studies that deliberately started with a premise of the importance of any particular domain of quality of life or were structured solely around a pre-conceived list of domains.

Qualitative research

We included primary qualitative research studies that used qualitative interviews or focus groups data to identify the views of individuals with mental health problems. We excluded studies that used content analysis which presented results as a frequency list with no supporting participant quotes. Some studies sought the views of people with mental health problems and of carers or professionals; in such cases, we only included those studies in which the views of people with mental health problems could be separately identified.

• Mental health

We included research on all mood disorders (eg depression, bi-polar, mania), neurosis and stress related disorders (eg anxiety, phobias, post traumatic stress disorder) personality disorders and schizophrenia, schizotypal and delusional disorders. Included studies had to state that participants had mental health problems as identified either through diagnosis, or through attendance at an establishment for people with mental health problems. Studies where mental health problems were secondary to a physical health problem were excluded.

The use of quality assessment in reviews of qualitative research is contested. Quality assessment is usually used in framework synthesis but this may be associated with its use alongside systematic reviews of effectiveness [ 16 ]. In this review, articles were not quality assessed and systematically excluded on the basis of quality. However, it was of paramount importance that any included study elicited the perspective of individuals with mental health problems and where this appeared not to be the case they were excluded. Consequently, studies were excluded when it was strongly suspected that the views of the researcher, or the method of analysis, had overly influenced the findings. These articles were examined and discussed at length by the research team before being excluded.

Although the searches were not restricted to English language articles, non-English language articles were excluded because of the potential for mis-interpretation. Five potentially relevant articles were excluded on the grounds of language (Figure  1 ).

PRISMA flow diagram of searched articles.

Data extraction and analysis

The following details of the studies were extracted: mental health problem studied; author affiliation; time and location of study; number and demographic details of participants; research aims and questions; recruitment and sampling methods; and method of data collection and analysis. Themes within the findings and discussion sections were extracted for the thematic analysis.

Framework analysis [ 18 ] was used to allow the identification of common and variable patterns of themes within and across different studies. The first stage of framework analysis- familiarisation - was undertaken by reading all included papers. The second stage involved examining the findings from these papers to identify initial themes for a thematic framework. These ten initial descriptive themes were either identified as main themes from more than one study, or arose consistently across studies. These were: activity; relationships; the self; the future/aspirations; symptoms/well-being/emotions; spirituality; control/coping; insight/education; health care services/interventions; and resources/basic needs. The third stage, data organisation, involved charting data from the findings and discussion sections that corresponded to each theme. Text was transferred verbatim to ensure contextual accuracy. It was common for text to be identified as supporting more than one theme, for example a quote describing how work was good for their self-esteem would be placed in the thematic categories ‘activity’ and ‘self’. At the next stage each initial theme was examined and further sub-themes identified and documented within the framework chart. To assist with the final stage of framework - mapping - the sub-themes were listed and examined for their conceptual similarities and differences. To aid this process, we searched the wider literature to find papers which would help us to understand the data, to make connections between sub-themes, and to assist in the development of our final themes. For example, ‘belonging’ was an emerging theme, and we identified Hagerty et al’s [ 20 ] research which explored and defined this concept. We then returned to our framework chart to re-examine our data in light of the wider literature. Other influential literature was on the theory of ‘doing, being, becoming’ [ 21 ], ill-being vs well-being and intrinsic and extrinsic quality of life [ 22 , 23 ] and demoralization [ 24 ]. We have reported this literature when describing the theme in the findings because it was influential in shaping our understanding of the theme. The themes and domains from the included papers were presented and organised in contrasting styles by the authors of those papers. Depending upon the theoretical background of the researcher, and the method of analysis used, this resulted in themes which were either objective and descriptive (e.g. relationships, occupation) or abstract or metaphoric in their presentation (e.g. ‘Upset and calm changes patterns of being with and apart from others’). For the latter, whether a theme was major or minor was the subjective view of the authors. We have reported a theme as being a major theme within the studies if it was: a) a titled theme within the study findings b) was reported as being represented throughout the data or c) formed a substantive part of those studies that used abstract or metaphoric themes or of those that were not organised thematically. For transparency the original themes or section titles from the original papers have been presented after the quotes provided to illustrate our findings.

Validation and trustworthiness

Validation procedures were incorporated into the review at all stages. Two researchers (JC and MLJ) independently identified articles from the first search iteration, and compared results to clarify the inclusion and exclusion criteria. Potential full articles were identified from further searches by the primary researcher and independently checked by the second researcher. The included articles were examined independently by both researchers to identify the main themes for the initial framework. Disagreements at all stages were resolved by discussion. Additionally, a multidisciplinary team of researchers met regularly in addition to meetings with clinicians and a user representative to discuss and challenge the inclusion and exclusion criteria, thematic framework, and conceptual interpretations and conclusions.

Description of included studies

Thirteen studies were identified from 16 articles [ 25 – 40 ]; two had fuller reports available, one an internal report [ 25 , 26 ] and the other a dissertation [ 27 , 28 ], the fuller reports [ 26 , 28 ] have been referenced in the findings. Further, one study indicated that not all emerging themes were presented in the paper and had a supplementary paper dedicated to the impact of bi-polar disorder on work functioning, which was included in our analysis [ 37 , 38 ]. The studies were published between 1994 and 2010 in a number of countries: Canada (5), UK (3), Sweden (2), USA (1), Australia (1) and New Zealand (1). The professional affiliations of the first author were occupational therapy (5), nursing (4), psychology (2), psychiatry (1) and social work (1). The mental health disorder most frequently represented was schizophrenia (or other psychotic disorder): this was the only population researched in three studies and the majority population in a further two. Three studies included individuals with bi-polar disorder only and one panic disorder only. Other studies had a mixed population including the above disorders plus persons with personality disorder, severe depression, and anxiety disorders. Two studies did not specify the disorder; they included persons described as having ‘enduring mental health problems’ and ‘psychiatric disability’.

Two studies had a primarily positive orientation in that they asked ‘what is required for a good quality of life’, and four studies a negative orientation through asking ‘how has your mental health affected your quality of life’. The remainder considered both ‘what had helped and hindered quality of life’. Most studies presented their findings descriptively, and four had a conceptual/abstract orientation. Further details of the studies [ 25 – 40 ] can be found in Table  1 .

We identified six major themes: well-being and ill-being; control, autonomy and choice; self-perception; belonging; activity; and hope and hopelessness. The themes identified within each of the studies can be found in Table  2 .

Well-being and Ill-being

Well-being has long been regarded as an important dimension of health related quality of life scales [ 14 ]. The emotional component of subjective well-being consists of high levels of positive affect (experiencing pleasant emotions and moods), and lack of low levels of negative affect (experiencing few unpleasant emotions and moods) [ 23 ]. Within our papers, symptoms of mental illness and aspects of emotional well-being were intertwined, with an emphasis on the negative rather than the positive. This suggested that ill-being, which is more akin to distress and the symptoms of mental illness, is an important aspect of quality of life for those with severe mental health problems.

The most evident ‘ill-being’ themes were general feelings of distress from symptoms; the experience of psychosis/mania; depressed mood; problems with energy and motivation and fear and anxiety.

Distress from symptoms

Distress, or the subjective experience of the symptoms of mental illness, was evident in the majority of studies [ 26 , 28 , 30 – 32 , 35 , 36 , 40 ] and a major theme in four [ 28 , 30 , 35 , 40 ]. The subjective experience of mental illness was described as wretched [ 36 ] a burden, debilitating, painful [ 40 ], tormenting [ 35 ], and as having a tyrannical power over life [ 28 ]. Pre-occupation with the symptoms of mental health problems interfered greatly with the most basic tasks of everyday living [ 26 , 28 , 31 , 40 ], making it difficult to deal with anything but the present moment [ 40 ]. Instead life was consumed with coping on a daily basis and living ‘one day at a time’ - sometimes on a moment to moment basis [ 28 , 31 , 34 ].

Symptoms of mental illness were described primarily in negative and restrictive ways . Subjects reported continually trying to deal with the symptoms , describing symptoms as “ a great burden .” The symptoms seemed to be so encompassing that these men had difficulty seeing beyond the pain of today . “ This illness is a great burden . Day - to - day survival is a big question , and I just feel in a turmoil a lot of the time ”; “ I ’ ve had terrible suffering for over 20 years.” [ 40 - A pervasive feeling of distress ]

Experience of psychosis/mania

Distressing symptoms reported included hallucinations and delusions (particularly hearing voices, thought disturbances and paranoia) [ 26 , 28 , 30 ], reality disorientation [ 28 ], mania, and hypomania [ 38 ], feelings of discomfort, weirdness or oddness [ 28 ], and irritability or agitation [ 30 ]. These symptoms could interfere directly with day to day living by having an effect on behaviour control [ 26 , 30 , 35 , 38 ], concentration, memory or decision making [ 26 , 30 , 31 ] and sense of self-identity [ 28 , 31 , 37 ].

“ When I hear voices erm , that stops me from doing a day to day existence , I ’ m preoccupied with the voices ”; “ … the voices , how they ’ ve affected my life , erm , er just day to day living basically … Erm just er , getting out , getting out and doing things er … go to the shops , erm , erm , cooking , anything , anything like that ”; “ I daren ’ t go out now , thoughts in my head , make me think bad things ; I get paranoid when there ’ s crowds of people. ” [ 26 - Fear of exacerbating mental health difficulties ].

Depressed mood

Depression was a diagnosis of a proportion of participants in two of the studies [ 28 , 29 ] and bi-polar disorder the primary diagnosis in three further studies [ 35 , 37 , 39 ]. Negative affect, in the more severe form of depression including feeling suicidal [ 26 ] (as opposed to simply being sad, unhappy), was also identified in studies where the primary diagnosis was psychosis related [ 26 , 30 , 34 , 36 , 40 ]. It was also the symptoms of depression in bi-polar patients that were reported as being particularly distressing [ 35 ], together with the unpredictability and instability of mood [ 35 , 38 ].

Energy and motivation

Depression was often expressed as associated with a lack of energy and/or motivation. Although energy and motivation might be regarded as two distinct concepts (physical and psychological), they were closely associated and for the most part reported together within the primary research. Energy, or lack of it, was a major theme in one study [ 39 ] and all but three of the primary research articles [ 32 , 33 , 35 ] described the debilitating effects of lack of energy. The three studies where energy and motivation were not evident focused on the nursing implications of panic disorder [ 32 ] the psycho-social issues related to bipolar disorder [ 35 ] and the positive determinants of health [ 33 ]. Participants reported feeling generally drained of energy [ 26 , 28 – 30 , 38 , 40 ] associated with a lack of motivation, enthusiasm, or interest in things [ 26 , 28 – 31 , 34 , 36 , 40 ]. The side effects of medication [ 26 ] or problems with sleep [ 26 , 30 ] were reported as having a causal effect.

“ The quality of my life in the last few years has been horrible , because it has taken so much energy and struggle to get through so many things …. I ’ ve got to get out , go out and do things or go to concerts or go to school things , or go to meetings or something , and doing some of those things is so tough , to make yourself , you know , get up and go . Just getting up to go out for a walk was really hard for me , whereas walking is one of my , you know , I love to go out and walk .” [ 29 - Distant hopes fuel the relentless struggle to carry on ]

Because lack of energy was a problem, conserving energy for those activities that brought pleasure and joy was important [ 39 ]. Whilst lack of energy was the dominant theme, hypomanic states in bi-polar disorder were associated with increased energy and enthusiasm but were often short-lived with a return to a usual depressed state [ 38 ].

Fear and anxiety

Two studies reported that ‘fear’ was a theme that was represented throughout their interview data [ 28 , 30 ]. Fear, anxiety, or worry was present in some form in all of the studies. The subjective experiences of the symptoms were reported as being very frightening [ 26 , 28 , 31 , 32 , 35 , 40 ]. This tended to be identified in the studies on schizophrenia, bi-polar disorder and panic disorder. As a consequence, individuals lived in fear of relapse or a return to hospital [ 26 , 28 , 30 ]. There were associated financial worries which had implications for planning for the future and making commitments [ 30 , 34 , 37 ].

Living day to day with a psychotic illness was described as a very frightening and isolating experience . The participants described their sense of fear while experiencing symptoms , watchfulness for reoccurrence of illness , concerns over safety , experiences of anxiety and rejection in interactions with others , avoidance of stressors , feelings that they were being treated as “ fragile ” by their families , and a sense of powerlessness in gaining control over symptoms [ 27 - The experience of illness ]

Anxiety in social situations was especially evident and took various forms including anxiety about leaving the house, crowds and public places [ 26 ], concerns for their own safety [ 26 , 28 , 36 ], and that of others [ 26 ], worrying about what others thought of them and how they appeared [ 26 , 28 , 30 ], worries and concerns within relationships [ 29 ] and fears of rejection [ 40 ]. Worries concerning relapse or aggravation of symptoms and social anxiety often resulted in the avoidance of any activity or situation which might be perceived as stressful [ 26 , 28 , 30 , 33 ] thus limiting the possibilities of improving other aspects of quality of life.

Avoiding situations they had previously enjoyed because of fear of how they would appear or that the stress associated with those situations would mean deterioration in mental health : “ I ’ ve cut down on the sort of positions I get myself in … because of bad experiences in the past …. you just try less things with the fear that you ’ re going to get very ill again and go to hospital ” [ 30 - reduced control of behaviour and actions ]

Within the studies reviewed there tended to be an emphasis on the absence of ill-being rather than the presence of well-being. However, the positive themes identified that were important to people included an overall sense of well-being [ 31 , 33 , 39 ], feeling healthy [ 31 ], peaceful, calm and relaxed [ 26 , 30 , 33 , 39 ], stable [ 30 , 35 ], safe [ 33 , 39 ] and free from worry and demands [ 33 , 39 ]. Enjoyment or happiness were not identifiable themes within the reviewed studies but were associated primarily with the need for activities to be enjoyable [ 31 , 36 , 39 ].

Physical well-being

Physical health was not a strong theme within the reviewed studies. The compounding effects of physical health problems were indicated in two studies [ 26 , 36 ] and physical health was listed as the second most important aspect of quality of life by participants in another [ 37 ]. A healthy lifestyle was considered beneficial which included exercise, avoiding drugs and generally taking care of oneself [ 26 , 28 , 33 ].

Control, autonomy and choice

The importance of aspects of choice and control to quality of life was identified in eight studies [ 26 , 28 , 30 , 31 , 34 , 35 , 37 , 39 ] and was a main theme in three of these [ 30 , 34 , 35 ]. It was often discussed in the context of the availability of external resources which enabled choice and control, including medication and treatment, support, information and finances.

Symptom control

One of the most evident aspects of control was the management of the most distressing or pervading aspects of mental illness, particularly for those with psychosis related disorders [ 26 , 28 , 31 – 35 , 38 , 39 ]. Control was usually described as being achieved through medication [ 26 , 28 , 33 – 35 , 39 ]. Having control meant that individuals could move beyond ‘the all encompassing world of their illness’ [ 28 ] and instead attend to other important areas of their lives [ 28 , 31 ]. However, medication could also have a detrimental effect on quality of life through side effects, [ 26 , 28 , 30 , 34 ] feelings of dependency, [ 34 , 35 ] and fear of the consequences of not taking it [ 30 ]. It was therefore necessary to find the right medication to balance symptom management and side effects [ 26 , 28 , 32 , 33 , 35 , 39 ] as a means to a sense of well-being [ 28 ].

“ I ’ m on good medication , no symptoms , no side effects . I used to go through all the side - effects and symptoms and I don ’ t have anything now . . before that , I never really felt human . . I ’ m human , I ’ m flesh , you know like that in my mind and , it ’ s just a good feeling . I can ’ t explain how I was , used to be but since I ’ ve been on this medication I feel like a human … I don ’ t have any side - effects or anything or any problems . . I just take my pills and go . Like I feel like a human being … it ’ s just great ”; “ I think for me , apparently the most important one is just managing the illness … different medications , side - effects , knowing what they are … for me there ' s been limited discomfort ” [ 28 - Experience of illness - gaining control ]

The concept of control was particularly important for those with bipolar disorder, and was related to an inability to control or pre-empt the onset of mood episodes or their behaviour [ 35 , 38 ] and to a need for stability [ 35 ].

Being informed and having an understanding and insight about the illness was considered to be important [ 26 , 28 , 32 , 34 , 39 ]. To achieve this it was important to have an accurate diagnosis [ 32 , 33 ]. This meant that people could receive effective medication [ 33 ], knew what to expect for the future [ 28 , 33 , 39 ] and could develop strategies to manage their illness and deal with it better [ 28 , 34 ]. This was regarded as a first step on the way to recovery [ 32 ] and improving quality of life [ 39 ].

Independence/dependence

There was a complex relationship between independence, dependence, and support. Both support [ 26 , 28 , 31 , 33 , 34 , 37 , 39 , 40 ] and independence [ 32 , 33 , 37 ], particularly financial independence [ 37 ] were regarded as being important for quality of life. Support helped people manage their illness, access resources, and increase their self-confidence [ 33 ]. However, it could also result in feelings of dependency [ 26 , 37 ] with a resulting loss of a sense of control and self-esteem [ 37 ]. Hence there could be a dilemma between wanting help and support and at the same time resenting it [ 29 ]. On the other hand, choosing to be dependent could enhance power and control [ 39 ]. Personal autonomy, finding the optimum balance between support and independence, was therefore important to quality of life [ 25 , 33 ].

“ I think that ’ s a big part of what I recognize now as quality of life is feeling I can take care of myself without being heavily dependent on a long - term basis on either the welfare system or my Dad , unless I ’ m choosing to do so for a specific reason ” [ 33 - Independence : ‘ Or rather , not being independent , but not being dependent ]

Personal strength, determination, and self-sufficiency were also regarded as important [ 26 , 32 , 33 , 38 ]. It meant people were able to make use of available resources and develop self-help and personal coping strategies [ 26 , 28 , 32 , 37 ] which in turn promoted independence and a sense of control [ 28 , 32 , 37 ].

The concept of choice was most associated with the availability of financial resources [ 26 , 28 , 30 , 33 , 34 , 37 ] and with limited employment opportunities [ 26 , 28 , 30 , 34 , 38 , 40 ]. Having sufficient financial resources meant people could more readily have a healthy lifestyle [ 33 ], engage in activities that promoted well-being [ 26 , 28 , 30 , 33 ], facilitate the attainment of an optimum balance between dependency and independence [ 26 , 37 ], have a choice in their surroundings [ 26 , 28 , 34 ] and be able to plan for the future [ 30 ].

“ I ’ d have had more money if I ’ d stayed in the [ job ] … I ’ d have been able to board the animals and go on holiday . I would have been able to afford a bigger house maybe even have some help with some of my domestic tasks . yes . it ’ s limited my choices ”…“ Lack of control of your finances because what you get in benefits goes immediately what with all the things you have to pay out for . So you have to be very careful … That ’ s another sort of loss of control of part of your life which doesn ’ t make you feel very good about yourself ” [ 30 - Financial constraints on activities and plans ]

Also of value was being able to choose whether or not to take part in things (particularly social activities), [ 28 , 34 ] flexible work conditions, [ 38 ] when and with whom to disclose mental illness, [ 34 ] and choices associated with mental health services, workers and interventions [ 26 ].

Self-perception

A number of aspects of self associated with quality of life were identified: self-efficacy - having a belief and confidence in your own abilities; self-identity - having a perception of self and knowing who you are; self-esteem - having a sense of self-worth and self-respect; and self-stigma - internalizing the negative views of others. These were linked to a further theme of self-acceptance. These self concepts were closely associated and used interchangeably within the studies reviewed making them difficult to differentiate. Aspects of the self and self-perception were a major theme in three studies [ 28 , 32 , 35 ] and were present in some form within all of the other studies except one [ 29 ] which had an abstract analytical style and only had undertones suggesting low self- esteem/image.

Self-identity

Problems related to self-identity, having a sense of self and ‘knowing who you are’ appeared particularly to be related to bi-polar disorder, schizophrenia, and panic disorder. The studies described difficulties with having a coherent sense of self, identity, and personality [ 31 , 32 , 35 , 37 , 39 ].

‘ when you end up in the hospital with a full - blown mania and you think that you ’ re a king and you ’ re screaming at the top of your lungs … trying to eat your hospital bed and , and … you don ’ t know how to deal with it or , or how to be . You don ’ t know how to become yourself again . You don ’ t know what happened to you . It ’ s like your identity has been changed . It ’ s like somebody hands you a different driver ’ s license and you ’ re like , ‘ Well who is this person ?’ [ 37 - Identity ]

This loss of a sense of self necessitated a re-negotiation [ 31 ] or reclaiming [ 32 ] of self, based on self-acceptance, self-knowledge and understanding, [ 31 , 32 , 37 , 39 ] and relationships with reliable others [ 39 ]. Spirituality also had a role in achieving a sense of self [ 28 ].

Self-efficacy

This concept was expressed in the reviewed studies primarily as a lack of self-confidence, but also as feelings of inadequacy, uselessness, failure, an inability to cope, and helplessness [ 26 , 28 , 30 – 33 , 35 , 37 ]. Mental health problems were associated with a lack of confidence [ 26 , 31 , 32 , 35 , 38 ]. This lack of confidence limited day to day functioning and activities [ 26 ], and access to helpful resources [ 26 ] and affected choice and opportunities in employment [ 26 , 28 , 38 ] and relationships [ 26 , 28 ]. Bipolar disorder could be associated with an increase in self-confidence during manic episodes [ 38 ].

Self-esteem and self-acceptance

The theme of self- esteem includes the concepts of self-image, worth, value, and shame, and a view of the self as ‘defective’ [ 26 , 28 , 30 , 35 – 37 , 40 ]. It was primarily reported as a negative concept closely associated with loss of self-identity [ 37 ] and confidence [ 35 ]. Occupational activity was considered particularly important for self-esteem and status [ 28 , 36 , 38 ], as was the satisfaction gained from helping others [ 28 ]. However, the difficulties encountered in obtaining employment often resulted in a lowering of self-esteem [ 30 , 40 ]. A closely related concept to self-esteem was the positive concept of self-acceptance, [ 28 , 32 , 37 , 40 ] acceptance of the self as a person with an illness [ 32 ], or the belief that the illness did not represent everything that they were [ 28 , 37 ].

Self-stigma

The theme of ‘the self’ was closely related to the next theme of ‘belonging’, particularly through the concepts of ‘stigma’ and ‘feeling normal’ (see below). This inter-relationship is most evident in the concept of self-stigmatization, an internalisation of the negative views of others [ 28 ].

Individuals living with severe and persistent mental illnesses suffer from a form of stigma - self - stigma - perhaps the most powerful of all stigmas as it affects the inner sense of self in very profound ways . ‘ I stigmatize myself . I just have a very low self - image . I ' m kind of hard on myself for not conducting myself the way I should be … not being as productive as I could be . It ' s a reflection from general community ' s perceptions of what this illness is all about . […] [ 27 - Sense of Self : Self doubt , criticism - a barrier ]

The concept of belonging has been defined as the experience of integration and personal involvement in a system or environment at differing interpersonal levels. It can have two dimensions: ‘valued involvement’ - the experience of feeling valued, needed, accepted; and ‘fit’ - the person’s perception that his or her characteristics articulate with, or complement, the system or environment [ 20 ].

Of the primary research studies included in the review, one identified ‘connecting and belonging’ as being important to quality of life [ 34 ]. Others identified closely related main themes: being part of a social context [ 33 ], rejection and isolation from the community [ 35 ], a need for acceptance by others [ 40 ], social support [ 37 ], relationships [ 28 ], barriers placed on relationships [ 30 ], labeling and attitudes from others [ 30 ], stigma [ 28 , 30 , 37 , 40 ], alienation [ 40 ], detachment and isolation [ 30 ].

Relationships

Relationships were clearly central to the concept of ‘belonging’. These relationships included close connections with family and friends and also more casual relations with the local community, in the workplace, with service providers or with society at large. The complex nature of relationships and the positive and/or negative effects on quality of life were evident in all the primary studies.

The provision of support was a particularly strong theme, being a major theme in three studies [ 33 , 37 , 39 ]. Both practical [ 26 , 28 , 32 , 33 , 37 , 39 ] and emotional [ 26 , 28 , 32 – 34 , 37 , 39 ] care and support was identified as important to quality of life. This could be from family and friends [ 26 , 28 , 31 , 33 , 34 , 37 , 39 , 40 ] or peers and work colleagues [ 28 , 38 , 39 ]. Also important was the support received from professionals [ 26 , 28 , 32 , 33 , 35 , 39 ]. When families and professionals were unsupportive, quality of life declined [ 26 , 28 , 39 ].

“[.] if you have schizophrenia or you have mental illnesses a lot of support helps , helps you get back on track ”; “ The support that they give me means a lot to me . I wouldn ' t be where I am today without my family and my friends . They ' ve supported me in every little way that they could … like my Mom will drive me to doctor ' s appointments … just having my family in [ name ] living around me … I know that if , if I can ' t get somewhere myself I can always rely on family members to take me ” [ 28 - Relationships with supportive family members ]

Within the reviewed studies the most predominant benefits of good and reliable relationships were to feel accepted and understood [ 26 , 28 , 33 – 35 , 37 , 40 ], and having company, camaraderie and shared interests [ 28 – 31 , 33 , 34 , 36 ]. Good relationships also satisfied the need for love, care, and affection [ 26 , 28 , 33 , 34 , 37 ], facilitated the experience of joy, fun, and happiness [ 29 , 33 ], someone to talk to/share problems with [ 26 , 28 , 29 , 33 , 39 ], to feel needed/helpful to others [ 28 , 30 , 33 , 39 ], to have people in whom one had trust and confidence [ 26 , 33 , 39 ] and who provided motivation and encouragement [ 33 ].

Connecting with others and achieving a sense of belonging emerged as key to quality of life : “ You need friends to be happy … you need affection , you need to be loved by people , or else you would never get ahead in life . You will always be miserable and unhappy ” [ 34 - Connecting and Belonging ]

Given the importance of others, their well-being was also important to the quality of life of the study participants [ 33 ].

Whilst relationships which satisfied the need to belong were important, difficulties forming and maintaining these relationships were evident [ 26 , 28 – 30 , 34 – 36 , 40 ]. These difficulties included problems and tensions within supportive long term relationships [ 26 , 28 , 29 , 35 , 37 ].

“ My Dad considers me a problem son . My mother thinking it ' s going to be a bit of a problem … you ' re not treated with the same kind of respect that you were before … you ' re not given the same kind of credibility … it ' s not , not quite the same . You don ' t feel a part anymore . You ' re separated … You ' re not even part of your family … you don ' t feel part of the community ; I don ' t feel part of anything .” [ 28 - Negative reactions from family members - a barrier ]

Problems with relationships represented a complex multidirectional interaction between the person and society at varying interpersonal levels. This interaction involved the effect of the person’s illness when relating to others, other people’s subsequent reactions and attitudes to them, and the effect of those reactions and attitudes in further exacerbating symptoms of anxiety and depression and affecting the person’s perception of themself. Examples of the barriers experienced in connecting and relating to people included cognitive and thought disorders resulting in problems with concentration and attention [ 28 , 30 , 40 ] problems controlling behaviour [ 30 , 35 , 37 ] including acting out [ 30 , 37 ], irritability, volatile or inappropriate behaviour [ 37 ], grandiosity or self-inflation [ 37 ], and feelings of anxiety when talking to or being around people, including problems with trust and paranoia [ 26 , 28 , 38 ].

Stigma can be defined as ‘any condition, attribute, trait or behaviour that symbolically identifies the bearer as culturally unacceptable or inferior’ [ 41 ]. Stigmatisation was a major theme in four of the studies [ 28 , 30 , 37 , 40 ] and evident in three others [ 26 , 34 , 35 ]. The experience and perception of negative reactions on the part of family, friends, service providers, employers, and society at large was shown to have a detrimental effect on quality of life. Individuals felt that they were perceived as lesser human beings who were discriminated against and treated accordingly [ 28 ] and that they were feared, avoided, or not accepted, which in turn led to feelings of rejection, marginalization, or being written off [ 28 , 30 , 35 , 37 , 40 ]. As a result, disclosure of mental illness was problematic and often avoided, and this had consequences for employment and close relationships [ 28 , 34 , 37 ]. Stigma had a detrimental effect on most aspects of life, including relationships [ 26 , 28 , 30 , 37 ], employment and career [ 26 , 28 , 30 , 37 ], going out and pursuing leisure activities [ 26 , 30 ], obtaining services [ 28 ], and planning for the future [ 28 ]. Stigma was considered to be more predominant in bipolar than unipolar depression [ 37 ].

Feeling normal

A major barrier to achieving a sense of belonging was that informants were not perceived by others – and often did not perceive themselves – as “normal” [ 34 ]. Whilst feeling normal was something they held in high regard, instead they were aware of being perceived differently and consequently treated differently [ 40 ]. Feelings that they were different, and attempts to appear normal, do normal things, or be accepted as normal, formed a theme that permeated many of the studies reviewed [ 28 , 30 , 31 , 34 , 35 , 40 ], being a major theme of three [ 28 , 31 , 34 ]. This is consistent with the dimension of ‘fit’ within the concept of ‘belonging’ - the person’s perception that his or her characteristics articulate with, or complement, the system or environment [ 20 ].

… most informants expressed a need to both feel and be perceived as normal . For example , Informant 2 remarked , “ The thing is that I want to be a normal person and achieve something in my life ,” and Informant 25 stated , “ I ’ d like to be treated as equal in society .” Informants spoke about not feeling like other persons and implied that this set them apart . As Informant 16 stated , I don ’ t want to be mentally ill , I wanna be normal so I can study normally , go to school normally , get married , this and that . […]” [ 34 - Connecting and belonging : being normal ]

Loneliness/isolation/alienation

Feelings of isolation, loneliness, and particularly the concept of alienation can be regarded as the antithesis of a sense of belonging. Whilst highlighted as a main theme in one study only [ 40 ], these feelings were evident within the themes of relationships and stigmatization in all studies except one [ 31 ]. The symptoms of mental illness, the barriers these caused in the formation of relationships, the stigma and consequential effects on the self, together with feelings of being different and not accepted, resulted in a pervasive sense of loneliness and isolation. People chose isolation, or avoided relationships, as a way of protecting themselves against rejection and dealing with the fears of how they appeared and what others thought of them [ 28 , 30 , 40 ]. The effects of being consistently treated as undesirable or different became internalised and further influenced their sense of self [ 28 ]. Isolation was further compounded by the feelings that they were the only person suffering in this way [ 28 ]. Hence, isolation was not just feeling as though they did not have any friends but became a painful feeling of despair that affected all aspects of life.

“ I think one of the things about schizophrenia , I don ' t know whether it ' s schizophrenia or whether it ' s , it happens in other mental illnesses too , is this terrible , terrible kind of inner isolation feeling , like you ' re the only person … who is going through what you are going through and you , and you ' re completely alone […] it ' s just a terrible , painful sense of utter loneliness and isolation .” [ 28 - The Tyranny of Psychosis - a barrier ]

For quality of life, people wanted a reciprocal relationship with others [ 33 , 37 ] which involved understanding and acceptance [ 26 , 28 , 33 – 35 , 37 , 40 ]. This could be achieved through ‘supportive own’, those who share their illness and experiences [ 28 , 33 , 34 , 37 , 39 ], or through belonging to a religious community [ 26 ]. However, it was also possible to have a sense of belonging to a social network that was ultimately not beneficial to quality of life [ 37 ], and difficulties disentangling ‘real’ spiritual experience from hyper-religiosity when hypo/manic could make belonging to a religious community problematic [ 37 ].

By ‘doing’, a person achieves a sense of self, mastery, and successfully participates in the external world [ 21 , 42 ]. The importance of activity in some form to quality of life was expressed in all of the studies except one (which examined panic disorder from a nursing perspective) [ 32 ]. There was a difference in emphasis between studies: some focused specifically on the benefit of employment [ 30 , 35 , 38 , 40 ] and others on activity or occupation in its broader sense, including both employment and leisure activity [ 26 , 28 , 31 , 33 , 34 , 36 , 39 ]. Whatever the type of activity, it was stressed that it should be meaningful or fulfilling [ 26 , 28 , 31 , 33 , 34 , 36 , 39 ], enjoyable, [ 31 , 36 , 39 ] and suited to need and capabilities [ 26 , 31 , 33 ].

The benefit of activity is that it can provide the means for many of the factors important to quality of life discussed above. It is through activity that the opportunity arises to interact with others and hence develop a sense of belonging [ 34 ]. Activity can also improve mood [ 26 , 28 , 31 , 33 , 34 ], increase energy and/or motivation [ 28 , 34 , 39 ], relieve stress [ 26 ] and boredom [ 34 , 36 ] and provide a distraction from problems [ 26 , 33 , 34 ]. It also helps self-esteem and self-confidence, engenders a positive self-identity, [ 26 , 28 , 30 , 34 , 36 , 38 , 40 ] and enables people to take control of their lives [ 34 ].

One further factor is how activity provides order, routine, and structure [ 30 , 33 , 34 , 37 , 39 ]. Routine and structure can be achieved through employment [ 30 , 37 ], childcare [ 30 , 37 ] or activity in general, be it work or leisure [ 33 , 34 , 37 , 39 ]. However, one study highlighted how too much structure could be problematic and that what was important was flexibility and choice [ 37 ]. Having a physiological routine - particularly regular sleep, meals, and exercise - was considered important for general well-being [ 37 , 39 ].

Positive outcomes that could be derived from the strategy of using activity to structure and fill time included increased motivation , diversion from present problems , and avoidance of negative moods : [.] “ The actual work , whatever it is , is good for the mind and soul … you forget yourself . You forget your own problems when you are working ” [.] “ In the morning I have to do something . Some job or something I should do . Otherwise , I become bored and then become depressed because I don ’ t have anything to do …. when I have nothing to do I become sad and unhappy and become very depressed , and I don ’ t know what to do . It is very difficult .” [ 34 - Managing time ].

Whilst activity was almost universally considered to be beneficial, taking part could be difficult if the activity was too demanding and not suited to needs [ 33 , 38 , 39 ]. The symptoms of mental illness could make difficult even the most rudimentary of activities, such as self-care, cooking and shopping, [ 26 , 36 ] and taking up employment was especially problematic [ 31 ]. Even potentially enjoyable leisure activities were avoided because of concern regarding other people’s reactions, [ 26 , 30 , 36 ] problems relating to people, [ 36 ] and the associated fear and stress resulting in a deterioration in health [ 26 , 30 ]. Lack of money also put a restriction on enjoyable pastimes [ 30 ].

For those who were employed, interpersonal relationships at work were particularly affected due to social withdrawal and irritability, or interfering, inappropriate, or volatile behaviour during hypomania, although work productivity could increase during hypomania [ 38 ].

Hope and hopelessness

Integral to the concept of hope is having dreams, goals and a positive view of the future. The importance to quality of life of having dreams and goals or personal achievement was evident in six of the studies [ 28 , 29 , 31 , 33 , 34 , 37 ], the importance of activity and/or life in general being fulfilling and having some meaning and purpose was also evident [ 28 , 33 , 34 , 37 , 40 ]. Both having dreams and goals and having meaning and purpose in life were necessary to instigate change, make plans, and to move forward. Again, the difficulty of achieving this was stressed [ 28 , 31 , 34 ]. Losses experienced in the past affected the view of the future with a perception of reduced opportunities and choices [ 35 ] and diminished hopes and dreams, [ 29 , 31 ] particularly in the fields of employment [ 30 , 38 , 40 ] and relationships [ 29 , 40 ]. Loss and the effect of past experiences was a theme in seven of the studies,[ 26 , 28 – 31 , 35 , 38 , 40 ] and a major theme in three of these [ 29 , 31 , 35 ]. These losses included the loss of life roles generally, and more specifically the loss of work and career opportunities, relationship and the parental role, skills and ability, time, financial losses, and, ultimately, the loss of a sense of self and identity. Losses which had occurred in the past were perceived as a burden [ 28 ] with a pervasive sense of ‘something missing’ [ 40 ] which had long-lasting effects and made life a constant struggle [ 29 , 35 , 40 ]. Participants compared their own lives negatively with those of others [ 29 , 35 , 40 ], or with their own lives before illness struck [ 29 , 31 ], and all this brought about feelings of failure, of being cheated, and a sense of unfairness [ 35 , 38 , 40 ].

Past losses, including the loss of meaning and purpose in life, a sense of helplessness and inability to cope, all brought about a sense of hopelessness, necessitating a renegotiation and a lowering of aspirations and priorities [ 28 , 29 , 31 ].

The concepts of ‘hope’ and ‘hopelessness’ permeated the review studies [ 29 , 30 , 35 , 39 , 40 ] and formed a major theme for two [ 29 , 35 ]. Hopelessness was an expression of the view that life would never change for the better, and brought about a pervasive feeling of distress [ 40 ]. Conversely, hope provided a catalyst for change and a better life [ 39 ].

" Well , my whole life feels problematic , I feel as if I ' m not going anywhere … I know it sounds negative and I ' m not really negative like this all the time , but you know , I find it hard , projecting myself into the future , and leading a happy life . I don ' t think my life is very happy at the moment , it ' s not very fulfilling . I haven ' t got any real struggles at the moment , but it could be better . I don ' t know if it ' s because of the illness or the sort of person I am …"; " I don ' t have hope that I ' ll ever have a nice boyfriend , I don ' t have any hope that I ' ll get married , I don ' t have any hope that I ' ll work a full week — week after week after week . I don ' t really have hope for stability …" [ 35 - Bipolar Patients ' View of Their Future ]

We identified six major themes associated with quality of life for those with mental health problems: well-being and ill-being; control, autonomy and choice; self-perception; belonging; activity; and hope and hopelessness.

Measuring quality of life for people with mental health problems is of interest currently because of concerns about the emphasis of mental health services on reducing symptoms. Yet our review identified the importance of distress and symptom control from the perspective of people with mental health problems. Amongst academic circles quality of life has confusingly come to be known as anything which is not clinical [ 14 ]. However, this review of the qualitative literature indicates that, when those with severe mental health problems are interviewed, the distress related to symptoms is integral to their quality of life, and in some instances seeing beyond this distress is difficult.

One of the strongest themes revealed by the review was a sense of belonging achieved principally by good quality relationships and lack of stigma. It has been stated that people are fundamentally motivated by a need to belong [ 43 ], and that belonging is the missing conceptual link in understanding mental health and mental illness [ 44 ]. Our review also indicates that negative social relationships are detrimental to quality of life. This is supported by research that shows that, whilst a large social network and satisfaction with social relations are associated with a better quality of life [ 45 ], negative social interactions and stigma are related to a worse quality of life [ 46 ]. Social exchange theory emphasizes that social interaction entails both rewards and costs, and that negative social outcomes can have a greater impact on well-being than positive outcomes [ 47 ]. There is also evidence that loneliness is caused more by a lack of intimate connections than by a lack of social contact [ 48 ]. Hence, the important factor is the sense of belonging, rather than social contact. So, whilst there is a strong argument that those people who experience supportive, caring, loving relationships and have a sense of belonging have a better quality of life, it is less clear which is the more detrimental - to experience and risk the negative impact of uncaring and disrespectful relationships, rejection and stigma, or to protect oneself through self-isolation.

As good and poor relationships can have a positive or negative impact, so activity can both help and hinder quality of life. For some, the severity of symptoms can mean that basic self-care and day to day functioning are difficult. Activity beyond perceived capabilities can also result in feelings of anxiety, which in turn can lead to deterioration in other mental health symptoms such as hearing voices and paranoia. This results in avoidance of any potentially stressful situations. This finding is supported by the findings of research into the occupational activity of those with severe mental illness which indicated that, though employment was valued, people made choices constrained by fear of relapse, and entered, avoided, and shaped their social and occupational activity to remain well [ 49 ] It was found that doing too much could exacerbate symptoms, yet doing too little could also cause illness, and therefore people with severe mental illness sought out daily occupations with structure, flexibility, and easily met demands over which they had control [ 49 ]. Therefore, to achieve well-being and quality of life, people need to find a balance and be enabled towards what they are best fitted [ 50 ].

Although avoidance of social and occupational activity may reduce anxiety and the occurrence of other related symptoms, at the same time it can compromise other aspects of quality of life. The consequent reduction in choice and opportunity has a detrimental effect on self-esteem and confidence. However, self-worth is gained through positive social feedback and successfully engaging in activity. Lack of self-esteem has also been shown to increase the risk of psychiatric disorders, the development of delusions, and the maintenance of psychotic symptoms [ 51 ]. The perception of self is therefore both a cause and a consequence of mental health, and can therefore be regarded as being pivotal to quality of life.

In relation to the finding of the importance of hope and hopelessness to quality of life, parallels can be seen between the results of this review and the concept of demoralization [ 24 , 52 ] whereby a persistent inability to cope with internally or externally induced stresses result in feelings of helplessness, incompetence, and loss of mastery and control leading to diminished self-esteem, hopelessness and demoralization which in turn adds to the distress of symptoms and further reduces a person’s capacity to cope. The demoralized person clings to a small number of habitual activities, avoids novelty and challenge, and fears making long term plans [ 24 , 52 ]. This feeling of demoralization further impacts upon ill-being and, if untreated, leads to chronic distress and possible suicide [ 24 , 53 ].

Strengths and limitations of review

The primary studies included those with severe mental health problems only, with a majority having schizophrenia or psychotic disorders. Where there was a mixed population, studies rarely indicated any differences between people with different diagnoses. The findings may therefore have biases towards those with psychotic rather than affective disorders. The evidence base could therefore be improved by undertaking research with a wider range of mental health conditions.

Findings from the primary studies could be negatively or positively oriented depending upon the approach: research that asked how the illness had affected quality of life led to negative concepts (e.g. fear/stigma/isolation) whereas research that asked what would improve participants’ lives resulted in positive concepts (e.g. love, support, understanding). Some research papers addressed both, and identified factors that both helped and hindered quality of life. There was a greater emphasis on negative than positive concepts in the primary studies, and this has influenced the analysis and subsequent findings.

The range of themes included in the reviewed articles was extensive, in this review we have focused on those that are most closely associated with ‘health related’ quality of life.

Setting boundaries

There were difficulties setting boundaries around themes because of the strong inter-relationship of the different domains which make up quality of life. To avoid repetition, sub-themes have been placed in the main theme with which they were considered to be most strongly associated, but aspects of these themes could be placed in other themes. For example, ‘feeling normal’ has been included under the main theme of ‘belonging’ but could also be regarded as an element of ‘ill-being/ well-being’ and ‘the self’. Likewise, symptom management through medication is also an aspect of ‘well-being’ but probably due to the emphasis on psychosis related disorders in the reviewed studies it was the control aspect of medication use that predominated.

Complexities also arose when setting boundaries around the concept of quality of life. It was evident that there was a considerable overlap in findings with studies examining ‘recovery’, ‘lived/subjective experience’, ‘psychosocial issues’, ‘health needs’, and ‘strategies for living’. After much discussion and deliberation within the team, these studies were excluded from the review. Since completing our analysis a systematic review of the concept of ‘personal recovery’ has been undertaken [ 54 ] a concept previously defined as ‘a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness’ [ 55 ]. Interestingly, they identified five recovery processes comprising ‘connectedness’, ‘hope and optimism about the future’, ‘identity’, ‘meaning in life’ and ‘empowerment’ which are very similar to our own final themes. They do not include ‘well-being’ and this may be due to the rejection of an emphasis on symptoms within the recovery movement. This suggests that the concepts of ‘recovery’ and ‘quality of life’ are very closely related. This is important to understand as the concept of ‘recovery’ is gaining prominence as a guiding principle for mental health services [ 56 ].

Implications for measuring quality of life

The findings of this review indicate six major themes associated with quality of life for those with mental health problems: well-being and ill-being; control, autonomy and choice; self-perception; belonging; activity; and hope and hopelessness. This provides important evidence for critically examining the content of measures currently being used in mental health and particularly the generic measures of health related quality of life like EQ-5D that are being used to inform resource allocation decisions and the monitoring of outcomes. Concerns with the generic measures have been that they are designed by experts with little or no input from people with mental health problems and their coverage is too limited. The EQ-5D, for example, has the following five dimensions of health: mobility, self-care, usual activities, pain and discomfort, and depression and anxiety. Respondents are asked to report their level of problems (no problems, some/moderate problems or severe/extreme problem) on each dimension to provide a position on the EQ-5D health state classification. A key concern raised about this measure is the focus on physical health rather than mental health problems [ 5 , 6 ]. These can be seen as a combination of physical functioning (mobility, self-care), well-being (depression and anxiety), social functioning (that may be included in usual activities) and physical symptoms (pain and discomfort). There is only a modest degree of fit between these EQ-5D dimensions and the six themes within our review. Anxiety and depression may reflect, however crudely, ill-being (though not well-being). Usual activity is again rather crude, but arguably covers aspects of activity. However it makes no allowance for the finding that some activity can have a negative as well as a positive impact. This leaves the themes of control, autonomy and choice; self-perception; belonging; and hope/hopelessness which are not addressed within the EQ-5D.

The findings of this review can help to provide useful evidence for examining the content validity of different measures. This evidence can be used alongside quantitative psychometric evidence on the performance of measures in different groups. In the case of EQ-5D, for example, recent reviews have found supporting evidence for construct validity and responsiveness in people with depression and personality disorder, but reflected the concerns about their appropriateness for those with anxiety, bipolar disorder and schizophrenia [ 57 – 59 ].

A good quality of life is characterized by feelings of well-being, control and autonomy, a positive self-perception, a sense of belonging, participation in enjoyable and meaningful activity, and a positive view of the future. In contrast, a poor quality of life is associated with feelings of distress, lack of control over symptoms and life in general, a negative perception of self, stigmatization and rejection, diminished activity and difficulties with day to day functioning, and a negative outlook. These life domains interact in a complex and reciprocal way. Generic measures of quality of life may fail to address this complexity and the rich and broad range of domains important to people with mental health problems.

Gladis MM, Gosch EA, Dishuk NM, Crits-Christoph P: Quality of life: Expanding the scope of clinical significance. J Consult Clin Psychol 1999, 67: 320–331.

Article   CAS   PubMed   Google Scholar  

British Psychological Society: Psychological health and well-being . Leicester: A new ethos for mental health; 2009.

Google Scholar  

National Institute for Health and Clinical Excellence (NICE): Guide to the methods of technology appraisal . London: NICE; 2008.

Gilbody SM, House AO, Sheldon T: Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments to improve psychological outcome – a systematic review. Psychol Med 2002, 32: 1345–1356.

Brazier J: Is the EQ-5D fit for purpose in mental health. Br J Psychiatry 2010, 197: 348–349.

Article   PubMed   Google Scholar  

Saarni SI, Viertiö D, Perälä J, Koskinen S, Lönnqvist J, Suvisaari J: Quality of life of people with schizophrenia, bipolar disorder and other psychotic disorders. Br J Psychiatry 2010, 197: 386–394.

Barry MM, Zissi A: Quality of life as an outcome measure in evaluating mental health services: a review of the empirical evidence. Soc Psychiatry Psychiatr Epidemiol 1997, 32: 38–47.

Brown J, Bowling A, Flynn T: Models of quality of life: a taxonomy and systematic review of the literature . FORUM Project: University of Sheffield; 2004.

Phillips D: Quality of Life: Concept, Policy and Practice . New York: Routledge; 2006.

Book   Google Scholar  

McMahan EA, Estes D: Measuring lay conceptions of well-being: the beliefs about well-being scale. J Happiness Stud 2011, 12: 267–287.

Article   Google Scholar  

Diener E, Emmons RA, Larsen RJ, Griffin S: The satisfaction with life scale. J Pers Assess 1985, 49: 71–75.

Johansson S: Conceptualizing and measuring quality of life for national policy. Soc Indic Res 2001, 58: 13–32.

Van Nieuwenhuizen C, Schene AH, Boevink WA, Wolf JRLM: Measuring the quality of life of clients with severe mental illness: a review of instruments. Psychiatr Rehab J 2011, 4: 33–42.

Bowling A: Measuring Health. A review of quality of life measurement scales . Buckingham: Open University Press; 1997.

Hunt SM: The problem of quality of life. Qual Life Res 1997, 6(3):205–212.

Barnett-Page E, Thomas J: Methods for the synthesis of qualitative research: a critical review. BMC Med Res Methodol 2009. [ http://www.biomedcentral.com/1471–2288/9/59 ]

Paterson BL, Thorne SE, Canam C, Jillings C: Meta-Study of Qualitative Health Research: A Practical Guide to Meta-Analysis and Meta-Synthesis . Thousand Oaks, CA: Sage; 2001.

Ritchie J, Spencer L: Qualitative data analysis for applied policy research. In Analysing Qualitative Data . Edited by: Bryman A, Burgess RG. London: Routledge; 1994:173–194.

Chapter   Google Scholar  

Sandelowski M, Docherty S, Emden C: Qualitative meta-synthesis: Issues and techniques. Res Nurs Health 1997, 20(4):365–371.

Hagerty BMK, Lynch-Sauer J, Patusky KL, Bouwsema M, Collier P: Sense of belonging: A vital mental health concept. Arc Psychiatr Nurs 1992, 6(3):172–17.

Article   CAS   Google Scholar  

Fidler GS, Fidler JW: Doing and becoming: purposeful action and self actualization. Am J Occup Ther 1978, 32: 5,305–310.

de Leval N: The three time dimensions synoptic scale (3TSS) for depressive population. Quality of Life News Letter 2001, 26: 15–16.

Diener E: Guidelines for national indicators of subjective well-being and Ill-being. Appl Res Qual Life 2006, 1: 151–157.

Clarke DM, Kissane DW: Demoralization: its phenomenology and importance. Aust N Zeal J Psychiatry 2002, 36: 733–742.

Cook S, Chambers E: What helps and hinders people with psychotic conditions doing what they want in their daily lives. Br J Occup Ther 2009, 72(6):238–248.

Chambers E, Cook S Internal report. University of Sheffield. What helps and hinders people with psychotic conditions doing what they want in their daily lives: The views of people with psychotic conditions 2006.

Corring DJ, Cook JV: Use of qualitative methods to explore the quality-of-life construct from a consumer perspective. Psychiatr Serv 2007, 58: 240–244.

Corring DJ PhD Dissertation. In “Being normal”: Quality of life domains for persons with a mental illness . University of Western Ontario: Department of Rehabilitation Sciences; 2005.

Fisher MA, Mitchell GJ: Patients’ views of quality of life: transforming the knowledge base of nursing. [see comment]. Clin Nurse Spec 1998, 12: 99–105.

Gee L, Pearce E, Jackson M: Quality of life in schizophrenia: a grounded theory approach. Health Qual Life Outcomes 2003, 1: 31.

Article   PubMed Central   PubMed   Google Scholar  

Gould A, DeSouza S, Rebeiro-Gruhl KL: And then I lost that life: a shared narrative of four young men with schizophrenia. Br J Occ Ther 2005, 68: 467–473.

Hamer HP, McCallin AM, Garrett N: Searching for self: the layers and labels of panic disorder: a New Zealand study. Nurs Health Sci 2009, 11: 51–57.

Hedberg L, Skärsäter I: The importance of health for persons with psychiatric disabilities. J Psychiatr Ment Health Nurs 2009, 16: 455–461.

Laliberte-Rudman D, Yu B, Scott E, Pajouhandeh P: Exploration of the perspectives of persons with schizophrenia regarding quality of life. Am J Occup Ther 2000, 54: 137–147.

Lim L, Nathan P, O'Brien-Malone A, Williams S, Lim L, Nathan P, et al .: A qualitative approach to identifying psychosocial issues faced by bipolar patients. J Nerv Ment Dis 2004, 192: 810–817.

Mayers CA: Quality of life: priorities for people with enduring mental health problems. Br J Occ Ther 2000, 63(12):591–6.

Michalak EE, Yatham LN, Kolesar S, Lam RW, Michalak EE, Yatham LN, et al .: Bipolar disorder and quality of life: a patient-centered perspective. Qual Life Res 2006, 15: 25–37.

Michalak EE, Yatham LN, Maxwell V, Hale S, Lam RW, Michalak EE, et al .: The impact of bipolar disorder upon work functioning: a qualitative analysis. Bipolar Disord 2007, 9: 126–143.

Rusner M, Carlsson G, Brunt D, Nyström M: A dependence that empowers - the meaning of the conditions that enable a good life with bipolar disorder. Int J Qual Stud Health Wellbeing 2010, 5(1):4653. 10.3402/qhw.v5i1.4653

Vallenga BA, Christenson J: Persistent and severely mentally ill clients' perceptions of their mental illness. Issues Ment Health Nurs 1994, 15: 359–371.

Goffman E: Stigma: Notes on the Management of Spoiled Identity . London: Penguin; 1963.

Erikson EH: Childhood and Society . New York: W W Norton; 1963.

Baumeister R, Leary M: The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychol Bull 1995, 117(3):497–529.

Anant SS: The need to belong. Can Ment Health 1966, 14: 21–21.

Hansson L: Determinants of quality of life in people with severe mental illness. Acta Psychiatr Scand Suppl 2006, 113(429):46–50.

El-Badri S, Mellsop G: Stigma and quality of life as experienced by people with mental illness. Australas Psychiatry 2007, 15(3):195–200.

Newsom JT, Rook KS, Nishishiba M, Sorkin DH, Mahan TL: Understanding the relative importance of positive and negative social exchanges: examining specific domains and appraisals. J Gerontol B Psychol Sci Soc Sci 2005, 60(6):304–312.

Reis HT: The role of intimacy in interpersonal relations. J Soc Clin Psychol 1990, 9: 15–30.

Nagle S, Cook J, Polatajko HJ: I’m doing as much as i can: occupational choices of persons with a severe and persistent mental illness. J Occup Sci 2002, 9(2):72–81.

Wilcock AA: Reflections on doing being and becoming. Can J Occup Ther 1998, 65(5):279–85.

Romm KL, Rossberg JI, Hansen CF, Haug E, Andreassen OA: Melle: Self-esteem is associated with premorbid adjustment and positive psychotic symptoms in early psychosis. BMC Psychiatry 2011, 11: 136.

Frank JD: Psychotherapy. the restoration of morale. Am J Psychiat 1974, 131: 271–274.

Strada AE: Grief, demoralization and depression: diagnostic challenges and treatment modalities. Prim Psychiatry 2009, 16(5):49–55.

Leamy M, Bird V, Le Boutillier C, Williams J, Slade M: A conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. Brit J Psychiat 2011, 199: 445–452.

Anthony WA: Recovery from mental illness: the guiding vision of the mental health service system in the 1990s. Psychosoc Rehabil J 1993, 16(4):11–23.

Care Services Improvement Partnership; Royal College of Psychiatrists; Social Care Institute for Excellence: A common purpose: Recovery in future mental health services . Leeds: Care Services Improvement Partnership; 2007.

Brazier J, Connell J, Papaioannou D, Parry G, O'Cathain A, Mukuria C, Mulhern B, Parry G: Validating generic preference-based measures of health in mental health populations and estimating mapping functions for widely used measures. Health Technol Asses forthcoming

Papaioannou D, Brazier JE, Parry G: How to measure quality of life for cost effectiveness analyses in personality disorders? A systematic review. J Pers Disord in press

Papaioannou D, Brazier J, Parry G: How valid and responsive are generic health status measures, such as the EQ-5D and SF-36, in schizophrenia? A systematic review. Value Health 2011, 14(6):907–920.

Download references

Acknowledgements

Funding sources for this research were the Medical Research Council Ref No. G0801394. We would also like to thank Prof. Michael Barkham, Prof. Glenys Parry and Eleni Chambers for their helpful and wise comments on draft versions of the paper.

Author information

Authors and affiliations.

Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK

Janice Connell & Alicia O’Cathain

Health Economics, School of Health and Related Research, University of Sheffield, Sheffield, UK

John Brazier & Myfanwy Lloyd-Jones

Information Resources, School of Health and Related Research, University of Sheffield, Sheffield, UK

Suzy Paisley

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Janice Connell .

Additional information

Competing interests.

The authors declare that they have no competing interests.

Authors’ contributions

JC, primary researcher, screened titles and abstracts, reviewed included papers, conducted additional searches, developed the conceptual framework, analysed the data, and drafted the manuscript. JB, principal investigator, reviewed included papers, reviewed and advised on the conceptual framework. AOC, co-investigator, reviewed included papers, reviewed and advised on the conceptual framework. MLJ, co-investigator, screened titles and abstracts, reviewed included papers, and developed the conceptual framework. SP developed the search strategy, conducted the electronic database searches and drafted the related section of the manuscript. All authors reviewed and revised drafts and approved the final manuscript.

Electronic supplementary material

Additional file 1: appendix i. summary of search iterations. (doc 32 kb), additional file 2: appendix ii. keyword search strategies. (doc 72 kb), authors’ original submitted files for images.

Below are the links to the authors’ original submitted files for images.

Authors’ original file for figure 1

Rights and permissions.

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and permissions

About this article

Cite this article.

Connell, J., Brazier, J., O’Cathain, A. et al. Quality of life of people with mental health problems: a synthesis of qualitative research. Health Qual Life Outcomes 10 , 138 (2012). https://doi.org/10.1186/1477-7525-10-138

Download citation

Received : 29 March 2012

Accepted : 07 November 2012

Published : 22 November 2012

DOI : https://doi.org/10.1186/1477-7525-10-138

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Functioning

Health and Quality of Life Outcomes

ISSN: 1477-7525

• Submission enquiries: [email protected]

• Social Integrity
• Submit Content
• Social Media Account Request
• x (twitter)

• © 2024 The Regents of the University of Michigan

U-M Social Media

• X (Twitter)

My Mental Health Story: A Student Reflects on Her Recovery Journey

In honor of May being Mental Health Awareness Month, I want to share my story in the hope that it resonates with some of you. Hearing other peoples’ stories has been one of the strongest motivators in my recovery journey. Seeing other people be vulnerable has given me bravery to do so as well. So, I share what I have learned not from a place of having all the answers. Quite the opposite, in fact; I don’t really believe there are any concrete answers to confronting a mental health struggle. Each is unique and deserves to be treated that way. However, I do hope that in sharing my personal realizations, it resonates with someone and pushes them just one step closer to living their most authentic life — the life we all deserve to live.  

I have struggled with an eating disorder and anxiety for most of my teen and adult life. I was formally diagnosed (otherwise known as the time it became too obvious to hide from my parents and doctor) with anorexia nervosa and generalized anxiety disorder at the beginning of my junior year of high school. Under the careful care of my parents and my treatment team, I was able to keep things ~mostly~ under control. I stayed in school, continued playing sports, and participated in extracurricular activities. 

Then, I went away to college. Coming to Michigan, 10 hours away from my home in New York, I was entirely on my own for the first time in my life. And for the first time in my life, I felt free. Or, at least I thought I did. I was ecstatic to be at Michigan. It was my dream school and I was determined to make the best of it, leaving no opportunity unexplored. I threw myself into commitments left and right. Club rowing team, sorority, and a business club, piled on top of the full course load of classes I was taking. And all of that was in addition to merely existing as a freshman — navigating dorm life at Bursley, making friends, finding my place at a huge school. 

The thing is, I genuinely thought I was thriving. Getting involved, making great friends, and performing well in my classes is pretty much the best-case scenario for first semester freshman year. I couldn’t see that I was being crushed under an avalanche of essays, exams, club meetings, practices, and parties. Sleep was a luxury and self care was foreign. There was a battle being fought inside my head 24/7, a battle that most of the time I was losing. I was slowly disappearing. Barely held together by the anxiety driving me to chase perfection and an eating disorder to feel a sense of control amidst uncertainty run rampant. 

When I returned home for Thanksgiving, the first time since leaving in August, my parents saw through my facade of good grades, involvement, and fun stories. It was obvious I needed help. They wanted me to stay home. But there were only two weeks left of the semester. There was absolutely no way I was going to leave all of my hard work unfinished. I made a deal, if they let me return to Ann Arbor and finish the semester, I would seek treatment when I came home for winter break. They agreed. 

When I returned home I completed the intake process at The Renfrew Center for Eating Disorders. Then, I awaited their recommendation. 

Residential. 

A treatment center 4 hours away from my home, living with about 40 other women also working toward recovery. Days filled with therapy groups, one after another. I would be there for weeks, months even. 

A whirlwind of thoughts ran through my head…

I cannot miss school. I’ll fall behind and never be able to catch up. 

Your mind is exhausted, you barely finished this semester.

I have leadership positions in my club and my sorority, I can’t just abandon them. 

Someone else will have the opportunity to fulfill the position better than you can right now.

I’ll miss precious time with my friends. They will grow closer without me. 

You weren’t fully present with them. Your mind was constantly at war with itself.

I am stronger than this. I can do this on my own. 

Why are you so determined to be alone? Accept help, you need it desperately.

Other people have it so much worse than I do. Getting help would be selfish. 

You getting help does not make anyone else less worthy of getting help.

Perhaps your bravery will encourage someone else to do the same.

Nothing bad has happened to me. I haven’t hit rock bottom. 

Why can’t this be your rock bottom?

Is it not enough that you are fighting a battle inside your brain every second of every day?

Is it not enough that your weight has dropped to less than what it was when you were 10 years old?

Is it not enough that you are relentlessly freezing or that your hair is falling out in large clumps?

Is it not enough that you feel exhausted all the time or that you get dizzy when you stand up?

Is it not enough that you are in danger of going into cardiac arrest?

What more are you searching for?

It was the following statement, from my therapist, that finally got through to me: 

“Rock bottom is death, do you realize that? The only difference between where you are right now and rock bottom is that you still have a second chance.”

I agreed to go to residential treatment and accept the level of care that I needed, taking off the second semester of my freshman year. I arrived at the Renfrew Center in Philadelphia, bags packed without knowing how long I was staying, feeling terrified and alone. The road ahead of me was dauntingly long but I finally made the decision to put my needs first. Leaving school, no matter how painful right now, would allow me to return as more myself. Without an ongoing battle inside my head, I could be present with my friends, get the most out of my classes, and truly enjoy campus life. 

My recovery journey has been anything but smooth. In residential treatment I found support in the community of women fighting for the lives they deserved to live, just as I was. They welcomed me, inspired me, and gave me hope. In therapy I have confronted the most painful beliefs I had about myself, ones that had kept me paralyzed for years. Untangling my authentic self from my eating disorder, rewriting my narrative, learning to feel again. Creating a motivation that was internal. I gained the necessary skills to take recovery into the real world, into a life of true independence and freedom. 

Today, almost three years later, I am living my second chance. It is a fight I have vowed to never give up. 

The following is a collection of the most important things I have learned throughout my journey… 

• I am worthy of being helped. It is okay to ask for help. 

Aching for independence, this was not an easy realization. However, the more and more I let my eating disorder take over my thoughts, the less independent I became. Accepting help was the first step in regaining my independence and fighting for myself. At the time I saw it as a moment of weakness. Now, I see it only as a sign of strength. We are all worthy and deserving of help. Ask for it, accept it, let it move you forward. 

• I always have time for the things that are important to me. 

As high-achieving and driven students, I’m sure many of you can relate to the “not enough time” backtrack constantly playing in your thoughts. It’s not true. Yes, I acknowledge that time is a limited resource. And that we all have commitments. But you are in control of how you decide to spend your time. I’m not saying you can do everything; that is impossible. Rather, I am advocating for intentional decisions about your time. What nourishes you? What makes you feel alive and energized? If something truly matters, make time for it.

• Life isn’t black and white. The depth and richness of life exist in the gray. 

I was a perfectionist paralyzed by indecision. No matter how much research and consulting others I did, it was never enough. Yet the one person whose opinion I always seemed to neglect was my own. Why did I so readily trust the opinions of others (or the Internet) and not myself? One thing that helped me begin to rebuild trust with myself was to stop thinking about things as solely black and white, a right choice and a wrong choice. Instead, I had options and information. Information about myself and information about each option. All I could do was make the best choice given the information and options I had at the current moment. There is no way to make a “wrong” choice if you can think about each decision as an opportunity to learn more about yourself. 

• I write my own story. And how I narrate it matters. 

In untangling and rewriting my internal narrative, I have found that even the smallest shifts can make an incredible difference. I stopped saying things “happened to me.” I am the object of this sentence. A passive being in my own life. Instead, I say, “I lived through this.” I am the subject. I am active and empowered. I have agency. 

The way we think shapes our perception. And the way we think is dictated by the words we choose to narrate our lives. We have the power to change our thoughts by changing our narration. Narrate wisely.

Written by #UMSocial intern and Michigan Ross senior Keara Kotten

• Contact | Submit Content

Office of the Vice President for Communications

• Mission and Vision
• Scientific Advancement Plan
• Science Visioning
• Research Framework
• Minority Health and Health Disparities Definitions
• Organizational Structure
• Staff Directory
• About the Director
• Director’s Messages
• News Mentions
• Presentations
• Selected Publications
• Director's Laboratory
• Congressional Justification
• Congressional Testimony
• Legislative History
• NIH Minority Health and Health Disparities Strategic Plan 2021-2025
• Minority Health and Health Disparities: Definitions and Parameters
• NIH and HHS Commitment
• Foundation for Planning
• Structure of This Plan
• Strategic Plan Categories
• Summary of Categories and Goals
• Scientific Goals, Research Strategies, and Priority Areas
• Research-Sustaining Activities: Goals, Strategies, and Priority Areas
• Outreach, Collaboration, and Dissemination: Goals and Strategies
• Leap Forward Research Challenge
• Future Plans
• Research Interest Areas
• Research Centers
• Research Endowment
• Community Based Participatory Research Program (CBPR)
• SBIR/STTR: Small Business Innovation/Tech Transfer
• Solicited and Investigator-Initiated Research Project Grants
• Scientific Conferences
• Training and Career Development
• Loan Repayment Program (LRP)
• Data Management and Sharing
• Social and Behavioral Sciences
• Population and Community Health Sciences
• Epidemiology and Genetics
• Medical Research Scholars Program (MRSP)
• Coleman Research Innovation Award
• Health Disparities Interest Group
• Art Challenge
• Breathe Better Network
• Healthy Hearts Network
• DEBUT Challenge
• Healthy Mind Initiative
• Mental Health Essay Contest
• Science Day for Students at NIH
• Fuel Up to Play 60 en Español
• Brother, You're on My Mind
• Celebrating National Minority Health Month
• Reaching People in Multiple Languages
• Funding Strategy
• Active Funding Opportunities
• Expired Funding Opportunities
• Technical Assistance Webinars

• Community Health and Population Sciences
• Clinical and Health Services Research
• Integrative Biological and Behavioral Sciences
• Intramural Research Program
• Training and Diverse Workforce Development
• Inside NIMHD
• ScHARe HDPulse PhenX SDOH Toolkit Understanding Health Disparities For Research Applicants For Research Grantees Research and Training Programs Reports and Data Resources Health Information for the Public Science Education

• NIMHD Programs
• NIMHD Education and Outreach
• NIH Teen Mental Health Essay Contest

• Extramural Research
• Intramural Research
• NIMHD Collaborations
• Fuel Up to Play 60 en Espanol
• COVID-19 Information and Resources

Speaking Up About Mental Health

National essay contest.

SUBMIT YOUR ESSAY The contest is open to high school students ages 16-18

PROMOTION TOOLKIT Help spread the word with social media and email tools

December 1, 2023

Dec. 1, 2023

January 16, 2024

Jan. 16, 2024

May 31, 2024

Mental health is an important part of overall health across all life stages. However, far too often, symptoms are not addressed or recognized among teens.

Speaking Up About Mental Health is an essay contest that challenges high school students ages 16-18 to raise awareness of mental health. The contest gives students a platform to share ways to eliminate and/or reduce mental health stigma faced by young people, especially in diverse communities.

This contest is soliciting essays that:

• Discuss ways to eliminate and/or reduce mental health stigma faced by young people, especially in diverse communities
• Share resilience and coping strategies to overcome mental health issues such as social isolation and loneliness, depression, and anxiety
• Address mental health stigma
• Encourage conversations about mental health, social media, and/or technology
• Suggest school policies or practices that could help reduce stigma
• Describe barriers to mental health treatment
• Cover other areas of concern to individuals and their communities with respect to mental health

Get details on contest rules and submit your entry on Challenge.gov

Promotion toolkit : Help promote the Speaking Up About Mental Health essay contest

The contest is led by:

National Institute of Mental Health

National Institute on Minority Health and Health Disparities

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Page updated Jan. 23, 2024

September 2022: NIH Announces Winners of High School Mental Health Essay Contest

2022 Essay Awardees

2019 Essay Awardees

[email protected]

Staying Connected

• Funding Opportunities  
• News & Events  
• HHS Vulnerability Disclosure  
• Privacy/Disclaimer/Accessibility Policy  
• Viewers & Players  

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• v.12(6); 2020 Jun

Social Media Use and Its Connection to Mental Health: A Systematic Review

Fazida karim.

1 Psychology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA

2 Business & Management, University Sultan Zainal Abidin, Terengganu, MYS

Azeezat A Oyewande

3 Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA

4 Family Medicine, Lagos State Health Service Commission/Alimosho General Hospital, Lagos, NGA

Lamis F Abdalla

5 Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA

Reem Chaudhry Ehsanullah

Safeera khan.

Social media are responsible for aggravating mental health problems. This systematic study summarizes the effects of social network usage on mental health. Fifty papers were shortlisted from google scholar databases, and after the application of various inclusion and exclusion criteria, 16 papers were chosen and all papers were evaluated for quality. Eight papers were cross-sectional studies, three were longitudinal studies, two were qualitative studies, and others were systematic reviews. Findings were classified into two outcomes of mental health: anxiety and depression. Social media activity such as time spent to have a positive effect on the mental health domain. However, due to the cross-sectional design and methodological limitations of sampling, there are considerable differences. The structure of social media influences on mental health needs to be further analyzed through qualitative research and vertical cohort studies.

Introduction and background

Human beings are social creatures that require the companionship of others to make progress in life. Thus, being socially connected with other people can relieve stress, anxiety, and sadness, but lack of social connection can pose serious risks to mental health [ 1 ].

Social media

Social media has recently become part of people's daily activities; many of them spend hours each day on Messenger, Instagram, Facebook, and other popular social media. Thus, many researchers and scholars study the impact of social media and applications on various aspects of people’s lives [ 2 ]. Moreover, the number of social media users worldwide in 2019 is 3.484 billion, up 9% year-on-year [ 3 - 5 ]. A statistic in Figure  1  shows the gender distribution of social media audiences worldwide as of January 2020, sorted by platform. It was found that only 38% of Twitter users were male but 61% were using Snapchat. In contrast, females were more likely to use LinkedIn and Facebook. There is no denying that social media has now become an important part of many people's lives. Social media has many positive and enjoyable benefits, but it can also lead to mental health problems. Previous research found that age did not have an effect but gender did; females were much more likely to experience mental health than males [ 6 , 7 ].

Impact on mental health

Mental health is defined as a state of well-being in which people understand their abilities, solve everyday life problems, work well, and make a significant contribution to the lives of their communities [ 8 ]. There is debated presently going on regarding the benefits and negative impacts of social media on mental health [ 9 , 10 ]. Social networking is a crucial element in protecting our mental health. Both the quantity and quality of social relationships affect mental health, health behavior, physical health, and mortality risk [ 9 ]. The Displaced Behavior Theory may help explain why social media shows a connection with mental health. According to the theory, people who spend more time in sedentary behaviors such as social media use have less time for face-to-face social interaction, both of which have been proven to be protective against mental disorders [ 11 , 12 ]. On the other hand, social theories found how social media use affects mental health by influencing how people view, maintain, and interact with their social network [ 13 ]. A number of studies have been conducted on the impacts of social media, and it has been indicated that the prolonged use of social media platforms such as Facebook may be related to negative signs and symptoms of depression, anxiety, and stress [ 10 - 15 ]. Furthermore, social media can create a lot of pressure to create the stereotype that others want to see and also being as popular as others.

The need for a systematic review

Systematic studies can quantitatively and qualitatively identify, aggregate, and evaluate all accessible data to generate a warm and accurate response to the research questions involved [ 4 ]. In addition, many existing systematic studies related to mental health studies have been conducted worldwide. However, only a limited number of studies are integrated with social media and conducted in the context of social science because the available literature heavily focused on medical science [ 6 ]. Because social media is a relatively new phenomenon, the potential links between their use and mental health have not been widely investigated.

This paper attempt to systematically review all the relevant literature with the aim of filling the gap by examining social media impact on mental health, which is sedentary behavior, which, if in excess, raises the risk of health problems [ 7 , 9 , 12 ]. This study is important because it provides information on the extent of the focus of peer review literature, which can assist the researchers in delivering a prospect with the aim of understanding the future attention related to climate change strategies that require scholarly attention. This study is very useful because it provides information on the extent to which peer review literature can assist researchers in presenting prospects with a view to understanding future concerns related to mental health strategies that require scientific attention. The development of the current systematic review is based on the main research question: how does social media affect mental health?

Research strategy

The research was conducted to identify studies analyzing the role of social media on mental health. Google Scholar was used as our main database to find the relevant articles. Keywords that were used for the search were: (1) “social media”, (2) “mental health”, (3) “social media” AND “mental health”, (4) “social networking” AND “mental health”, and (5) “social networking” OR “social media” AND “mental health” (Table  1 ).

Out of the results in Table  1 , a total of 50 articles relevant to the research question were selected. After applying the inclusion and exclusion criteria, duplicate papers were removed, and, finally, a total of 28 articles were selected for review (Figure  2 ).

PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Inclusion and exclusion criteria

Peer-reviewed, full-text research papers from the past five years were included in the review. All selected articles were in English language and any non-peer-reviewed and duplicate papers were excluded from finally selected articles.

Of the 16 selected research papers, there were a research focus on adults, gender, and preadolescents [ 10 - 19 ]. In the design, there were qualitative and quantitative studies [ 15 , 16 ]. There were three systematic reviews and one thematic analysis that explored the better or worse of using social media among adolescents [ 20 - 23 ]. In addition, eight were cross-sectional studies and only three were longitudinal studies [ 24 - 29 ].The meta-analyses included studies published beyond the last five years in this population. Table  2  presents a selection of studies from the review.

IGU, internet gaming disorder; PSMU, problematic social media use

This study has attempted to systematically analyze the existing literature on the effect of social media use on mental health. Although the results of the study were not completely consistent, this review found a general association between social media use and mental health issues. Although there is positive evidence for a link between social media and mental health, the opposite has been reported.

For example, a previous study found no relationship between the amount of time spent on social media and depression or between social media-related activities, such as the number of online friends and the number of “selfies”, and depression [ 29 ]. Similarly, Neira and Barber found that while higher investment in social media (e.g. active social media use) predicted adolescents’ depressive symptoms, no relationship was found between the frequency of social media use and depressed mood [ 28 ].

In the 16 studies, anxiety and depression were the most commonly measured outcome. The prominent risk factors for anxiety and depression emerging from this study comprised time spent, activity, and addiction to social media. In today's world, anxiety is one of the basic mental health problems. People liked and commented on their uploaded photos and videos. In today's age, everyone is immune to the social media context. Some teens experience anxiety from social media related to fear of loss, which causes teens to try to respond and check all their friends' messages and messages on a regular basis.

On the contrary, depression is one of the unintended significances of unnecessary use of social media. In detail, depression is limited not only to Facebooks but also to other social networking sites, which causes psychological problems. A new study found that individuals who are involved in social media, games, texts, mobile phones, etc. are more likely to experience depression.

The previous study found a 70% increase in self-reported depressive symptoms among the group using social media. The other social media influence that causes depression is sexual fun [ 12 ]. The intimacy fun happens when social media promotes putting on a facade that highlights the fun and excitement but does not tell us much about where we are struggling in our daily lives at a deeper level [ 28 ]. Another study revealed that depression and time spent on Facebook by adolescents are positively correlated [ 22 ]. More importantly, symptoms of major depression have been found among the individuals who spent most of their time in online activities and performing image management on social networking sites [ 14 ].

Another study assessed gender differences in associations between social media use and mental health. Females were found to be more addicted to social media as compared with males [ 26 ]. Passive activity in social media use such as reading posts is more strongly associated with depression than doing active use like making posts [ 23 ]. Other important findings of this review suggest that other factors such as interpersonal trust and family functioning may have a greater influence on the symptoms of depression than the frequency of social media use [ 28 , 29 ].

Limitation and suggestion

The limitations and suggestions were identified by the evidence involved in the study and review process. Previously, 7 of the 16 studies were cross-sectional and slightly failed to determine the causal relationship between the variables of interest. Given the evidence from cross-sectional studies, it is not possible to conclude that the use of social networks causes mental health problems. Only three longitudinal studies examined the causal relationship between social media and mental health, which is hard to examine if the mental health problem appeared more pronounced in those who use social media more compared with those who use it less or do not use at all [ 19 , 20 , 24 ]. Next, despite the fact that the proposed relationship between social media and mental health is complex, a few studies investigated mediating factors that may contribute or exacerbate this relationship. Further investigations are required to clarify the underlying factors that help examine why social media has a negative impact on some peoples’ mental health, whereas it has no or positive effect on others’ mental health.

Conclusions

Social media is a new study that is rapidly growing and gaining popularity. Thus, there are many unexplored and unexpected constructive answers associated with it. Lately, studies have found that using social media platforms can have a detrimental effect on the psychological health of its users. However, the extent to which the use of social media impacts the public is yet to be determined. This systematic review has found that social media envy can affect the level of anxiety and depression in individuals. In addition, other potential causes of anxiety and depression have been identified, which require further exploration.

The importance of such findings is to facilitate further research on social media and mental health. In addition, the information obtained from this study can be helpful not only to medical professionals but also to social science research. The findings of this study suggest that potential causal factors from social media can be considered when cooperating with patients who have been diagnosed with anxiety or depression. Also, if the results from this study were used to explore more relationships with another construct, this could potentially enhance the findings to reduce anxiety and depression rates and prevent suicide rates from occurring.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

There’s a Reason They’re Called ‘Gut’ Feelings

I n the 1800s, a French Canadian named Alexis St. Martin was shot in the stomach while at a fur trading post, when someone’s musket accidentally fired at close range. He survived, but his injuries resulted in a hole in his stomach wall. This provided an early window—literally—into how our emotions and mental health affect the gut. Through careful experiments, the surgeon William Beaumont discovered that St. Martin’s mental state had direct physiological consequences on his stomach’s activity: when he felt irritable, for example, his digestion slowed. Somehow, his emotional states were manifest in the specific, local biology of his gut.

Most people have experienced the gut consequences of their emotional feelings. Nerves before an exam might lead you to feel nauseous or even vomit. Profound sadness might make you lose your appetite, or perhaps cause a hunger impossible to satiate. Gut symptoms are common in mental health conditions, from appetite changes in depression to debilitating “psychosomatic” stomach pains. Many of our feelings are gut feelings.

But the gut doesn’t just respond to emotional feelings: it influences them, too. Take disgust. Disgust is visceral. Our stomach, like our heart, has a regular electrical rhythm; even just seeing something disgusting causes disruptions, called “dysrhythmias,” in this electrical signalling. Although disgust is crucial for survival—helping us avoid disease and stay alive—in many mental health conditions disgust becomes pathological. In obsessive compulsive disorder (OCD), for instance, dirt or germs can preoccupy someone’s thoughts, causing symptoms like compulsive hand-washing. Self-disgust is common in depression and eating disorders. And even post-traumatic disorder can be brought on by profoundly disgusting traumas.

Pathological disgust is particularly hard to treat : exposure therapy and other psychological approaches are much less effective than for fear-based mental health problems. A couple years ago, working as a neuroscientist at the University of Cambridge, I wondered if abnormal signals from the stomach could be causing disgust avoidance. I ran an experiment to test this hypothesis, and found that changing someone’s gut activity with a common anti-nausea drug reduced their disgust avoidance . This could represent a new way of treating pathological disgust in mental health disorders. For example, an anti-nausea drug could be administered just before exposure therapy, enabling patients to engage with therapy under a more optimal gut state.

Read More: How I Learned to Listen to What My Gut Was Telling Me

So gut feelings are not “all in your mind”—but they are not “all in your gut,” either. Sensations from the gut are transmitted to the brain via the vagus nerve, the primary channel of information sent from the body to the brain. A second route to target “gut feelings” is by electrically stimulating this nerve, which changes the electrical rhythm of the stomach . That said,  the idea is not new: vagus nerve stimulation for patients with major depression dates back to 2000 .

A new theory published in November 2023 proposes that vagus nerve stimulation amplifies signals from the internal body to the brain, which helps us adapt our behaviour to its current challenges and needs. That could explain why the effects of vagus nerve stimulation are so wide-reaching, altering learning, memory, and motivation. That means amplifying signals from the gut using vagus nerve stimulation might improve mental health in some cases, but in others could be ineffective or even detrimental. Ultimately, we need to consider the state and needs of someone’s internal body before amplifying the body’s influence on the brain.

But the importance of the vagus nerve extends to even more established treatments: evidence from mice suggests that the most common type of antidepressant drugs (SSRIs, or selective serotonin reuptake inhibitors) require the vagus nerve to work. This, too, could begin to provide clues why antidepressants do, or don’t, work for a given person, and even help us understand why they might cause side effects in some people.

If the vagus nerve’s role helps us adapt to our bodily needs, perhaps the most important internal need of all is energy. One function of the gut—together with other organs—is metabolism, converting food to energy the body can use. There are mysterious and wide-ranging connections between our metabolic system and mental health. For example, the prevalence of depression in people with diabetes is two or three times higher than in the general population. It’s not clear why: diabetes could increase depression risk, or vice versa. My lab is currently testing a third possibility: that common metabolic factors might increase your risk of both depression and diabetes because of interactions between the body and the brain. If we’re right, this could open up avenues toward metabolic interventions that improve both physical and mental health.

Our brain and wider nervous system adapts to its circumstances, including the body’s internal, metabolic needs, as well as our experience of the environment around us. Because of this, your gut-brain connection is not static, but rather changes and adapts over time. A fascinating study in 2021 discovered that brain cells can re-activate gut inflammation that an animal has previously experienced. The mere “memory” of gut inflammation, stored in cells in the brain, induced the physical state in the body. So sometimes a “gut feeling” actually originates from the brain. This role of the brain in “gut feelings” means our brain has the capacity to produce dysfunctional gut symptoms via brain changes alone. This ability of the brain could have upsides as well, perhaps explaining why psychological therapy—which causes brain changes —can also treat some gut conditions .

Gut feelings originate from many sources: directly through the gut, through channels of communication between gut and brain, or even through the brain itself. In neuroscience, as we unravel the dynamic communications between gut and brain, we can begin to understand how these processes helped our ancestors survive—and how we could better harness them to improve emotional and mental wellbeing. A gut feeling might have many possible causes, but each of these represent a potential solution for mental health.

More Must-Reads From TIME

• Jane Fonda Champions Climate Action for Every Generation
• Biden’s Campaign Is In Trouble. Will the Turnaround Plan Work?
• Why We're Spending So Much Money Now
• The Financial Influencers Women Actually Want to Listen To
• Breaker Sunny Choi Is Heading to Paris
• Why TV Can’t Stop Making Silly Shows About Lady Journalists
• The Case for Wearing Shoes in the House
• Want Weekly Recs on What to Watch, Read, and More? Sign Up for Worth Your Time

Contact us at [email protected]

You May Also Like

Home — Essay Samples — Nursing & Health — Mental Health — Understanding Mental Health: Definition, Causes, and Impacts

Understanding Mental Health: Definition, Causes, and Impacts

• Categories: Mental Health

About this sample

Words: 638 |

Published: Jan 29, 2024

Words: 638 | Page: 1 | 4 min read

Table of contents

Definition and understanding of mental health, causes of mental health issues, common mental health disorders, impact of mental health on individuals, stigma surrounding mental health, effective ways to promote positive mental health.

• World Health Organization. (2014). Mental health: a state of well-being. Retrieved from https://www.who.int/features/factfiles/mental_health/en/
• National Institute of Mental Health. (n.d.). Mental Health Information. Retrieved from https://www.nimh.nih.gov/health/publications/mental-health-information/index.shtml

Cite this Essay

Let us write you an essay from scratch

• 450+ experts on 30 subjects ready to help
• Custom essay delivered in as few as 3 hours

Get high-quality help

Verified writer

• Expert in: Nursing & Health

+ 120 experts online

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Related Essays

1 pages / 670 words

5 pages / 2449 words

3 pages / 1405 words

2 pages / 834 words

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

Still can’t find what you need?

Browse our vast selection of original essay samples, each expertly formatted and styled

Related Essays on Mental Health

The relationship between mental illness and homelessness is a deeply intertwined and complex issue that affects individuals and communities across the globe. This essay delves into the multifaceted connection between mental [...]

Mental health stigma is a pervasive issue that hinders individuals from seeking help, perpetuates myths, and marginalizes those who experience mental health challenges. This essay explores the nature of mental health stigma in [...]

Easterlin, M., Chung, P., & Leng, M. (2023). Association of Team Sports Participation With Long-term Mental Health Outcomes Among Individuals Exposed to Adverse Childhood Experiences. JAMA Pediatrics.National Public Radio (NPR). [...]

Mental illness within the criminal justice system is a complex and pressing issue that intersects legal, medical, and ethical considerations. This essay examines the challenges posed by mental illness among individuals in the [...]

“Eat your vegetables! Exercise! Get a good night's sleep!” We’ve all known to take care of our bodies since grade school P. E. class. But what about our mental health, isn’t mental health just as important as physical health? [...]

J.D. is an 8 year-old male student at Central Philadelphia elementary school whom is diagnosed with Attention-Deficit Hyperactivity Disorder. J.D. was referred by his physician to receive psychiatric inpatient treatment [...]

Related Topics

By clicking “Send”, you agree to our Terms of service and Privacy statement . We will occasionally send you account related emails.

Where do you want us to send this sample?

By clicking “Continue”, you agree to our terms of service and privacy policy.

Be careful. This essay is not unique

This essay was donated by a student and is likely to have been used and submitted before

Download this Sample

Free samples may contain mistakes and not unique parts

Sorry, we could not paraphrase this essay. Our professional writers can rewrite it and get you a unique paper.

Please check your inbox.

We can write you a custom essay that will follow your exact instructions and meet the deadlines. Let's fix your grades together!

Get Your Personalized Essay in 3 Hours or Less!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

• Instructions Followed To The Letter
• Deadlines Met At Every Stage
• Unique And Plagiarism Free

Journaling For Mental Health: How To Do It Effectively To Improve Mood And Well-Being

Here's what the science says.

“Journaling can be a powerful way to organize your thoughts, feelings, and ideas, leading to increased self-awareness, self-discovery, and growth,” says Jaci Witmer Lopez, PsyD, a licensed clinical psychologist based in New York City. “In my practice, I've seen firsthand how regular journaling can transform lives.”

Maybe you've kept a fitness journal in the past to help you stay on track toward your wellness goals, or you currently have a gratitude journal to stay grounded. There are travel journals to help you document your adventures, and if you’re less artistically inclined, there are even journaling apps to help you stay mindful on the go. Below, experts share the benefits of journaling for mental health, how to start one yourself, and specific writing prompts for inspiration.

Meet the experts: Jaci Witmer Lopez, PsyD , is a clinical psychologist based in New York City. Marc Campbell, LMHC , is a licensed therapist based in Orlando, Florida, and the author of I Love My Queer Kid .

Common Benefits Of Journaling

Apart from having a dedicated place for juicy diary entries, there are several general benefits of journaling. The practice has been shown to help people process stressful events, according to a study published in Annals of Behavioral Medicine . In another study about college students, researchers found that journaling may improve self-efficacy —in other words, it can help you believe in yourself. Writing has even been studied as a behavioral intervention for children—so if you have kiddos at home, encouraging them to write may not be such a bad idea.

Common benefits of journaling include:

• Finding inspiration
• Creative expression
• Tracking your goals
• Fun freewriting
• General reflection
• Brainstorming ideas

5 Mental Health Benefits Of Journaling

Apart from its general benefits, here's how journaling can impact your mental health, specifically, according to experts.

1. It can help you process (and learn from) your emotions.

“Remembering the events from your day—both the ups and the downs—can help your brain practice processing and regulating your emotions,” says Marc Campbell, LMHC, a licensed therapist based in Orlando, Florida. For instance, if you’re feeling rejected from a recent breakup or you're burned out at work, writing about how you feel and reading it back to yourself can help you process the difficult emotions. Journaling can also help you recognize certain patterns, practice more acceptance, and have more empathy for yourself, Campbell says.

2. It can help you heal from traumatic events.

Journaling can significantly impact your ability to process and heal from trauma, Lopez says. “ Research has shown that writing can reduce symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD),” she says. “When you write things down as opposed to just thinking about them, you hold yourself accountable to reframing or changing your narrative.” Although the mental health effects of trauma won’t disappear by simply writing down how you feel, journaling can be a helpful practice in addition to seeking therapy and trauma treatment .

3. It may help you manage anxiety and depression.

Anxiety and depression are among the most commonly cited mental health struggles in America, per the American Psychological Association (APA). And although having a writing practice won't cure these conditions overnight, journaling may have the potential to decrease depression and anxiety and improve resilience over time, according to a recent study . Plus, if you’re struggling to find meaning in everyday life or you feel generally disengaged—both of which are common experiences when facing mental health challenges— some studies suggest that journaling may help.

4. It can help you track your therapy progress.

If you're seeing a therapist right now, journaling can help you check in with yourself daily or weekly about how it’s going—or even help you hold yourself accountable for certain behaviors you’d like to change, Campbell says. “Through the process of journaling, you can reflect on past entries and potentially learn about any patterns you have,” he says.

You can also use a journal to reflect on what, exactly you speak about during your therapy sessions and begin to process how you’re feeling about it, Lopez adds. An added benefit? One day, you can look back at your journal and celebrate how far you've come.

5. It can help you practice self-compassion.

Whether you're dealing with a specific mental health issue or you're simply feeling overwhelmed, negative self-talk, shame, and embarrassment are common. It can be difficult to be kind to yourself, however, practicing self-compassion can go a long way, experts say. A recent study in the American Journal of Speech-Language Pathology found that daily journaling as a mindfulness practice led to increased levels of self-compassion, and another study on registered nurses found that journaling can boost compassion and help manage burnout.

How To Start Journaling For Mental Health

If you aren't someone who spilled your heart out in a childhood diary, don't worry—journaling can be as simple as jotting things down on your phone, in a notebook, or responding to a specific prompt to get inspiration (more on that soon).

There’s no “right” or “wrong” way to journal, but it should be a personal process, Campbell says. “I recommend starting journaling in the way that feels most authentic to you. If you prefer pen and paper, start with that. If you prefer typing things out in your notes app, that works, too. If you aren’t sure, try both and more—a laptop or even typewriter if you’re feeling adventurous,” he says. Also, writing for mental health is personal, but you shouldn't feel pressured to document your whole life story all at once (unless you want to).

Whether you incorporate journaling into your morning routine or you attempt five minutes before bedtime to free-write, experts recommend starting slow. “If you're new to journaling, my advice is to start small and be patient with yourself. Set aside just a few minutes a day to begin with, and gradually increase the time as you build the habit. It’s important to find a method that you'll stick with consistently," Lopez says. Try to pace yourself and make the practice as manageable as possible so that it becomes a habit formed over time, she adds.

10 Journal Prompts For Mental Health

• What was the highlight of my day?
• What was a lot moment of my day?
• What's a challenge I'm facing right now?
• What people, places, or things am I grateful for and why?
• Who is someone that's inspired me lately and why?
• What are three things I'm proud of myself for, and why?
• What is a small act of kindness I can do for myself this week?
• What is one limiting belief I have about myself? (And is there a way I can begin to reframe it)?
• Describe something you are struggling with. Then, read it from the perspective of someone you care about. What would they have to say about it?
• If I could change an aspect of my mental health and well-being right now, what would it be and why?

When it comes to journaling for mental health, consistency is key. Whatever method, prompt, or format you choose, your mental health will thank you.

Best Journals For Mental Health

The Five Minute Journal

Looking for a simple, sleek journal that will help you practice more mindfulness and gratitude? This popular option might be a good fit for you. It encourages you to cultivate a sense of calm for just five minutes a day, but there are plenty of helpful tools packed into the journal itself—like prompts, daily highlights, weekly challenges, affirmations, and more. If you're brand new to journaling for mental health, this one provides clear cues and outlines to help you self-reflect and feel more confident. Plus, it's aesthetically pleasing. What could be better?

The Big Feelings Survival Guide

This colorful, activity-filled workbook by licensed art therapist Alyse Ruriani, LPC, is a great option if you're ready to dive into mental health in a fun, accessible, yet meaningful way. The workbook includes practical and creative activities that are all rooted in dialectical behavior therapy (DBT), which, ICYMI, is a revolutionary treatment that helps people move through emotions. Not only will you gain major insight about your mental health journey, but the workbook itself is super bright and engaging—the helpful illustrations and eye-opening exercises are sure to help you reflect and gain inspiration.

Self-Love Workbook for Women

This self-love workbook by therapist Megan Logan, LCSW, is uniquely designed to help you release self-doubt and have more self-compassion. The journal includes quizzes, writing prompts, and fun activities to help you cultivate more self-love, like writing a message to your younger self and making a "happy playlist." You'll also find empowering affirmations for those days when your mental health isn't so good—plus, the journal provides helpful resources for goal-tracking, identifying emotions, and embracing who you are.

90-Day Mental Health Journal

This easy-to-follow journal encourages you to care for your mental health in a holistic way. If you're dealing with stress, anxiety, or uncertainty about the future, the journal claims to help you self-reflect and gain self-awareness while focusing on the power of the present moment. This journal is ideal for anyone who wants to breathe, reconnect with themselves, and cultivate more mindfulness. It comes with grounding activities and daily check-ins to help you keep track of your emotions—and understand their roots.

Lexi Inks (she/her) is a lifestyle journalist based in Jacksonville, Florida. She has reported on countless topics, including sexual wellness, astrology, relationship issues, non-monogamy, mental health, pop culture, and more. In addition to Women’s Health, her work has been published on Bustle, Cosmopolitan, Well + Good, Byrdie, Popsugar, and others. As a queer and plus-size woman with living with mental illness, Lexi strives for intersectionality and representation in all of her writing. She holds a BFA in Musical Theatre from Jacksonville University, which she has chosen to make everyone’s problem.

Mental Health

20 Best Guided Journals For Your Wellness Journey

‘I Had SCAD As A Healthy, Fit 36-Year-Old Woman’

'How I Trained For An Ironman With Parkinson's'

WNBA's Diamond DeShields Reflects On Spinal Tumor

'I Did 7 Marathons In 7 Days With Type 1 Diabetes'

'Ultra-Running Helps Me Cope With Lupus Symptoms'

‘What It's Like To Be A Dancer With Hearing Loss’

'How I Progressed To Deadlift 375 Pounds'

What Is Anticipatory Grief?

What Is Body Neutrality, Exactly? Experts Weigh In

Why Don’t We Prescribe Exercise For Mental Health?

I deleted my email app. My mental health, free time, and productivity skyrocketed.

• I've deleted social media apps from my phone, but was still hooked to my email app. 
• Deleting it freed up time in my day for more meaningful things.
• Checking my email less actually helped me to stay on top of my emails. 

Deleting apps for the sake of my mental health and productivity is nothing new for me. Instagram and TikTok don't live on my phone; they're merely temporary tenants I let stop by on weekends. But as a self-employed writer, there's one app that's haunted me far more than social media: my email app.

Unlike social media, my email is inherently tied to my work. Where TikTok shows me trending dances, my inbox shows me all the people I've yet to respond to. Not to mention, email itself is work. I can dip into social media as I dip my hands into a rushing stream — delighting in the cool waters of a distracting video, then dip back out. With email, I am Sisyphus, desperately trying to scoop the whole stream into little buckets all day while the gods laugh at their sick joke — the stream never stops rushing.

It wasn't until I attended a small business workshop a few months ago that I latched onto a radical idea for curbing my email addiction . Toward the end of the workshop, the host offhandedly mentioned she hadn't had email on her phone since 2020. It had never occurred to me: you could just... delete your email app?

Staying on top of my email had become synonymous with staying on top of my work . But I had to know: what would happen if I ditched my email app and only checked my inbox on my computer a few times a day?

It immediately freed up my time for more meaningful work

From the first day, it became clear just how much time I wasted trying to stay on top of my inbox . Instead of focusing on my to-do list for the day, all too often I'd get sucked into requests from others.

Related stories

Over the coming weeks, it became easier to dive into my creative flow and focus on my own priorities when the temptation to check my email app was gone. I was no longer stuck on the hamster wheel of reacting to others' needs and subsequently sacrificing my own.

It transformed my work-life balance

When I first deleted my email app , I decided I would only check my desktop inbox three times a day: in the morning, at lunch, and at the end of my workday. The habit became a powerful signal of stepping in and out of my professional identity. I'd put on my metaphorical Writer Hat by checking my email in the morning, and I'd hang it up again when I checked my inbox in the afternoon.

My work stopped bleeding into evenings and weekends. While it was scary at first, I realized anyone who genuinely needed me in an emergency had my phone number and knew how to use it.

It actually helped me stay on top of my email

Paradoxically, I consistently live closer to Inbox Zero than I ever have. Before, checking my email multiple times an hour was an easy way to get a hit of feel-good chemicals to my brain.

Now that I check less frequently, I'm not browsing for a dopamine hit — I'm really there to check my email. I've been shocked to realize how much easier it is to handle my inbox in a few fell swoops throughout the day rather than sitting and hitting refresh all daylong.

I have more time for what matters

For me, keeping on top of my emails simply isn't as important as other work tasks. So why was I treating my inbox as one of my highest priorities by checking it all the time? My email app had become a facade of busyness and efficiency. By stepping away, I've found greater clarity and peace.

Anyone interested in the same is welcome to message me — just remember, it may take me a little while to get back your email.

Watch: Threads vs. Twitter: What we know about the apps

• Main content

Study Tracks Shifts in Student Mental Health During College

Dartmouth study followed 200 students all four years, including through the pandemic.

Phone App Uses AI to Detect Depression From Facial Cues

A four-year study by Dartmouth researchers captures the most in-depth data yet on how college students’ self-esteem and mental health fluctuates during their four years in academia, identifying key populations and stressors that the researchers say administrators could target to improve student well-being. 

The study also provides among the first real-time accounts of how the coronavirus pandemic affected students’ behavior and mental health. The stress and uncertainty of COVID-19 resulted in long-lasting behavioral changes that persisted as a “new normal” even as the pandemic diminished, including students feeling more stressed, less socially engaged, and sleeping more.

The researchers tracked more than 200 Dartmouth undergraduates in the classes of 2021 and 2022 for all four years of college. Students volunteered to let a specially developed app called StudentLife tap into the sensors that are built into smartphones. The app cataloged their daily physical and social activity, how long they slept, their location and travel, the time they spent on their phone, and how often they listened to music or watched videos. Students also filled out weekly behavioral surveys, and selected students gave post-study interviews. 

The study—which is the longest mobile-sensing study ever conducted—is published in the Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies .

The researchers will present it at the Association of Computing Machinery’s UbiComp/ISWC 2024 conference in Melbourne, Australia, in October. 

These sorts of tools will have a tremendous impact on projecting forward and developing much more data-driven ways to intervene and respond exactly when students need it most.

The team made their anonymized data set publicly available —including self-reports, surveys, and phone-sensing and brain-imaging data—to help advance research into the mental health of students during their college years. 

Andrew Campbell , the paper’s senior author and Dartmouth’s Albert Bradley 1915 Third Century Professor of Computer Science, says that the study’s extensive data reinforces the importance of college and university administrators across the country being more attuned to how and when students’ mental well-being changes during the school year.

“For the first time, we’ve produced granular data about the ebb and flow of student mental health. It’s incredibly dynamic—there’s nothing that’s steady state through the term, let alone through the year,” he says. “These sorts of tools will have a tremendous impact on projecting forward and developing much more data-driven ways to intervene and respond exactly when students need it most.”

First-year and female students are especially at risk for high anxiety and low self-esteem, the study finds. Among first-year students, self-esteem dropped to its lowest point in the first weeks of their transition from high school to college but rose steadily every semester until it was about 10% higher by graduation.

“We can see that students came out of high school with a certain level of self-esteem that dropped off to the lowest point of the four years. Some said they started to experience ‘imposter syndrome’ from being around other high-performing students,” Campbell says. “As the years progress, though, we can draw a straight line from low to high as their self-esteem improves. I think we would see a similar trend class over class. To me, that’s a very positive thing.”

Female students—who made up 60% of study participants—experienced on average 5% greater stress levels and 10% lower self-esteem than male students. More significantly, the data show that female students tended to be less active, with male students walking 37% more often.

Sophomores were 40% more socially active compared to their first year, the researchers report. But these students also reported feeling 13% more stressed during their second year than during their first year as their workload increased, they felt pressure to socialize, or as first-year social groups dispersed.

One student in a sorority recalled that having pre-arranged activities “kind of adds stress as I feel like I should be having fun because everyone tells me that it is fun.” Another student noted that after the first year, “students have more access to the whole campus and that is when you start feeling excluded from things.” 

In a novel finding, the researchers identify an “anticipatory stress spike” of 17% experienced in the last two weeks of summer break. While still lower than mid-academic year stress, the spike was consistent across different summers.

In post-study interviews, some students pointed to returning to campus early for team sports as a source of stress. Others specified reconnecting with family and high school friends during their first summer home, saying they felt “a sense of leaving behind the comfort and familiarity of these long-standing friendships” as the break ended, the researchers report. 

“This is a foundational study,” says Subigya Nepal , first author of the study and a PhD candidate in Campbell’s research group. “It has more real-time granular data than anything we or anyone else has provided before. We don’t know yet how it will translate to campuses nationwide, but it can be a template for getting the conversation going.”

The depth and accuracy of the study data suggest that mobile-sensing software could eventually give universities the ability to create proactive mental-health policies specific to certain student populations and times of year, Campbell says.

For example, a paper Campbell’s research group published in 2022 based on StudentLife data showed that first-generation students experienced lower self-esteem and higher levels of depression than other students throughout their four years of college.

“We will be able to look at campus in much more nuanced ways than waiting for the results of an annual mental health study and then developing policy,” Campbell says. “We know that Dartmouth is a small and very tight-knit campus community. But if we applied these same methods to a college with similar attributes, I believe we would find very similar trends.”

Weathering the pandemic

When students returned home at the start of the coronavirus pandemic, the researchers found that self-esteem actually increased during the pandemic by 5% overall and by another 6% afterward when life returned closer to what it was before. One student suggested in their interview that getting older came with more confidence. Others indicated that being home led to them spending more time with friends talking on the phone, on social media, or streaming movies together. 

The data show that phone usage—measured by the duration a phone was unlocked—indeed increased by nearly 33 minutes, or 19%, during the pandemic, while time spent in physical activity dropped by 52 minutes, or 27%. By 2022, phone usage fell from its pandemic peak to just above pre-pandemic levels, while engagement in physical activity had recovered to exceed the pre-pandemic period by three minutes. 

Despite reporting higher self-esteem, students’ feelings of stress increased by more than 10% during the pandemic. By the end of the study in June 2022, stress had fallen by less than 2% of its pandemic peak, indicating that the experience had a lasting impact on student well-being, the researchers report. 

In early 2021, as students returned to campus, their reunion with friends and community was tempered by an overwhelming concern about the still-rampant coronavirus. “There was the first outbreak in winter 2021 and that was terrifying,” one student recalls. Another student adds: “You could be put into isolation for a long time even if you did not have COVID. Everyone was afraid to contact-trace anyone else in case they got mad at each other.”

Female students were especially concerned about the coronavirus, on average 13% more than male students. “Even though the girls might have been hanging out with each other more, they are more aware of the impact,” one female student reported. “I actually had COVID and exposed some friends of mine. All the girls that I told tested as they were worried. They were continually checking up to make sure that they did not have it and take it home to their family.”

Students still learning remotely had social levels 16% higher than students on campus, who engaged in activity an average of 10% less often than when they were learning from home. However, on-campus students used their phones 47% more often. When interviewed after the study, these students reported spending extended periods of time video-calling or streaming movies with friends and family.

Social activity and engagement had not yet returned to pre-pandemic levels by the end of the study in June 2022, recovering by a little less than 3% after a nearly 10% drop during the pandemic. Similarly, the pandemic correlates with students sticking closer to home, with their distance traveled nearly cut in half during the pandemic and holding at that level since then.

Campbell and several of his fellow researchers are now developing a smartphone app known as MoodCapture that uses artificial intelligence paired with facial-image processing software to reliably detect the onset of depression before the user even knows something is wrong.

Morgan Kelly can be reached at [email protected] .

• Mental Health and Wellness
• Innovation and Impact
• Arts and Sciences
• Class of 2021
• Class of 2022
• Department of Computer Science
• Guarini School of Graduate and Advanced Studies
• Mental Health

A Q&A With Film Critic and Theorist Vinzenz Hediger

After a Year of Turmoil, Harvard’s Applications Drop

End the Phone-Based Childhood Now

The environment in which kids grow up today is hostile to human development.

Listen to this article

Produced by ElevenLabs and News Over Audio (NOA) using AI narration.

This article was featured in the One Story to Read Today newsletter. Sign up for it here .

S omething went suddenly and horribly wrong for adolescents in the early 2010s. By now you’ve likely seen the statistics : Rates of depression and anxiety in the United States—fairly stable in the 2000s—rose by more than 50 percent in many studies from 2010 to 2019. The suicide rate rose 48 percent for adolescents ages 10 to 19. For girls ages 10 to 14, it rose 131 percent.

The problem was not limited to the U.S.: Similar patterns emerged around the same time in Canada, the U.K., Australia, New Zealand , the Nordic countries , and beyond . By a variety of measures and in a variety of countries, the members of Generation Z (born in and after 1996) are suffering from anxiety, depression, self-harm, and related disorders at levels higher than any other generation for which we have data.

The decline in mental health is just one of many signs that something went awry. Loneliness and friendlessness among American teens began to surge around 2012. Academic achievement went down, too. According to “The Nation’s Report Card,” scores in reading and math began to decline for U.S. students after 2012, reversing decades of slow but generally steady increase. PISA, the major international measure of educational trends, shows that declines in math, reading, and science happened globally, also beginning in the early 2010s.

Read: It sure looks like phones are making students dumber

As the oldest members of Gen Z reach their late 20s, their troubles are carrying over into adulthood. Young adults are dating less , having less sex, and showing less interest in ever having children than prior generations. They are more likely to live with their parents. They were less likely to get jobs as teens , and managers say they are harder to work with. Many of these trends began with earlier generations, but most of them accelerated with Gen Z.

Surveys show that members of Gen Z are shyer and more risk averse than previous generations, too, and risk aversion may make them less ambitious. In an interview last May , OpenAI co-founder Sam Altman and Stripe co-founder Patrick Collison noted that, for the first time since the 1970s, none of Silicon Valley’s preeminent entrepreneurs are under 30. “Something has really gone wrong,” Altman said. In a famously young industry, he was baffled by the sudden absence of great founders in their 20s.

Generations are not monolithic, of course. Many young people are flourishing. Taken as a whole, however, Gen Z is in poor mental health and is lagging behind previous generations on many important metrics. And if a generation is doing poorly––if it is more anxious and depressed and is starting families, careers, and important companies at a substantially lower rate than previous generations––then the sociological and economic consequences will be profound for the entire society.

What happened in the early 2010s that altered adolescent development and worsened mental health? Theories abound , but the fact that similar trends are found in many countries worldwide means that events and trends that are specific to the United States cannot be the main story.

I think the answer can be stated simply, although the underlying psychology is complex: Those were the years when adolescents in rich countries traded in their flip phones for smartphones and moved much more of their social lives online—particularly onto social-media platforms designed for virality and addiction . Once young people began carrying the entire internet in their pockets, available to them day and night, it altered their daily experiences and developmental pathways across the board. Friendship, dating, sexuality, exercise, sleep, academics, politics, family dynamics, identity—all were affected. Life changed rapidly for younger children, too, as they began to get access to their parents’ smartphones and, later, got their own iPads, laptops, and even smartphones during elementary school.

Jonathan Haidt: Get phones out of schools now

Related Podcast

As a social psychologist who has long studied social and moral development, I have been involved in debates about the effects of digital technology for years. Typically, the scientific questions have been framed somewhat narrowly, to make them easier to address with data. For example, do adolescents who consume more social media have higher levels of depression? Does using a smartphone just before bedtime interfere with sleep? The answer to these questions is usually found to be yes, although the size of the relationship is often statistically small, which has led some researchers to conclude that these new technologies are not responsible for the gigantic increases in mental illness that began in the early 2010s.

But before we can evaluate the evidence on any one potential avenue of harm, we need to step back and ask a broader question: What is childhood––including adolescence––and how did it change when smartphones moved to the center of it? If we take a more holistic view of what childhood is and what young children, tweens, and teens need to do to mature into competent adults, the picture becomes much clearer. Smartphone-based life, it turns out, alters or interferes with a great number of developmental processes.

The intrusion of smartphones and social media are not the only changes that have deformed childhood. There’s an important backstory, beginning as long ago as the 1980s, when we started systematically depriving children and adolescents of freedom, unsupervised play, responsibility, and opportunities for risk taking, all of which promote competence, maturity, and mental health. But the change in childhood accelerated in the early 2010s, when an already independence-deprived generation was lured into a new virtual universe that seemed safe to parents but in fact is more dangerous, in many respects, than the physical world.

My claim is that the new phone-based childhood that took shape roughly 12 years ago is making young people sick and blocking their progress to flourishing in adulthood. We need a dramatic cultural correction, and we need it now.

Brain development is sometimes said to be “experience-expectant,” because specific parts of the brain show increased plasticity during periods of life when an animal’s brain can “expect” to have certain kinds of experiences. You can see this with baby geese, who will imprint on whatever mother-sized object moves in their vicinity just after they hatch. You can see it with human children, who are able to learn languages quickly and take on the local accent, but only through early puberty; after that, it’s hard to learn a language and sound like a native speaker. There is also some evidence of a sensitive period for cultural learning more generally. Japanese children who spent a few years in California in the 1970s came to feel “American” in their identity and ways of interacting only if they attended American schools for a few years between ages 9 and 15. If they left before age 9, there was no lasting impact. If they didn’t arrive until they were 15, it was too late; they didn’t come to feel American.

Human childhood is an extended cultural apprenticeship with different tasks at different ages all the way through puberty. Once we see it this way, we can identify factors that promote or impede the right kinds of learning at each age. For children of all ages, one of the most powerful drivers of learning is the strong motivation to play. Play is the work of childhood, and all young mammals have the same job: to wire up their brains by playing vigorously and often, practicing the moves and skills they’ll need as adults. Kittens will play-pounce on anything that looks like a mouse tail. Human children will play games such as tag and sharks and minnows, which let them practice both their predator skills and their escaping-from-predator skills. Adolescents will play sports with greater intensity, and will incorporate playfulness into their social interactions—flirting, teasing, and developing inside jokes that bond friends together. Hundreds of studies on young rats, monkeys, and humans show that young mammals want to play, need to play, and end up socially, cognitively, and emotionally impaired when they are deprived of play .

One crucial aspect of play is physical risk taking. Children and adolescents must take risks and fail—often—in environments in which failure is not very costly. This is how they extend their abilities, overcome their fears, learn to estimate risk, and learn to cooperate in order to take on larger challenges later. The ever-present possibility of getting hurt while running around, exploring, play-fighting, or getting into a real conflict with another group adds an element of thrill, and thrilling play appears to be the most effective kind for overcoming childhood anxieties and building social, emotional, and physical competence. The desire for risk and thrill increases in the teen years, when failure might carry more serious consequences. Children of all ages need to choose the risk they are ready for at a given moment. Young people who are deprived of opportunities for risk taking and independent exploration will, on average, develop into more anxious and risk-averse adults .

From the April 2014 issue: The overprotected kid

Human childhood and adolescence evolved outdoors, in a physical world full of dangers and opportunities. Its central activities––play, exploration, and intense socializing––were largely unsupervised by adults, allowing children to make their own choices, resolve their own conflicts, and take care of one another. Shared adventures and shared adversity bound young people together into strong friendship clusters within which they mastered the social dynamics of small groups, which prepared them to master bigger challenges and larger groups later on.

And then we changed childhood.

The changes started slowly in the late 1970s and ’80s, before the arrival of the internet, as many parents in the U.S. grew fearful that their children would be harmed or abducted if left unsupervised. Such crimes have always been extremely rare, but they loomed larger in parents’ minds thanks in part to rising levels of street crime combined with the arrival of cable TV, which enabled round-the-clock coverage of missing-children cases. A general decline in social capital ––the degree to which people knew and trusted their neighbors and institutions–– exacerbated parental fears . Meanwhile, rising competition for college admissions encouraged more intensive forms of parenting . In the 1990s, American parents began pulling their children indoors or insisting that afternoons be spent in adult-run enrichment activities. Free play, independent exploration, and teen-hangout time declined.

In recent decades, seeing unchaperoned children outdoors has become so novel that when one is spotted in the wild, some adults feel it is their duty to call the police. In 2015, the Pew Research Center found that parents, on average, believed that children should be at least 10 years old to play unsupervised in front of their house, and that kids should be 14 before being allowed to go unsupervised to a public park. Most of these same parents had enjoyed joyous and unsupervised outdoor play by the age of 7 or 8.

But overprotection is only part of the story. The transition away from a more independent childhood was facilitated by steady improvements in digital technology, which made it easier and more inviting for young people to spend a lot more time at home, indoors, and alone in their rooms. Eventually, tech companies got access to children 24/7. They developed exciting virtual activities, engineered for “engagement,” that are nothing like the real-world experiences young brains evolved to expect.

The first wave came ashore in the 1990s with the arrival of dial-up internet access, which made personal computers good for something beyond word processing and basic games. By 2003, 55 percent of American households had a computer with (slow) internet access. Rates of adolescent depression, loneliness, and other measures of poor mental health did not rise in this first wave. If anything, they went down a bit. Millennial teens (born 1981 through 1995), who were the first to go through puberty with access to the internet, were psychologically healthier and happier, on average, than their older siblings or parents in Generation X (born 1965 through 1980).

The second wave began to rise in the 2000s, though its full force didn’t hit until the early 2010s. It began rather innocently with the introduction of social-media platforms that helped people connect with their friends. Posting and sharing content became much easier with sites such as Friendster (launched in 2003), Myspace (2003), and Facebook (2004).

Teens embraced social media soon after it came out, but the time they could spend on these sites was limited in those early years because the sites could only be accessed from a computer, often the family computer in the living room. Young people couldn’t access social media (and the rest of the internet) from the school bus, during class time, or while hanging out with friends outdoors. Many teens in the early-to-mid-2000s had cellphones, but these were basic phones (many of them flip phones) that had no internet access. Typing on them was difficult––they had only number keys. Basic phones were tools that helped Millennials meet up with one another in person or talk with each other one-on-one. I have seen no evidence to suggest that basic cellphones harmed the mental health of Millennials.

It was not until the introduction of the iPhone (2007), the App Store (2008), and high-speed internet (which reached 50 percent of American homes in 2007 )—and the corresponding pivot to mobile made by many providers of social media, video games, and porn—that it became possible for adolescents to spend nearly every waking moment online. The extraordinary synergy among these innovations was what powered the second technological wave. In 2011, only 23 percent of teens had a smartphone. By 2015, that number had risen to 73 percent , and a quarter of teens said they were online “almost constantly.” Their younger siblings in elementary school didn’t usually have their own smartphones, but after its release in 2010, the iPad quickly became a staple of young children’s daily lives. It was in this brief period, from 2010 to 2015, that childhood in America (and many other countries) was rewired into a form that was more sedentary, solitary, virtual, and incompatible with healthy human development.

In the 2000s, Silicon Valley and its world-changing inventions were a source of pride and excitement in America. Smart and ambitious young people around the world wanted to move to the West Coast to be part of the digital revolution. Tech-company founders such as Steve Jobs and Sergey Brin were lauded as gods, or at least as modern Prometheans, bringing humans godlike powers. The Arab Spring bloomed in 2011 with the help of decentralized social platforms, including Twitter and Facebook. When pundits and entrepreneurs talked about the power of social media to transform society, it didn’t sound like a dark prophecy.

You have to put yourself back in this heady time to understand why adults acquiesced so readily to the rapid transformation of childhood. Many parents had concerns , even then, about what their children were doing online, especially because of the internet’s ability to put children in contact with strangers. But there was also a lot of excitement about the upsides of this new digital world. If computers and the internet were the vanguards of progress, and if young people––widely referred to as “digital natives”––were going to live their lives entwined with these technologies, then why not give them a head start? I remember how exciting it was to see my 2-year-old son master the touch-and-swipe interface of my first iPhone in 2008. I thought I could see his neurons being woven together faster as a result of the stimulation it brought to his brain, compared to the passivity of watching television or the slowness of building a block tower. I thought I could see his future job prospects improving.

Touchscreen devices were also a godsend for harried parents. Many of us discovered that we could have peace at a restaurant, on a long car trip, or at home while making dinner or replying to emails if we just gave our children what they most wanted: our smartphones and tablets. We saw that everyone else was doing it and figured it must be okay.

It was the same for older children, desperate to join their friends on social-media platforms, where the minimum age to open an account was set by law to 13, even though no research had been done to establish the safety of these products for minors. Because the platforms did nothing (and still do nothing) to verify the stated age of new-account applicants, any 10-year-old could open multiple accounts without parental permission or knowledge, and many did. Facebook and later Instagram became places where many sixth and seventh graders were hanging out and socializing. If parents did find out about these accounts, it was too late. Nobody wanted their child to be isolated and alone, so parents rarely forced their children to shut down their accounts.

We had no idea what we were doing.

The numbers are hard to believe. The most recent Gallup data show that American teens spend about five hours a day just on social-media platforms (including watching videos on TikTok and YouTube). Add in all the other phone- and screen-based activities, and the number rises to somewhere between seven and nine hours a day, on average . The numbers are even higher in single-parent and low-income families, and among Black, Hispanic, and Native American families.

These very high numbers do not include time spent in front of screens for school or homework, nor do they include all the time adolescents spend paying only partial attention to events in the real world while thinking about what they’re missing on social media or waiting for their phones to ping. Pew reports that in 2022, one-third of teens said they were on one of the major social-media sites “almost constantly,” and nearly half said the same of the internet in general. For these heavy users, nearly every waking hour is an hour absorbed, in full or in part, by their devices.

In Thoreau’s terms, how much of life is exchanged for all this screen time? Arguably, most of it. Everything else in an adolescent’s day must get squeezed down or eliminated entirely to make room for the vast amount of content that is consumed, and for the hundreds of “friends,” “followers,” and other network connections that must be serviced with texts, posts, comments, likes, snaps, and direct messages. I recently surveyed my students at NYU, and most of them reported that the very first thing they do when they open their eyes in the morning is check their texts, direct messages, and social-media feeds. It’s also the last thing they do before they close their eyes at night. And it’s a lot of what they do in between.

The amount of time that adolescents spend sleeping declined in the early 2010s , and many studies tie sleep loss directly to the use of devices around bedtime, particularly when they’re used to scroll through social media . Exercise declined , too, which is unfortunate because exercise, like sleep, improves both mental and physical health. Book reading has been declining for decades, pushed aside by digital alternatives, but the decline, like so much else, sped up in the early 2010 s. With passive entertainment always available, adolescent minds likely wander less than they used to; contemplation and imagination might be placed on the list of things winnowed down or crowded out.

But perhaps the most devastating cost of the new phone-based childhood was the collapse of time spent interacting with other people face-to-face. A study of how Americans spend their time found that, before 2010, young people (ages 15 to 24) reported spending far more time with their friends (about two hours a day, on average, not counting time together at school) than did older people (who spent just 30 to 60 minutes with friends). Time with friends began decreasing for young people in the 2000s, but the drop accelerated in the 2010s, while it barely changed for older people. By 2019, young people’s time with friends had dropped to just 67 minutes a day. It turns out that Gen Z had been socially distancing for many years and had mostly completed the project by the time COVID-19 struck.

Read: What happens when kids don’t see their peers for months

You might question the importance of this decline. After all, isn’t much of this online time spent interacting with friends through texting, social media, and multiplayer video games? Isn’t that just as good?

Some of it surely is, and virtual interactions offer unique benefits too, especially for young people who are geographically or socially isolated. But in general, the virtual world lacks many of the features that make human interactions in the real world nutritious, as we might say, for physical, social, and emotional development. In particular, real-world relationships and social interactions are characterized by four features—typical for hundreds of thousands of years—that online interactions either distort or erase.

First, real-world interactions are embodied , meaning that we use our hands and facial expressions to communicate, and we learn to respond to the body language of others. Virtual interactions, in contrast, mostly rely on language alone. No matter how many emojis are offered as compensation, the elimination of communication channels for which we have eons of evolutionary programming is likely to produce adults who are less comfortable and less skilled at interacting in person.

Second, real-world interactions are synchronous ; they happen at the same time. As a result, we learn subtle cues about timing and conversational turn taking. Synchronous interactions make us feel closer to the other person because that’s what getting “in sync” does. Texts, posts, and many other virtual interactions lack synchrony. There is less real laughter, more room for misinterpretation, and more stress after a comment that gets no immediate response.

Third, real-world interactions primarily involve one‐to‐one communication , or sometimes one-to-several. But many virtual communications are broadcast to a potentially huge audience. Online, each person can engage in dozens of asynchronous interactions in parallel, which interferes with the depth achieved in all of them. The sender’s motivations are different, too: With a large audience, one’s reputation is always on the line; an error or poor performance can damage social standing with large numbers of peers. These communications thus tend to be more performative and anxiety-inducing than one-to-one conversations.

Finally, real-world interactions usually take place within communities that have a high bar for entry and exit , so people are strongly motivated to invest in relationships and repair rifts when they happen. But in many virtual networks, people can easily block others or quit when they are displeased. Relationships within such networks are usually more disposable.

From the September 2015 issue: The coddling of the American mind

These unsatisfying and anxiety-producing features of life online should be recognizable to most adults. Online interactions can bring out antisocial behavior that people would never display in their offline communities. But if life online takes a toll on adults, just imagine what it does to adolescents in the early years of puberty, when their “experience expectant” brains are rewiring based on feedback from their social interactions.

Kids going through puberty online are likely to experience far more social comparison, self-consciousness, public shaming, and chronic anxiety than adolescents in previous generations, which could potentially set developing brains into a habitual state of defensiveness. The brain contains systems that are specialized for approach (when opportunities beckon) and withdrawal (when threats appear or seem likely). People can be in what we might call “discover mode” or “defend mode” at any moment, but generally not both. The two systems together form a mechanism for quickly adapting to changing conditions, like a thermostat that can activate either a heating system or a cooling system as the temperature fluctuates. Some people’s internal thermostats are generally set to discover mode, and they flip into defend mode only when clear threats arise. These people tend to see the world as full of opportunities. They are happier and less anxious. Other people’s internal thermostats are generally set to defend mode, and they flip into discover mode only when they feel unusually safe. They tend to see the world as full of threats and are more prone to anxiety and depressive disorders.

A simple way to understand the differences between Gen Z and previous generations is that people born in and after 1996 have internal thermostats that were shifted toward defend mode. This is why life on college campuses changed so suddenly when Gen Z arrived, beginning around 2014. Students began requesting “safe spaces” and trigger warnings. They were highly sensitive to “microaggressions” and sometimes claimed that words were “violence.” These trends mystified those of us in older generations at the time, but in hindsight, it all makes sense. Gen Z students found words, ideas, and ambiguous social encounters more threatening than had previous generations of students because we had fundamentally altered their psychological development.

Staying on task while sitting at a computer is hard enough for an adult with a fully developed prefrontal cortex. It is far more difficult for adolescents in front of their laptop trying to do homework. They are probably less intrinsically motivated to stay on task. They’re certainly less able, given their undeveloped prefrontal cortex, and hence it’s easy for any company with an app to lure them away with an offer of social validation or entertainment. Their phones are pinging constantly— one study found that the typical adolescent now gets 237 notifications a day, roughly 15 every waking hour. Sustained attention is essential for doing almost anything big, creative, or valuable, yet young people find their attention chopped up into little bits by notifications offering the possibility of high-pleasure, low-effort digital experiences.

It even happens in the classroom. Studies confirm that when students have access to their phones during class time, they use them, especially for texting and checking social media, and their grades and learning suffer . This might explain why benchmark test scores began to decline in the U.S. and around the world in the early 2010s—well before the pandemic hit.

The neural basis of behavioral addiction to social media or video games is not exactly the same as chemical addiction to cocaine or opioids. Nonetheless, they all involve abnormally heavy and sustained activation of dopamine neurons and reward pathways. Over time, the brain adapts to these high levels of dopamine; when the child is not engaged in digital activity, their brain doesn’t have enough dopamine, and the child experiences withdrawal symptoms. These generally include anxiety, insomnia, and intense irritability. Kids with these kinds of behavioral addictions often become surly and aggressive, and withdraw from their families into their bedrooms and devices.

Social-media and gaming platforms were designed to hook users. How successful are they? How many kids suffer from digital addictions?

The main addiction risks for boys seem to be video games and porn. “ Internet gaming disorder ,” which was added to the main diagnosis manual of psychiatry in 2013 as a condition for further study, describes “significant impairment or distress” in several aspects of life, along with many hallmarks of addiction, including an inability to reduce usage despite attempts to do so. Estimates for the prevalence of IGD range from 7 to 15 percent among adolescent boys and young men. As for porn, a nationally representative survey of American adults published in 2019 found that 7 percent of American men agreed or strongly agreed with the statement “I am addicted to pornography”—and the rates were higher for the youngest men.

Girls have much lower rates of addiction to video games and porn, but they use social media more intensely than boys do. A study of teens in 29 nations found that between 5 and 15 percent of adolescents engage in what is called “problematic social media use,” which includes symptoms such as preoccupation, withdrawal symptoms, neglect of other areas of life, and lying to parents and friends about time spent on social media. That study did not break down results by gender, but many others have found that rates of “problematic use” are higher for girls.

Jonathan Haidt: The dangerous experiment on teen girls

I don’t want to overstate the risks: Most teens do not become addicted to their phones and video games. But across multiple studies and across genders, rates of problematic use come out in the ballpark of 5 to 15 percent. Is there any other consumer product that parents would let their children use relatively freely if they knew that something like one in 10 kids would end up with a pattern of habitual and compulsive use that disrupted various domains of life and looked a lot like an addiction?

During that crucial sensitive period for cultural learning, from roughly ages 9 through 15, we should be especially thoughtful about who is socializing our children for adulthood. Instead, that’s when most kids get their first smartphone and sign themselves up (with or without parental permission) to consume rivers of content from random strangers. Much of that content is produced by other adolescents, in blocks of a few minutes or a few seconds.

This rerouting of enculturating content has created a generation that is largely cut off from older generations and, to some extent, from the accumulated wisdom of humankind, including knowledge about how to live a flourishing life. Adolescents spend less time steeped in their local or national culture. They are coming of age in a confusing, placeless, ahistorical maelstrom of 30-second stories curated by algorithms designed to mesmerize them. Without solid knowledge of the past and the filtering of good ideas from bad––a process that plays out over many generations––young people will be more prone to believe whatever terrible ideas become popular around them, which might explain why v ideos showing young people reacting positively to Osama bin Laden’s thoughts about America were trending on TikTok last fall.

All this is made worse by the fact that so much of digital public life is an unending supply of micro dramas about somebody somewhere in our country of 340 million people who did something that can fuel an outrage cycle, only to be pushed aside by the next. It doesn’t add up to anything and leaves behind only a distorted sense of human nature and affairs.

When our public life becomes fragmented, ephemeral, and incomprehensible, it is a recipe for anomie, or normlessness. The great French sociologist Émile Durkheim showed long ago that a society that fails to bind its people together with some shared sense of sacredness and common respect for rules and norms is not a society of great individual freedom; it is, rather, a place where disoriented individuals have difficulty setting goals and exerting themselves to achieve them. Durkheim argued that anomie was a major driver of suicide rates in European countries. Modern scholars continue to draw on his work to understand suicide rates today.

Durkheim’s observations are crucial for understanding what happened in the early 2010s. A long-running survey of American teens found that , from 1990 to 2010, high-school seniors became slightly less likely to agree with statements such as “Life often feels meaningless.” But as soon as they adopted a phone-based life and many began to live in the whirlpool of social media, where no stability can be found, every measure of despair increased. From 2010 to 2019, the number who agreed that their lives felt “meaningless” increased by about 70 percent, to more than one in five.

An additional source of evidence comes from Gen Z itself. With all the talk of regulating social media, raising age limits, and getting phones out of schools, you might expect to find many members of Gen Z writing and speaking out in opposition. I’ve looked for such arguments and found hardly any. In contrast, many young adults tell stories of devastation.

Freya India, a 24-year-old British essayist who writes about girls, explains how social-media sites carry girls off to unhealthy places: “It seems like your child is simply watching some makeup tutorials, following some mental health influencers, or experimenting with their identity. But let me tell you: they are on a conveyor belt to someplace bad. Whatever insecurity or vulnerability they are struggling with, they will be pushed further and further into it.” She continues:

Gen Z were the guinea pigs in this uncontrolled global social experiment. We were the first to have our vulnerabilities and insecurities fed into a machine that magnified and refracted them back at us, all the time, before we had any sense of who we were. We didn’t just grow up with algorithms. They raised us. They rearranged our faces. Shaped our identities. Convinced us we were sick.

Rikki Schlott, a 23-year-old American journalist and co-author of The Canceling of the American Mind , writes ,

The day-to-day life of a typical teen or tween today would be unrecognizable to someone who came of age before the smartphone arrived. Zoomers are spending an average of 9 hours daily in this screen-time doom loop—desperate to forget the gaping holes they’re bleeding out of, even if just for … 9 hours a day. Uncomfortable silence could be time to ponder why they’re so miserable in the first place. Drowning it out with algorithmic white noise is far easier.

A 27-year-old man who spent his adolescent years addicted (his word) to video games and pornography sent me this reflection on what that did to him:

I missed out on a lot of stuff in life—a lot of socialization. I feel the effects now: meeting new people, talking to people. I feel that my interactions are not as smooth and fluid as I want. My knowledge of the world (geography, politics, etc.) is lacking. I didn’t spend time having conversations or learning about sports. I often feel like a hollow operating system.

Or consider what Facebook found in a research project involving focus groups of young people, revealed in 2021 by the whistleblower Frances Haugen: “Teens blame Instagram for increases in the rates of anxiety and depression among teens,” an internal document said. “This reaction was unprompted and consistent across all groups.”

How can it be that an entire generation is hooked on consumer products that so few praise and so many ultimately regret using? Because smartphones and especially social media have put members of Gen Z and their parents into a series of collective-action traps. Once you understand the dynamics of these traps, the escape routes become clear.

Social media, in contrast, applies a lot more pressure on nonusers, at a much younger age and in a more insidious way. Once a few students in any middle school lie about their age and open accounts at age 11 or 12, they start posting photos and comments about themselves and other students. Drama ensues. The pressure on everyone else to join becomes intense. Even a girl who knows, consciously, that Instagram can foster beauty obsession, anxiety, and eating disorders might sooner take those risks than accept the seeming certainty of being out of the loop, clueless, and excluded. And indeed, if she resists while most of her classmates do not, she might, in fact, be marginalized, which puts her at risk for anxiety and depression, though via a different pathway than the one taken by those who use social media heavily. In this way, social media accomplishes a remarkable feat: It even harms adolescents who do not use it.

From the May 2022 issue: Jonathan Haidt on why the past 10 years of American life have been uniquely stupid

A recent study led by the University of Chicago economist Leonardo Bursztyn captured the dynamics of the social-media trap precisely. The researchers recruited more than 1,000 college students and asked them how much they’d need to be paid to deactivate their accounts on either Instagram or TikTok for four weeks. That’s a standard economist’s question to try to compute the net value of a product to society. On average, students said they’d need to be paid roughly $50 ($59 for TikTok, $47 for Instagram) to deactivate whichever platform they were asked about. Then the experimenters told the students that they were going to try to get most of the others in their school to deactivate that same platform, offering to pay them to do so as well, and asked, Now how much would you have to be paid to deactivate, if most others did so? The answer, on average, was less than zero. In each case, most students were willing to pay to have that happen.

Social media is all about network effects. Most students are only on it because everyone else is too. Most of them would prefer that nobody be on these platforms. Later in the study, students were asked directly, “Would you prefer to live in a world without Instagram [or TikTok]?” A majority of students said yes––58 percent for each app.

This is the textbook definition of what social scientists call a collective-action problem . It’s what happens when a group would be better off if everyone in the group took a particular action, but each actor is deterred from acting, because unless the others do the same, the personal cost outweighs the benefit. Fishermen considering limiting their catch to avoid wiping out the local fish population are caught in this same kind of trap. If no one else does it too, they just lose profit.

Cigarettes trapped individual smokers with a biological addiction. Social media has trapped an entire generation in a collective-action problem. Early app developers deliberately and knowingly exploited the psychological weaknesses and insecurities of young people to pressure them to consume a product that, upon reflection, many wish they could use less, or not at all.

The trap here is that each child thinks they need a smartphone because “everyone else” has one, and many parents give in because they don’t want their child to feel excluded. But if no one else had a smartphone—or even if, say, only half of the child’s sixth-grade class had one—parents would feel more comfortable providing a basic flip phone (or no phone at all). Delaying round-the-clock internet access until ninth grade (around age 14) as a national or community norm would help to protect adolescents during the very vulnerable first few years of puberty. According to a 2022 British study , these are the years when social-media use is most correlated with poor mental health. Family policies about tablets, laptops, and video-game consoles should be aligned with smartphone restrictions to prevent overuse of other screen activities.

The trap here, as with smartphones, is that each adolescent feels a strong need to open accounts on TikTok, Instagram, Snapchat, and other platforms primarily because that’s where most of their peers are posting and gossiping. But if the majority of adolescents were not on these accounts until they were 16, families and adolescents could more easily resist the pressure to sign up. The delay would not mean that kids younger than 16 could never watch videos on TikTok or YouTube—only that they could not open accounts, give away their data, post their own content, and let algorithms get to know them and their preferences.

Most schools claim that they ban phones, but this usually just means that students aren’t supposed to take their phone out of their pocket during class. Research shows that most students do use their phones during class time. They also use them during lunchtime, free periods, and breaks between classes––times when students could and should be interacting with their classmates face-to-face. The only way to get students’ minds off their phones during the school day is to require all students to put their phones (and other devices that can send or receive texts) into a phone locker or locked pouch at the start of the day. Schools that have gone phone-free always seem to report that it has improved the culture, making students more attentive in class and more interactive with one another. Published studies back them up .

Many parents are afraid to give their children the level of independence and responsibility they themselves enjoyed when they were young, even though rates of homicide, drunk driving, and other physical threats to children are way down in recent decades. Part of the fear comes from the fact that parents look at each other to determine what is normal and therefore safe, and they see few examples of families acting as if a 9-year-old can be trusted to walk to a store without a chaperone. But if many parents started sending their children out to play or run errands, then the norms of what is safe and accepted would change quickly. So would ideas about what constitutes “good parenting.” And if more parents trusted their children with more responsibility––for example, by asking their kids to do more to help out, or to care for others––then the pervasive sense of uselessness now found in surveys of high-school students might begin to dissipate.

It would be a mistake to overlook this fourth norm. If parents don’t replace screen time with real-world experiences involving friends and independent activity, then banning devices will feel like deprivation, not the opening up of a world of opportunities.

The main reason why the phone-based childhood is so harmful is because it pushes aside everything else. Smartphones are experience blockers. Our ultimate goal should not be to remove screens entirely, nor should it be to return childhood to exactly the way it was in 1960. Rather, it should be to create a version of childhood and adolescence that keeps young people anchored in the real world while flourishing in the digital age.

In recent decades, however, Congress has not been good at addressing public concerns when the solutions would displease a powerful and deep-pocketed industry. Governors and state legislators have been much more effective, and their successes might let us evaluate how well various reforms work. But the bottom line is that to change norms, we’re going to need to do most of the work ourselves, in neighborhood groups, schools, and other communities.

Read: Why Congress keeps failing to protect kids online

There are now hundreds of organizations––most of them started by mothers who saw what smartphones had done to their children––that are working to roll back the phone-based childhood or promote a more independent, real-world childhood. (I have assembled a list of many of them.) One that I co-founded, at LetGrow.org , suggests a variety of simple programs for parents or schools, such as play club (schools keep the playground open at least one day a week before or after school, and kids sign up for phone-free, mixed-age, unstructured play as a regular weekly activity) and the Let Grow Experience (a series of homework assignments in which students––with their parents’ consent––choose something to do on their own that they’ve never done before, such as walk the dog, climb a tree, walk to a store, or cook dinner).

Even without the help of organizations, parents could break their families out of collective-action traps if they coordinated with the parents of their children’s friends. Together they could create common smartphone rules and organize unsupervised play sessions or encourage hangouts at a home, park, or shopping mall.

P arents are fed up with what childhood has become. Many are tired of having daily arguments about technologies that were designed to grab hold of their children’s attention and not let go. But the phone-based childhood is not inevitable.

We didn’t know what we were doing in the early 2010s. Now we do. It’s time to end the phone-based childhood.

This article is adapted from Jonathan Haidt’s forthcoming book, The Anxious Generation: How the Great Rewiring of Childhood Is Causing an Epidemic of Mental Illness .

​When you buy a book using a link on this page, we receive a commission. Thank you for supporting The Atlantic.

• Share full article

Advertisement

Subscriber-only Newsletter

Who Has the Secret to Well-Being? The Answer May Surprise You.

Toddlers — full of energy, curiosity and laughter — have a lot to teach adults, experts say.

By Jancee Dunn

When it comes to happiness and living well, we can learn a lot from toddlers.

Stay with me here. Hasan Merali, an associate professor of pediatrics at McMaster University and a pediatric emergency room physician, has treated thousands of patients between the ages of 1 and 5. In his book, “Sleep Well, Take Risks, Squish the Peas: Secrets From the Science of Toddlers for a Happier, More Successful Way of Life,” he writes that this group has an undeserved bad reputation.

“A term I dislike very much is ‘terrible twos,’” Dr. Merali told me. “Or ‘three-nagers.’ Can you imagine if we labeled another age group like this?”

Yes, he said, toddlers have tantrums, but research suggests that they occur, on average, once a day, and last three minutes.

The rest of the time, Dr. Merali said, toddlers are models of well-being. He shared a few good habits, common among the under-5 crowd, that can improve your mental and physical health.

Try positive self-talk.

Young children tend to coach themselves out loud, a practice known as private speech (such as this popular clip from a 4-year-old snowboarder).

Toddlers aren’t shy about self-talk, Dr. Merali said, and you shouldn’t be, either. Research suggests that for adults, positive self-talk can help with problem-solving, learning, confidence and managing your emotions.

I told Dr. Merali I tend to speak harshly to myself, but would try to sub in phrases like “You can do it” instead.

Take any opportunity to move.

Two-year-olds are active for almost five hours a day, according to a review of 24 studies . They move joyfully and instinctively, Dr. Merali said.

Adults can look for ways to move more, even if it’s just for a minute. Take a quick walk around the block, or schedule a meeting on foot rather than sitting down. If you’re home alone, do what Kelly McGonigal , a health psychologist at Stanford University, has called “full-body karaoke,” singing and moving to your favorite song.

Brief bursts of activity have been shown to increase longevity if they add up to 10 minutes per day. Standing up for three minutes every half-hour can help control your blood sugar , too.

You can also find ways to be around young kids, “a happiness that is unmatched,” Dr. Merali said. (The nonprofit Generations United features a national database of intergenerational programs and activities.)

Ask questions.

Young kids are not afraid to pose questions, Dr. Merali said. One study found that they asked an average of 107 questions an hour. (This will not surprise their parents.)

I have written a few children's books, and my favorite part of library readings was question time: “Have you ever been to the moon?” “Can you turn into a cheetah?”

Adults have been socialized to hold back our questions because we’re often worried about what other people think, Dr. Merali said. But asking questions not only helps us to gain information, it’s also an important way to build relationships , he said.

Fix your sleep schedule.

Toddlers thrive on routine, and having a schedule with consistent sleep and waking times will help you, too, said Alberto Ramos, a sleep neurologist and researcher with the University of Miami Miller School of Medicine.

If your schedule permits, and if you have the urge, napping also has a host of benefits , including sharper thinking and reaction times and improved memory.

As long as you’re not dealing with insomnia, which can be worsened by napping, Dr. Ramos recommended a short nap — 20 to 30 minutes maximum — in the early afternoon.

Look for opportunities to laugh.

Toddlers “see the world as a comedy club,” Dr. Merali writes. One study found that young children laugh six times as much as adults. But we can seek ways to build playfulness and humor into our day.

Listen to a comedy podcast or trade silly texts with someone, Dr. Merali said. Research shows you laugh more when you are with friends, so make time for them, he said.

“I get a daily dad joke mailed to me,” Dr. Merali told me. “And during my lunch break, I watch videos.”

I asked him what he watches: “Funny toddler videos,” he said. Of course.

The F.D.A. has approved Wegovy for heart health.

The weight loss drug Wegovy is now approved for reducing the risk of heart attacks, strokes and cardiovascular-related death in adults who have heart disease and are overweight or have obesity. The updated label will most likely put more pressure on employers to cover it, but Wegovy is in short supply. It’s unclear how long the shortage will last.

Read the story: Wegovy Moves Beyond Weight Loss

Four years ago, Covid shut the world down. Readers share their memories.

The World Health Organization declared Covid-19 a pandemic on March 11, 2020. To mark the four-year anniversary, we asked readers what they remembered.

Read the story: When the Pandemic Hit Home

The Week in Well

Here are some stories you don’t want to miss:

Talya Minsberg explores what popular fitness fads get wrong .

Christina Caron explains why lying on the floor feels so good .

The PCOS diet may not help at all , reports Alisha Haridasani Gupta.

What’s the best way to get rid of a hangnail? Caroline Hopkins has answers .

Let’s keep the conversation going. Follow Well on Instagram , or write to us at [email protected] . And check out last week’s newsletter about how to make end-of-life planning less stressful .

Jancee Dunn , who writes the weekly Well newsletter for The Times, has covered health and science for more than 20 years. More about Jancee Dunn

How to Be Happy

Happiness can predict health and longevity, but it doesn’t just happen to you..

Small changes in your behavior and surroundings can set you on course for happiness.  Here ’s how .

Our seven-day Happiness Challenge  will help you focus on a crucial element of living a good life — your relationships .

Finland has been ranked the happiest country on earth for six consecutive years. What’s the secret? The answer is complicated .

Cultivating a sense of wonder can be a salve  for a turbulent mind. Here is how to make it part of your everyday life .

It can seem impossible to be optimistic about the future. But these questions  will help you understand what all optimists have in common.

Exercise, even in small doses, can improve your mood. Try our eight-minute routine  that's based on movements researchers say are inspired by joy.