AXA : Mind Health Index 2023

Mind

Health

Index 2023

Abstract

A synopsis of the research and development effort undertaken to develop the AXA Mind Health Index as part of the Global AXA Mind Health Study 2023. This paper includes updates in relation to the second year of the survey, including new questions, formulation of new models, indices, concept validation and field testing of the new survey.

2 I AXA Mind Health Index 2023

Opening statement from Dr Chris Tomkins

2023 is the first year in which we can make year-on-year comparisons in order to provide insight to governments, employers and citizens about the trends in Mind Health.

The development of the AXA Mind Health Index from over 200 scientific papers gave us a robust platform from which to widen the discussion from mental ill health to a broader view to include the ingredients of good mind health. This is important because stress, anxiety and low mood are reaching epidemic proportions, but are often rooted in our lifestyle, work and environment. The study was very successful in 2022 when we were able to draw a distinction between struggling, languishing, getting by and flourishing. This gives us a more stable view of where an individual is on the spectrum of mind health, what factors put them there and, most importantly, what can we do as individuals and as a society to help everyone flourish.

The core index has changed little from 2022, with minor amendments to language. The scope has been expanded to other attributes such as Wellbeing Locus of Control, Gratification and Kindness and Loneliness. The design of the Index continues to be an international effort, involving expertise from multiple countries and we are delighted to have expanded to a further five countries giving us a more global footprint. Our focus this year has been now to apply the Index to gender, youth and the work lives.

Last year we saw that women were more likely to struggle and men more likely to flourish, and this year we set the ambition to explain the drivers behind that. The insights around people's lived experiences and the impact on whether they flourish are probably some of the most striking from this year's report. With both youth and workplaces we are seeing how developments at a societal level, whether it is the 'always-on' society, technology or new models of work, fundamentally contribute to or detract from good mind health. Such is the wealth of insight this year, we have not been able to address it all in the Global Report, so for the first time we will be producing a series

of addendum reports, and we will continue to mine for further insights throughout the year.

My sincere thanks to the scientific design and research teams in AXA UK, our team of international experts, Ipsos our fieldwork partner and the AXA Research Fund.

Dr Chris Tomkins,

Head of Wellbeing Propositions,

AXA Health UK

Table of contents

1. Background

1. Introduction
2. Core questions

06 Predictors

Preventive actions/skills

06 Authentic pride

1. Challenge response - rumination

1. Delayed gratification (new in MHI23)

1. Emotional competency (revised in MHI23)

1. Exercise

1. Kindness/giving (new in MHI23)
2. Locus of control (revised in MHI23)

1. Meaning/purpose

1. Me time

1. Mindfulness (revised in MHI23)

1. Nutrition

1. Openness to experience (new in MHI23)

1. Optimism
2. Positive actions

1. Resilience

1. Self-acceptance

1. Self-efficacy

1. Sleep

1. Social connectedness

1. Wellbeing locus of control (new in MHI23)

09 Modifiers

09 Attachment style

09 The health care system

09 Current and past mental health conditions

10 Outcomes

Supplementary questions - MHI23

1. Gender theme

1. Stigma

1. Workplace

Questions dropped from previous survey Previous reports

12 AXA report on mental health and wellbeing in Europe

12 AXA study of mind health and wellbeing in 2022

13 Methods

Fieldwork and statistics

Literature review

1. Factor selection criteria

1. Question level selection

1. Causality

1. Reverse causality

1. Self-reporting

Index creation

Other indices

16 Introduction

16 List of sub-indices

18 Appendix A

Questions used in creating the various indices

1. Validation

1. Summary

Summary

4 I AXA Mind Health Index 2023

AXA Mind Health Index (MHI) and Survey white paper

Background	Introduction
AXA is a major global investor and philanthropist	Mind health includes our emotional,
in multiple health topics.	psychological, and social wellbeing. It affects
Following the success of its first Mind Health Study in 2020,	how we think, feel, and act. It also helps
determine how we handle stress, relate to
during the pandemic, AXA decided to develop the first Mind
Health Index (MHI) in 2021 which was used to survey over	others, and make choices.1
11,000 participants from 8 European and 3 Asian countries.	In 2020 AXA identified an opportunity to contribute
This global report (MHI22) was released in early 2022.
The success of the survey resulted in an ongoing	meaningfully to the knowledge base of mental health
through a survey that leveraged expert-inspired pan-
commitment by AXA to track the MHI over the subsequent	European insights. The subsequent 2021 survey was
5-year period, with an extended offering to an additional	shaped by the global backdrop of COVID-19, and as a result,
five countries.	identified concrete levers and coping strategies which
This second MHI survey, MHI23, was conducted on over	allowed people, employers and society to flourish.
30,000 participants from 16 countries in September/October	The first survey sought to not only assess aspects of mental
2022, spanning 3 continents, welcoming the America region.	health across participating countries, but also gauge the
				impact of COVID-19 on mental health. The 2022 survey
				shifted focus from COVID-19 to new areas of interest - the
				workplace, young people, climate change and gender.
				The latest survey includes all eleven countries from the
				previous survey (Belgium, France, Germany, Ireland, Italy,
				Spain, Switzerland, UK, Mainland China, Hong Kong and
				Japan), in addition to a further five countries - Mexico,
				Philippines, Thailand, Turkey and the USA.
				The goal of the report is to provide scientifically backed
				insights into mind health related topics for multiple
				audiences: the general public, employers, insurance industry,
				consulting partners, and government.

1https://www.mentalhealth.gov/basics/what-is-mental-health

5 I AXA Mind Health Index 2023

A key component of AXA's MHI strategy is to track the changing mind health of participants in the post COVID-19 era. It was therefore important that the key questions from which the MHI score is derived remained largely unchanged.

Core questions

The survey consists of two main categories of questions:

1. A 'static' component (the index) which remains unchanged year on year, thereby allowing changes over time to be accurately and comparatively tracked, and
2. A 'dynamic' component of supplementary questions that are updated annually to provide insights into current themes and topics of interest.

As in the previous year, we used a systems approach to help understand the aetiology and maintenance of mind health.2 Using this framework, we sought to understand the factors that impact mind health at the individual, social and societal levels. A benefit of taking a multidimensional approach is that it provides a more holistic understanding of mental health and wellbeing, and as a result provides greater insight into how mind health can be supported and improved.

Our previous research identified areas of importance for mental health promotion and overall mind health.

Subsequent research for MHI23 identified other factors which expanded the scope of the second survey.

The core questions fell into 3 groups. These are also outlined in detail in the previous MHI White Paper,3 however a brief synopsis is provided here:

1. Predictors - individual skills and behaviours that have some predictive capability in terms of mental health outcomes (e.g. exercise is a predictor of mental health,
   it reduces stress, anxiety and depression, whilst improving life satisfaction via multiple pathways)
2. Outcomes - positive and negative mental health outcomes. On the negative side - stress, anxiety and depression, on the positive side - happiness and life satisfaction.

The behaviours and skills in the predictor group impact mental health outcomes, but they are impacted by an intermediary pathway: modifiers.

1. Modifiers - factors that mediate the degree to which the predictors impact outcomes. These include factors such as the health care system, intractable personality traits such as attachment style, as well as past and
   current mental health conditions.

The MHI score is an aggregation of these three sub-indices.

1. Bronfenbrenner, U., & Ceci, S. J. (1994). Nature-nurture reconceptualised: A bio-ecological model. Psychological Review, 10(4), 568-586.
2. Mind Health Index 2022. A synopsis of the development of the AXA Mind Health Index.