Summary: Contrary to previous research, a new study reveals a prior history of mental health disorders or substance abuse does not prevent a person from thriving and leading a high-functioning life.
Past research on mental illness has focused mostly on chronic and recurring mood, anxiety, and substance-use disorders that keep people from thriving and enjoying life.
New research published in the journal Clinical Psychological Science, however, reports that many people who have suffered from mental illness are able to thrive and lead a high-functioning life.
“Our research tells us how many people can recover from a mental illness and go on to experience a life with high levels of well-being and functioning,” said Andrew Devendorf, a researcher at the University of South Florida and lead author of the article.
“Contrary to traditional clinical wisdom, we found that mental illness and substance-use disorders may reduce but do not prevent the possibility of thriving.”
The researchers also found that having longer episodes of mental illness or experiencing multiple mental illnesses in one’s lifetime reduces, but does not eliminate, the chances of thriving.
Data for this research came from the 2012 Canadian Community Health Survey—Mental Health, a nationally representative survey that included more than 25,000 Canadian participants aged 15 to 80 and older.
The survey collected information about participants’ lifetime and 12-month mental health status, their access to and perceived need for formal and informal services and supports, their functioning and disabilities, and other factors that influence mental health.
Devendorf and his colleagues compared the mental health conditions tracked in the survey and other data associated with each participant’s quality of life, including their social relationships, positive emotions, perceived quality of life, and functioning (ability to fulfill life roles).
The researchers then calculated how many people with a lifetime history of mental illness—including depression, anxiety, bipolar disorder, or substance-use disorder—met “thriving” criteria at the time of the study.
To count as thriving after depression, a person not only had to be free of the major symptoms of depression, they also had to report better well-being than 75% of non-depressed adults surveyed in the United States. “We set a very high bar for thriving,” said Devendorf.
The results of the comparison showed that about 10% of Canadians with a history of mental illness met thriving criteria, compared to about 24% of Canadians who did not have a history of mental illness. People with a history of substance-use disorders (10%), depression (7%), and anxiety (6%) were more likely to thrive compared to people with a history of bipolar disorder (3%).
“These findings show that mental illnesses reduce—but do not preclude—the possibility to meet thriving criteria,” said Devendorf. “Although thriving after mental illness was not necessarily common, it should be noted that diagnostic recoveries after mental illness were much more common.”
The study found that about two thirds (67%) of people with any mental illness in their lifetime met symptomatic recovery, meaning they no longer met the diagnostic criteria for a particular illness. The rate at which people recover from mental illness and attain moderate to good, rather than optimal, levels of well-being is likely much higher, the researchers speculate.
“While we know traditional mental health treatments, like therapy and medication, can reduce mental illness symptoms, there is a lack of research on how treatments affect outcomes like well-being and functioning,” said Devendorf. “Now that we know thriving is possible after mental illness, we hope that researchers will begin to investigate how existing treatments can increase the chance for thriving after mental illness.”
Optimal Well-Being After Psychopathology: Prevalence and Correlates
Optimal functioning after psychopathology is understudied. We report the prevalence of optimal well-being (OWB) following recovery after depression, suicidal ideation, generalized anxiety disorder, bipolar disorder, and substance use disorders.
Using a national Canadian sample (N = 23,491), we operationalized OWB as absence of 12-month psychopathology, coupled with scoring above the 25th national percentile on psychological well-being and below the 25th percentile on disability measures. Compared with 24.1% of participants without a history of psychopathology, 9.8% of participants with a lifetime history of psychopathology met OWB.
Adults with a history of substance use disorders (10.2%) and depression (7.1%) were the most likely to report OWB. Persons with anxiety (5.7%), suicidal ideation (5.0%), bipolar I (3.3%), and bipolar II (3.2%) were less likely to report OWB. Having a lifetime history of just one disorder increased the odds of OWB by a factor of 4.2 relative to having a lifetime history of multiple disorders.
Although psychopathology substantially reduces the probability of OWB, many individuals with psychopathology attain OWB.