Prevalence and Correlates of Complete Mental Health in the South Korean Adult Population

Model

χ ²

TLI

CFI

RMSEA

Adults sample (N = 467)

One factor

281.389

0.602

0.734

0.202

Orthogonal two factor

78.263

0.904

0.936

0.099

Correlated two factor

41.933

0.971

0.954

0.069

TLI Tucker-Lewis index, CFI comparative fit index, RMSEA root mean square error of approximation

The results of our CFA showed that a correlated two-factor solution provided a suitable fit for the present data. This is consistent with the factor structure found by Keyes (2005). In sum, our data strongly support the structural axiom hypothesis that measures of mental health and mental illness clearly form separate, correlated factors (Keyes 2005) and that this model applies to a South Korean population.

Figure 5.1 reports the prevalence of mental health using the MHC–SF as diagnosed categorically and assessed continuously according to the suggestions by Keyes (2005). Only 7.9% fit the categorical diagnosis of flourishing (a state in which an individual feels positive emotion toward life and is functioning well psychologically and socially). Moreover, only 6.2% fit into the highest range of the continuous assessment of mental health (i.e., 50–70), which was the fifth most prevalent range of mental health scores. Most South Koreans, roughly 7 in 10 according to the categorical diagnosis, were moderately mentally healthy. The most prevalent range of mental health scores was the approximate midpoint of the continuous assessment (i.e., 20–30 scores, 30.0%; 30–40 scores, 27.6%). Although only one in five South Koreans were languishing, a state in which an individual is devoid of positive emotion toward life and is not functioning well psychologically or socially (about 21% according to the categorical diagnosis), it is important to note that more South Koreans were mentally unhealthy (i.e., languishing) than were mentally healthy (i.e., flourishing).

Fig. 5.1

Prevalence of mental health diagnosis (Note: MMH Moderately Mentally Healthy)

To obtain the estimates of the states of complete mental health, whether individuals had any of the mental disorders was cross-tabulated against the categorical mental health diagnosis (Fig. 5.2). The prevalence of complete mental health was nearly 6.2%, whereas 51.4% were moderately mentally healthy, and 13.1% had a form of pure languishing, which is languishing without any of the four mental disorders. Of the 29.3% of adults who had any of the four mental illnesses, 8.1% were also languishing, whereas 21.2% had a pure form of mental illness, indicating that this latter group had either moderate mental health or was flourishing.

Fig. 5.2

Point prevalence of complete mental health in South Korea in 2010

Mental Health: Psychosocial Functioning

Cross-tabulation of the four DSM-IV mental disorders and the mental health diagnoses revealed that flourishing individuals were at the lowest risk of three of the four mental disorders and that the prevalence of each mental disorder decreased as the level of mental health increased. For example, 23% of languishing and 22% of moderately mentally healthy individuals, compared with 10% of flourishing adults, had probable alcohol abuse or dependence, which is the most common diagnosis in South Korea. Moderately mentally healthy adults were about three times less likely than languishers to have a major depressive disorder. Moderately mentally healthy individuals also were about four times less likely than languishers to have comorbid mental disorders.

Respondents were asked to evaluate their physical health on a scale from poor, fair, very good, to excellent. Figure 5.3 shows that the diagnosis of complete mental health is consistent with individuals’ self-reported physical health. More than half of the adults who were languishing evaluated their physical health as either poor or fair. In contrast, fewer than 15% of completely mentally healthy individuals reported that their physical health was either poor or fair. However, 28.7% of moderately mentally healthy adults and 33.3% of adults with at least one mental disorder saw their physical health as either poor or fair. Sixty-two percent (62%) of the completely mentally healthy individuals felt that their physical health was either very good or excellent. In contrast, none of the pure languishing or languishing individuals, or those who were languishing and had at least one mental disorder, said their emotional health was excellent.

Fig. 5.3

Self-rated physical health by mental illness and mental health status

Participants reported their mental or emotional health on a scale from poor, fair, very good, to excellent. Figure 5.4 reveals that the diagnosis of complete mental health matches the individuals’ self-reported mental or emotional health. More than half of the adults who were languishing evaluated their emotional health as either poor or fair. In contrast, fewer than 4% of completely mentally healthy individuals said their emotional health was either poor or fair. However, 26.3% of moderately mentally healthy adults and 29.3% of adults with at least one mental disorder saw their emotional health as either poor or fair. Almost 80% of the completely mentally healthy individuals felt that their emotional health was either very good or excellent. In contrast, only 6.5% of pure languishing individuals and 10.5% of the adults who were languishing and had at least one mental disorder said that their emotional health was either very good or excellent.

Fig. 5.4

Self-rated mental, emotional health by mental illness and mental health status

Adults were also asked whether they agreed or disagreed with the following statements about helplessness: “I often feel helpless in dealing with the problems of life” and “There is little I can do to change the important things in my life.” To measure goal formation, we asked respondents whether the statements “I know what I want out of life” and “I find it helpful to set goals for the near future” described them a lot, some, a little, or not at all. Two additional statements were used to measure respondents’ resilience: “When faced with a bad situation, I do what I can to change it for the better” and “I find I usually learn something meaningful from a difficult situation.” Participants responded as to whether each statement described them a lot, some, a little, or not at all. Finally, intimacy was measured by asking respondents to indicate whether their (a) spouse or partner (or other family members) and (b) friends “really care(s) about them.” Again, respondents were asked whether each statement applied to them a lot, some, a little, or not at all.

Table 5.2 presents the mean level of psychosocial assets (resilience, goal formation, helplessness, and intimacy) by level of mental health. Completely mentally healthy individuals had higher scores on resilience and goal formation than any other group. They also scored higher on intimacy than purely languishing individuals. In addition, resilience, goal formation, and intimacy were higher among adults with pure mental illness than in adults with pure languishing.

Table 5.2

Psychosocial functioning by categorical diagnosis of complete mental health (N = 467)

	Mental illness and languishing	Pure mental illness	Pure languishing	Moderate mentally healthy	Completely mentally healthy
N	38	99	61	240	29
%	8.1	21.2	13.1	51.4	6.2
Resilience	4.71(1.35)	5.34(1.06)	4.80(1.09)	5.40(1.13)	6.31(1.07)
Goals	4.92(1.40)	5.76(1.01)	4.90(1.31)	5.67(1.27)	6.51(1.02)
Helplessness	5.18(1.43)	4.32(1.46)	4.14(1.47)	3.86(1.26)	3.72(1.66)
Intimacy	3.76(1.19)	5.03(1.41)	4.31(1.45)	5.27(1.26)	5.75(1.27)

In summary, completely mentally healthy adults reported higher levels of psychosocial functioning than those with pure languishing. Languishing with at least one mental disorder was associated with the worst outcomes and the most psychosocial impairment when compared with all diagnoses of complete mental health. Pure languishing, or the absence of mental health, appears to be more onerous to psychosocial functioning than the presence of at least one mental disorder.

Mental Health: Sociodemographic Correlates

Household Income

Regarding the reported monthly household income level of the respondents, 28.0% of the respondents had a household income of less than KW 2,500,000 (US$2,037), 56.6% of the respondents had a household income between KW 2,500,000 and KW 5,000,000 (US$2,037–4,074), and 15.4% had a household income of more than KW 5,000,000 (US$4,074). Figure 5.5 illustrates the association between the total and sub-domain scores of the MHC–SF and participants’ self-reported household income level. Adults with a monthly income of more than KW 5,000,000 had higher scores on the PWB subscale (M = 14.88, SD = 6.55) than people earning between KW 2,500,000 and KW 5,000,000.