Mental health is a global and increasingly visible issue, and the uncertainty and disruption of the COVID-19 pandemic has added fresh urgency to these concerns. That is why this year we are launching our annual AXA Mind Health Study that examines the building blocks of mental wellbeing in Europe and Asia. With Asia being a region where mental health can still be seen as taboo, this survey gives fresh insights into the current experiences and attitudes among people living in mainland China, Hong Kong and Japan.
We have made a conscious decision to use the term 'mind health' over mental health for this research, avoiding the common misconception that mental health only relates to mental ill health. It encompasses a range of societal, social and individual factors, and enables us to highlight the positive impacts and elements of good mind health.
That is why we have also introduced the AXA Mind Health Index, designed to monitor changes in mind health over time by classifying respondents into four states – "flourishing" at the top, followed by "getting by", "languishing" and "struggling". Coupled with the identification of 10 skills that can enable people to protect and optimise their mental wellbeing, it provides a path on how to reach the peak of mind health.
Yet effective solutions rely on good data and robust science. Our approach in this study has been led by clinical data to identify the correlations between our behaviours and our overall mind health, establishing a clear causal relationship on how to achieve a state of flourishing. As an annual survey that can measure changes over time, our ambition is that together these resources will equip individuals and businesses with the insights they need to foster positive mind health, contribute to effecting change in society.
This guide complements the Study and Index with a dive into the skills needed to thrive and how to foster them. I hope it provides a starting point for discussion and provokes action for individuals and companies as we look toward a future where we can all become 'fit to flourish'.
CEO, AXA Asia & Africa
CEO, AXA Asia & Africa
Respondents to the survey were classified into four mind-health states based on their responses, from "flourishing" at the top to "getting by", "languishing" and "struggling". Flourishing refers to the pinnacle of mind health, getting by describes those who may have some areas of good wellbeing but not enough to reach the state of flourishing, languishing represents the absence of positive wellbeing, and struggling is associated with emotional stress and psychosocial impairment.
Through this study, AXA seeks to provide the intelligence individuals and businesses need to foster and nurture their mental wellbeing, contributing to effecting change in society. To do this, the study has identified how people can proactively cultivate a set of 10 skills that help to protect and optimise mind health. The more of these skills people can develop, the more likely they are to flourish (defined as having at least eight of the 10 skills).
Some skills are more important than others to the improvement of wellbeing. Self-acceptance is perhaps the most important, and key to the idea of flourishing, assisted by a sense of achievement and purpose, social connection and emotional competency.
Our research also identified six physical health behaviours that promote mind health, including good nutrition, regular exercise, plenty of sleep, not smoking, low alcohol intake and taking "me time."
The good news is that these skills can be improved over time. No one is stuck permanently in the struggling, languishing or even getting-by categories. With positive action, attention to one's environment and the right kind of support, we can all manage to flourish.
Flourishing
8-10 skills
Getting by
6-7 skills
Languishing
4-5 skills
Struggling
0-3 skills
represents the pinnacle of mental health. Classified by a Mind Health Index score greater than 75%. Flourishing individuals do well across a range of mental wellbeing determinants and outcomes.
People who are flourishing have at least eight out of the 10 preventative skills identified in our index. In Asia, the most common are emotional competency, finding meaning or purpose in life and resilience. Self-confidence and self-acceptance are also prominent. The flourishing persona is more likely to have better nutrition, get regular exercise, sleep better and take personal time. Flourishers also have faith that the healthcare system can deal with mental health issues effectively, which many others don't. They are more likely to have secure incomes, meaningful work and a happier family life.
describes those who may have some areas of good wellbeing but not enough to be reach the state of flourishing. Those getting by may experience a dampened sense of wellbeing compared to those who are flourishing.
Moderately good preventative skills characterize those who are getting by. They tend to have six of the 10 skills, the strongest of which are emotional intelligence, self-confidence and close relationships. This persona is likely to have four of the six healthy behaviours but is far less likely than flourishers to practice good nutrition, regular exercise and get good sleep. Still, those getting by have fewer symptoms of stress, anxiety and depression than those languishing or struggling, and are twice as likely to experience joy and elation.
represents the absence of positive wellbeing. If you are languishing you are not functioning at full capacity, you may feel unmotivated and struggle to focus. Those who are languishing are at an increased risk of developing mental illness.
Those who languish generally have poor preventative skills, averaging only four of the 10, and those they do have are less well-developed than in those who are flourishing or getting by. Fewer than half in this category possess social connectedness, pride in achievement, self-acceptance and meaning or purpose, the bedrock for great results in the flourishing group. They also tend to have just two of the six healthy behaviours. Around one in four smoke. Languishers are less likely to have secure incomes, meaningful work and a happy family life, and one in four say they often or almost always feel agitated, overreactive or unable to wind down.
The absence of wellbeing in most areas is likely to results in struggle and difficulty. Struggling is associated with emotional distress and psychosocial impairment.
The struggling persona is characterized by having very poor preventative skills. Of those that they do possess, the most common in Asia was challenge response, which ranked last in importance among those in Asia who were flourishing. Self-acceptance, meaning and purpose and pride in achievement were all in short supply. Those who struggle are likely to have only one of the six healthy behaviors, low alcohol consumption, and one in three smoke. Strugglers are far less likely to have secure incomes, meaningful work and a happy family life. Over the past 12 months, those in this category were 39 times more likely to rate their stress levels at eight out of 10 than at zero to three out of 10.
Click each puzzle to learn how to improve your mind health skills
To watch all videos, including the World Mental Health Day Reflection videos by leading mind health experts, click here.
Self-acceptance, or the ability of someone to fully accept both the positive and negative attributes of themselves, is the most important skill to flourishing. It is seen across cultures as a mechanism for reducing emotional misery, and supports the progression towards happiness and fulfilment.
Social Connectedness, or Maintaining social relationships, tends to promote health and wellbeing in all ages. Loneliness, conversely, can be very destructive of mind health.
Meaning and purpose in life are predictive of emotional wellbeing and result in better recovery from negative life events. People tend to cite relationships, particularly with family, as the most important source of meaning in all cultures and age groups.
Pride in achievement is related to confidence and is associated with a psychologically healthy and socially desirable personality profile marked by agreeableness, conscientiousness, intrinsic motivation and other prosocial behaviours, including empathy and respect.
Emotional quotient, or emotional intelligence, describes a person's ability to understand and manage their emotions. This includes skills such as Self-awareness, emotional self-regulation, social awareness and social skills. A higher EQ can improve lifelong physical and mental health.
Self-confidence, or belief in one's abilities underpins successful self-management of behaviour; without self-belief, the incentive to engage in protective/preventive actions in relation to mental health is undermined. Research has found that self-efficacy ameliorates the effects of daily stressors on mental health, with the strongest relationship being found between self-efficacy and positive mental health.
Resilience is the ability to adapt in the face of adversity or stress. It involves bouncing back from difficult experiences, but it also involves profound personal growth. Lack of resilience means the adverse psycho-emotional consequences of a threat linger after the threat has passed.
The ability to form close relationships is an essential skill and has been shown as a predictor in a person’s ability to cope with stressful life events. The human need for attachment is said to have arisen out of evolutionary pressures for infants to elicit the care and protection of their caregivers in order to ensure survival.
Physical health behaviours can have a significant effect on a person’s mental health. Practicing most or all of the following six behaviours can help set one up to thrive:
Challenge response refers to the way people respond to challenges, whether constructive or destructive. Constructive responses include focusing on solutions and taking practical rational steps to resolve issues. Destructive responses include aggression and smoking and drinking more.
Self-acceptance, or the ability of someone to fully accept both the positive and negative attributes of themselves, is the most important skill to flourishing. It is seen across cultures as a mechanism for reducing emotional misery, and supports the progression towards happiness and fulfilment.
Social Connectedness, or Maintaining social relationships, tends to promote health and wellbeing in all ages. Loneliness, conversely, can be very destructive of mind health.
Meaning and purpose in life are predictive of emotional wellbeing and result in better recovery from negative life events. People tend to cite relationships, particularly with family, as the most important source of meaning in all cultures and age groups.
Pride in achievement is related to confidence and is associated with a psychologically healthy and socially desirable personality profile marked by agreeableness, conscientiousness, intrinsic motivation and other prosocial behaviours, including empathy and respect.
Emotional quotient, or emotional intelligence, describes a person's ability to understand and manage their emotions. This includes skills such as Self-awareness, emotional self-regulation, social awareness and social skills. A higher EQ can improve lifelong physical and mental health.
Self-confidence, or belief in one's abilities underpins successful self-management of behaviour; without self-belief, the incentive to engage in protective/preventive actions in relation to mental health is undermined. Research has found that self-efficacy ameliorates the effects of daily stressors on mental health, with the strongest relationship being found between self-efficacy and positive mental health.
Resilience is the ability to adapt in the face of adversity or stress. It involves bouncing back from difficult experiences, but it also involves profound personal growth. Lack of resilience means the adverse psycho-emotional consequences of a threat linger after the threat has passed.
The ability to form close relationships is an essential skill and has been shown as a predictor in a person’s ability to cope with stressful life events. The human need for attachment is said to have arisen out of evolutionary pressures for infants to elicit the care and protection of their caregivers in order to ensure survival.
Physical health behaviours can have a significant effect on a person’s mental health. Practicing most or all of the following six behaviours can help set one up to thrive:
Challenge response refers to the way people respond to challenges, whether constructive or destructive. Constructive responses include focusing on solutions and taking practical rational steps to resolve issues. Destructive responses include aggression and smoking and drinking more.