Wellbeing: more than being well

Alongside mental health, the term wellbeing is often included to describe influences that bear on a person’s quality of life, such as social or economic factors, or to a person’s subjective assessment of satisfaction or fulfillment. Competing concepts have proliferated, providing an important area in which increased clarity may help refine mental health research that includes wellbeing.

Against the long historical backdrop of psychiatry and psychology’s efforts to identify and to understand the symptoms and states associated with psychiatric disorders, it is not surprising that finding adequate and appropriate labels for the converse of mental illness appears to be nearly as challenging. For one, viewing mental health through a medical model lens of binary categories of illness or wellness not only may be inaccurate or insufficient but also opens the door for problematic interpretations that underestimate the complexity of individual differences and discount social and physical environments.

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Although numerous models have been posed, there is convergence around the notion that mental health is currently construed as a spectrum that encompasses polarities of distress and impairment (mental illness) and healthy, positive functioning, which some refer to as mental wellness. Wellness is generally interpreted as being aligned with the domain of health. Positive mental health, however, is but one facet of the broader and interconnected concept of wellbeing, which is crucial for understanding people’s lives more wholistically. Considering ‘mental health and wellbeing’ together offers both a challenge and an opportunity, by serving as a reminder that a person’s mental health per se does not exist in a vacuum and that social determinants — economic factors, built environments and access to healthcare — can be potent moderators of risk and resilience for mental health conditions.

One prominently used definition of wellbeing from the World Health Organization suggests that it is a positive state that encompasses one’s quality of life, as well as their capacity to meaningfully and purposefully contribute to society. Indeed, Sustainable Development Goal 3 endeavors to “Ensure healthy lives and promote wellbeing for all at all ages.” The formulation of this definition, which includes mental health, is purposefully open to allow for the complexities of the underlying and context-specific issues that bear on health, as well as to provide opportunities to build consensus around different countries’ needs and stakeholder viewpoints and priorities. Importantly, how wellbeing is defined for global social and economic development and the very specific factors that bear on a person’s subjective experience can be worlds apart.

In the February 2025 issue of Nature Mental Health, we present work that underscores some of the challenges and points of difference in defining and operationalizing wellbeing, especially in clinical research. By contrast, specific conceptualizations and applications of wellbeing may help to extend and expand understanding of the nature of certain mental health conditions, such as addiction.

In a Perspective, Fallon Goodman presents methodological and theoretical challenges for measuring wellbeing in clinical research and discusses the importance of including wellbeing measures in clinical studies. This piece lays out a comprehensive overview of the different concepts of wellbeing, various assessment tools available to measure it, and how progress can be made in mental health research by including appropriate ways to evaluate wellbeing depending on the research question and study design.

Goodman highlights the current criticism of treatment research, which is focused on reducing symptoms associated with a disorder, rather than improving positive affect and wellbeing. The Perspective also emphasizes the importance of positive psychology approaches — for example, interventions focused on enhancing positive thoughts, emotions and behaviors. Mental health treatments associated with increasing positive outcomes may reduce negative symptoms while reinforcing feelings such as happiness, fulfillment and contentedness.

Wellbeing may also have other clinically useful implications, as underscored in the Comment by Eric Garland, which presents the opioid crisis as one of the diseases of despair. This piece suggests that for centuries, people have made use of psychoactive drugs to seek relief or pleasure, with the intent of increasing so-called wellbeing. Garland details the importance of interventions that aim to restore adaptive hedonic regulation of the reward system through more-natural, healthy rewards and by reducing the craving caused by addictive drug-induced rewards.

One such intervention built on this is Mindfulness-Oriented Recovery Enhancement, which he and his colleagues designed. The intervention involves mindfulness training, cognitive–behavioral therapy and positive psychology practices to help people with addiction and/or chronic pain develop better cognitive control, reinterpret negative feelings and gain a sense of deeper meaning and purpose in life. The issue also includes a Q&A piece with Garland in which he discusses how his interest in mindfulness has fueled his research and his passion for disseminating that work to others, including, most recently, US legislators and policymakers.

Wellbeing research continues to evolve and expand, bringing to light not only new questions but also new stakeholders. With such close links to mental health and the many branches of clinical science with overlapping aims, it is an excellent time to foster more collaboration among researchers to explore how wellbeing can be promoted to improve lives.