Measuring Well-being: Key Indicators and Tools for Positive Mental Health

Mental health has long been defined by what goes wrong – depression, anxiety, psychosis. But positive mental health asks a fundamentally different question: what does it look like when things go right? Measuring that requires looking beyond the absence of illness toward specific indicators and validated tools that capture genuine well-being. From the broad brushstrokes of national development data to finely tuned psychological scales, the measurement of positive mental health operates at multiple levels – and understanding those levels helps both individuals and policymakers make better decisions about human flourishing.

Why measuring positive mental health matters 🔗

The World Health Organization defines health not merely as the absence of disease but as a state of complete physical, mental, social, and spiritual well-being. This definition shifted how researchers think about mental health – it is not enough to track how many people are unwell; we need concrete ways to track and promote wellness. Measurement is the first step. Without reliable indicators, there is no way to know whether interventions are working, how populations compare, or where resources should go.

Indicators of positive mental health exist at two broad levels: the macro level, which captures societal conditions that enable or constrain mental health, and the individual level, which measures psychological states directly within a person.

Macro-level indicators: societal conditions as a proxy 🔗

No individual exists in a vacuum. The conditions of the society a person lives in – economic stability, access to education, healthcare infrastructure – shape mental health in profound ways. This is why macro-level indicators serve as an indirect but important measure of population mental well-being.

The Human Development Index (HDI) 🔗

Introduced by the United Nations Development Programme (UNDP) in 1990, the Human Development Index was developed as a broader alternative to GDP-only measures of national progress. The HDI takes into account life expectancy at birth, expected years of schooling, and gross national income per capita, providing a more holistic picture of overall human development than economic output alone. It was introduced to highlight the importance of human well-being and to shift the focus from economic growth to human development.

While the HDI does not directly measure psychological states, its components – educational access and standard of living – are widely recognised as upstream determinants of mental health. Societies with higher literacy rates and greater material security tend to show better population-level psychological outcomes. A higher HDI implies longer, healthier lives, better education and higher command over resources; however, it does not capture inequality, sustainability or subjective wellbeing. This last point is critical: HDI gives a useful macro picture, but it must be complemented by more granular psychological indicators to tell the full story.

The Sustainable Development Goals (SDGs) and mental health 🔗

The United Nations’ Sustainable Development Goals provide another macro-level framework with mental health implications. SDG 3 explicitly targets good health and well-being, while goals related to poverty reduction, quality education, and reduced inequalities all act as indirect mental health indicators. When a society makes progress on these metrics, the psychological consequences – reduced chronic stress, greater sense of security, better social cohesion – are measurable downstream.

Core individual-level indicators 🔗

Moving from society to the individual, there are four well-established psychological constructs that researchers and clinicians use to assess positive mental health. Each captures a distinct dimension of how a person relates to themselves and the world.

Antonovsky’s sense of coherence (SOC) 🔗

Perhaps the most theoretically rich of all individual mental health indicators is Aaron Antonovsky’s sense of coherence. Antonovsky was a medical sociologist who posed a deceptively simple question: why do some people remain healthy and psychologically resilient in the face of severe hardship, while others do not? His answer led to the concept of salutogenesis – the study of the origins of health rather than the origins of disease.

When you have a sense of coherence, you see the world as something that is manageable, understandable, and meaningful. These three components – comprehensibility, manageability, and meaningfulness – form the core of the SOC construct. The SOC scale consists of at least three dimensions: the comprehensibility, the manageability, and the meaningfulness components.

Antonovsky developed the 29-item Orientation to Life Questionnaire to measure the sense of coherence, having 11 items measuring comprehensibility, 10 items measuring manageability, and 8 items measuring meaningfulness. The response alternatives are a semantic scale of 1 to 7 points. A shorter 13-item version was also developed. Both versions have been applied cross-culturally: Antonovsky’s scales have been used in at least 49 different languages in at least 48 different countries.

The research evidence strongly backs SOC as a mental health indicator. SOC is strongly related to perceived health, especially mental health. The stronger the SOC the better the perceived health in general, at least for those with an initial high SOC. This relation is manifested in study populations regardless of age, sex, ethnicity, nationality, and study design. Importantly, the SOC refers to an enduring attitude and measures how people view life and, in stressful situations, identify and use their general resistance resources to maintain and develop their health.

Rosenberg’s self-esteem scale 🔗

Self-esteem – how positively or negatively a person evaluates themselves – is one of the most studied constructs in all of psychology, and for good reason. Low self-esteem is consistently linked to depression, anxiety, and poor social functioning, while healthy self-esteem acts as a buffer against stress and adversity.

Morris Rosenberg’s Self-Esteem Scale (RSES), developed in 1965, remains the gold standard for measuring this construct. It consists of ten statements – five positively and five negatively worded – that respondents rate on a four-point scale from “strongly agree” to “strongly disagree.” Items tap into global feelings of self-worth rather than specific competencies or contexts. The scale is brief, reliable, and has been validated across cultures, making it one of the most widely used psychological instruments in the world. High scores indicate a stable, positive self-regard – a foundational component of positive mental health.

Pearlin’s mastery scale 🔗

Mastery refers to the degree to which a person feels they have control over the forces and outcomes that significantly affect their lives. Sociologist Leonard Pearlin developed his mastery scale to capture this sense of personal agency. The scale consists of seven items assessing whether respondents believe their life circumstances are within their own control or determined largely by external forces.

High mastery scores are associated with an internal locus of control – the conviction that one’s actions matter and can change outcomes. This is a significant predictor of positive mental health. People with a strong sense of mastery tend to use more effective, problem-focused coping strategies when facing stressors, experience lower levels of chronic anxiety, and demonstrate greater psychological resilience. Mastery also links closely to Antonovsky’s manageability dimension, but focuses more specifically on perceived personal agency rather than the broader salutogenic orientation.

Optimism: Scheier and Carver’s LOT-R 🔗

Optimism – the generalised expectation that positive outcomes will occur in the future – is the fourth critical individual-level indicator. Michael Scheier and Charles Carver developed the Life Orientation Test (LOT) in 1985, and later refined it into the Life Orientation Test-Revised (LOT-R) in 1994. The LOT-R measures dispositional optimism – a stable personality orientation toward positive expectations – through ten items, of which six are scored (three positively and three negatively worded) and four are fillers.

Research has shown that optimistic individuals tend to employ more effective coping strategies, experience better physical health outcomes, and show greater psychological resilience following setbacks. Crucially, optimism as measured by the LOT-R is distinct from wishful thinking – it reflects a genuine expectation of positive future outcomes that motivates adaptive behaviour in the present. This makes it a powerful predictor of both hedonic well-being (feeling good) and eudaimonic well-being (functioning well and living meaningfully).

Validated measurement tools 🔗

Beyond the individual scales for each psychological construct, researchers have developed composite tools designed to measure positive mental health as an integrated whole. These instruments operationalise well-being across both its hedonic and eudaimonic dimensions.

The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) 🔗

The Warwick-Edinburgh Mental Well-Being Scale is one of the most rigorously validated tools for measuring positive mental health in general and clinical populations. The WEMWBS was developed to enable the measuring of mental wellbeing in the general population and the evaluation of projects, programmes and policies which aim to improve mental wellbeing.

The 14-item scale has 5 response categories, summed to provide a single score. The items are all worded positively and cover both feeling and functioning aspects of mental wellbeing, thereby making the concept more accessible. This entirely positive framing is deliberate and significant – it ensures the scale captures the presence of well-being rather than simply inferring it from the absence of symptoms. As a short and psychometrically robust scale, with no ceiling effects in a population sample, it offers promise as a tool for monitoring mental well-being.

The WEMWBS covers both hedonic well-being (positive emotions, feelings of happiness and relaxation) and eudaimonic well-being (a sense of purpose, feeling engaged with life, having good relationships). Respondents rate each statement over the past two weeks, making it sensitive to change – which is why it has been widely adopted for evaluating mental health promotion interventions. The WEMWBS is a measure of subjective well-being and assesses both eudemonic and hedonic aspects of well-being.

Hedonic vs. eudaimonic well-being: what the tools are actually measuring 🔗

A key distinction running through all these measurement tools is the difference between two philosophically different conceptions of well-being. Hedonic well-being refers to the presence of positive emotions and the absence of negative ones – essentially, how good a person feels. Eudaimonic well-being, rooted in Aristotle’s concept of eudaimonia, refers to living in accordance with one’s values, fulfilling one’s potential, and having a sense of purpose and meaning.

Most validated tools now attempt to capture both. Antonovsky’s SOC scale leans eudaimonic – it emphasises meaning, comprehension, and coping as central to health. The LOT-R taps into hedonic expectations (feeling hopeful, anticipating good outcomes). The WEMWBS deliberately spans both, including items about feeling cheerful (hedonic) alongside items about feeling useful and purposeful (eudaimonic). Rosenberg’s self-esteem scale and Pearlin’s mastery scale sit closer to the eudaimonic end, capturing stable cognitive evaluations about the self rather than fluctuating emotional states.

Understanding this distinction matters in practice. A person might score well on hedonic well-being – feeling happy day to day – while scoring low on eudaimonic indicators like mastery or sense of coherence, suggesting they may be vulnerable to stress even while appearing outwardly content. This is why comprehensive measurement draws on multiple tools and constructs rather than relying on a single score.

From measurement to action 🔗

What makes these indicators and tools valuable is not just their academic rigour but their practical utility. At the macro level, HDI data helps governments identify populations where structural investment in education and income is most urgent. At the individual level, tools like the WEMWBS and LOT-R allow clinicians, community health workers, and researchers to track the effectiveness of interventions – from mindfulness programmes to social prescribing – in ways that go beyond simply asking whether a person is less depressed.

Crucially, these measures also shift the narrative of mental health care. When practitioners use instruments that measure coherence, mastery, optimism, and self-esteem – not just symptom checklists – they signal to clients that health is about building something, not merely fixing a deficit. That reframing is itself therapeutic. As Antonovsky’s work suggests, the question worth asking is not just “what is wrong?” but “what keeps people well?” – and answering it requires the right tools.

What do you think? If you were to measure your own positive mental health right now, which of these indicators – sense of coherence, self-esteem, mastery, or optimism – do you think would tell you the most about your current psychological state? And how might a society’s HDI score shape an individual’s ability to develop a strong sense of coherence in the first place?

References

1. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response
2. https://hdr.undp.org/data-center/human-development-index
3. https://doi.org/10.1017/S0033291700028124
4. https://doi.org/10.1037/0022-3514.55.2.169
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC2222612/
6. https://hdr.undp.org/data-center
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC2465600/