Looking Beyond Distress: A Call for Spanning the Continuum of Mental Health Care

Background Despite mental health's definition as a state of well-being, mental health research and practice has often narrowly focused on pathology and distress. The identification, treatment, and rehabilitation of mental illness are the primary activities pertaining to the role of mental health professionals, but only focusing on these primary activities carries the risk of neglecting other legitimate responsibilities related to prevention of illness and promotion of wellness. Therefore, it becomes important to highlight the potential utility of separately examining levels of distress, alongside levels of well-being in community samples. The goal of this study was to determine the extent to which low levels of distress or a lack of significant distress co-occurs with high levels of well-being in a sample of urban Indian adults. Methods Standardized measures of psychological distress, along with measures of emotional, psychological, and social well-being, were used in a sample of 300 adults aged 20 to 60 years. The participation of community-dwelling adults who could respond to the questionnaires in English or Hindi (the most widely spoken and official language in India) was solicited through posting announcements on various platforms in a metropolitan city in Southern India. The participants had the option to respond to the questionnaires via a paper-pencil version or through an online Google survey. Psychological distress was assessed using the Kessler Psychological Distress scale (K-10) on which a score over 19 indicated significant distress. We used the 25th and 75th percentile points on the respective distributions of scores to determine high, low, and moderate ranges on the three measures of well-being. Results Both men and women were well represented in the sample (47% and 53%, respectively). Approximately 41% were young adults, nearly 30% were in the 36 to 45-year age group, and 30% were in the 46 to 60-year age group. Approximately 48% of the overall sample (N = 143) exhibited an absence of significant distress. Patterns of well-being were examined in this group of low-distress participants. Only 13% of low-distress participants exhibited high emotional well-being (i.e., had a high positivity ratio) and high psychosocial functioning (i.e., had high psychological and social well-being). As many as 37.8% exhibited low well-being on at least one of the three measures of well-being, despite being low on distress. In other words, low well-being scores were fairly common in conjunction with non-significant levels of distress. Conclusion Reliance on low distress for operationalization of mental health may mask lower levels of emotional well-being and psychosocial functioning in a given population. The findings underscore the need to span the entire continuum of mental health care by routinely including preventive and promotive aspects in research and practice.