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Measurement of mental health, outcomes and key sources of data

Measurement is essential for public health to understand population health status and trends over time as well as to measure the effectiveness of interventions to improve it. Measurement of mental health and mental wellbeing presents a number of challenges not encountered in other areas of public health practice.

Mortality data, a mainstay of measurement, does not adequately capture the prevalence or incidence of mental illness nor the disability it causes. Mortality data is useful for exploring excess deaths due to suicide and trends over time. More research is needed into the contribution poor mental wellbeing and mental illness makes to overall mortality.

Prevalence data relies on diagnosis, which is dependent on access to health services. It is estimated that only 32% of those with clinical levels of mental illness receive treatment. (1) Unmet need remains a challenge to public health. Self-report of symptoms of mental illness is influenced by the stigma associated with it. Measuring recovery outcomes is an important outcome for mental health services but this remains a challenge due to the complexity of mental health conditions and the subjectivity of recovery.

Mental wellbeing has only recently been measureable with valid and reliable measures. The most popular scales of mental wellbeing in the UK are the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) (2) (3) (4) (5) and the short version (SWEMWBS). (6)

Mental wellbeing is not a diagnosis - representing one end of a continuum - and so prevalence statistics are not available. However, recent work in the UK has established population mean scores for mental wellbeing at a national level and in some local areas.

With the growth in public mental health practice over the past decade, there has been an increase in evidence and information regarding the measurement both of mental wellbeing itself and also of indicators and determinants. This briefing provides a summary of this work and signposts users to the datasets where the information is available.

Public Health England has established a Mental Health Intelligence Network to provide better access to the data already collected around mental health and wellbeing.  It includes common mental health problems, severe mental illness, children and young people's mental health, mental wellbeing, coexisting substance use and mental health issues and also dementia.

National outcome frameworks

Mental health and wellbeing features in the national outcome frameworks of England and Scotland. The measures used in these frameworks have been chosen because they are amongst the most robust mental health statistics available. The measures differ slightly in different parts of the UK.

Further Reading

Stewart-Brown S, Defining and Measuring Wellbeing in Quinn N and Knifton L (eds). Public Mental Health: Global Perspective, McGraw-Hill (Europe) Open University Press 2012.

References

1) McManus S et al. Meeting the mental health challenge in England: results from the Adult Psychiatric Morbidity Survey 2007. National Centre for Social Research, 2009.

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2) Tennant R, Hiller L, Fishwick R, Platt P et al. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health and Quality of Life Outcome 2007;5(63).

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3) Clarke A, Friede T, Putz R, Ashdown J et al. Warwick-Edinburgh Mental Well-being Scale (WEMWBS): Mixed methods assessment of validity and reliability in teenage school students in England and Scotland. BMC Health and Quality of Life Outcomes 2011;11:487.

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4) Maheswaran H, Weich S, Powell J, Stewart-Brown S. Evaluating the responsiveness of the Warwick Edinburgh Mental Well-Being Scale (WEMWBS): group and individual level analysis. BMC Health and Quality of Life Outcomes 2012, 10:156.

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5) Taggart F, Friede T, Weich S, Clarke A et al. Cross Cultural Evaluation of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS): a mixed methods study. Health and Quality of Life Outcomes. 2013;11:27. DOI: 10.1186/1477-7525-11-27.

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6) Stewart-Brown S, Tennant A ,Tennant R, Platt S et al. Internal construct validity of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS): a Rasch analysis using data from the Scottish Health Education Population Survey. Biomed Central Health and Quality of Life Outcome 2009;7(15). ISSN 1477-7525.

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Other references

Goldberg, Williams, DP and P.  The User's Guide to the General Health Questionnaire. NFER-Nelson: Windsor. 1998

Tennant R, Hiller L, Fishwick R, Platt P, Joseph S, Weich S, Parkinson J, Secker J, Stewart-Brown S. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health and Quality of Life Outcome 2007;5(63).

Clarke A, Friede T, Putz R, Ashdown J, Martin S, Blake A, Adi Y, Parkinson J, Flynn P, Platt S, Stewart-Brown S. Warwick-Edinburgh Mental Well-being Scale (WEMWBS): Mixed methods assessment of validity and reliability in teenage school students in England and Scotland. BMC Health and Quality of Life Outcomes 2011;11:487.

Taggart F, Friede T, Weich S, Clarke A,Johnson M, Stewart-Brown S. Cross Cultural Evaluation of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS): a mixed methods study. Health and Quality of Life Outcomes.2013;11:27. DOI: 10.1186/1477-7525-11-27.

Stewart-Brown S, Tennant A ,Tennant R, Platt S, Parkinson J, Weich S. Internal construct validity of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS): a Rasch analysis using data from the Scottish Health Education Population Survey. Biomed Central Health and Quality of Life Outcome 2009;7(15). ISSN 1477-7525.

13) See www.sdqinfo.com


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