What does it mean to flourish? Piloting the flourishing measure with adolescents and young adults with mood and anxiety disorders

Abstract

Introduction: Treatment for adolescents and young adults with mood and anxiety disorders typically focuses on recovery of symptoms and improvement in functioning. Measuring positive states of health—using self-report surveys such as the Flourishing Measure—may help to promote holistic treatment. We piloted the Flourishing Measure—Adolescent Version in a clinical sample of adolescents and young adults with mood and/or anxiety disorders to determine appropriateness and acceptability in this population.

Methods: We recruited adolescents (age 12–18) and young adults (age 19–25) with mood and/or anxiety disorders from an outpatient psychiatry clinic associated with an academic hospital. We used cognitive interviewing, a method used in survey development that determines whether respondents’ understanding aligns with instrument intention. Participants completed the Flourishing Measure and answered questions about their impressions of items.

Results: Sixteen participants (10 adolescents and 6 young adults) participated in the study. Participants generally understood the concept of flourishing and the intention of individual items. The items were generally considered clear and participants offered minor suggestions for improvement in wording of the items.

Discussion: Participants in our study understood the meaning of flourishing, as well as individual items in the measure. The Flourishing Measure may be suitable for use in clinical and research settings for adolescents and young adults, though piloting with larger, more diverse samples is needed.

Keywords

flourishing mood disorders anxiety disorders positive psychology adolescent young adult

Get full access to this article

View all access options for this article.

References

Arnett

J. J.

(2000). Emerging adulthood. A theory of development from the late teens through the twenties. The American Psychologist, 55(5), 469–480. https://doi.org/10.1037/0003-066X.55.5.469

Carr-Gregg

M. R.

Enderby

K. C.

Grover

S. R.

(2003). Risk-taking behaviour of young women in Australia: Screening for health-risk behaviours. The Medical Journal of Australia, 178(12), 601–604. https://doi.org/10.5694/j.1326-5377.2003.tb05381.x

Clarke

Friede

Putz

Ashdown

Martin

Blake

Adi

Parkinson

Flynn

Platt

Stewart-Brown

(2011). Warwick-edinburgh mental well-being scale (WEMWBS): Validated for teenage school students in England and scotland. A mixed methods assessment. BMC Public Health, 11, 487. https://doi.org/10.1186/1471-2458-11-487

Collins

(2003). Pretesting survey instruments: An overview of cognitive methods. Quality of Life Research, 12(3), 229–238. https://doi.org/10.1023/a:1023254226592

Daugherty

Harris-Kojetin

Squire

Jaël

Harris-Kojetin

(2001). Maximizing the quality of cognitive interviewing data: An exploration of three approaches and their informational contributions. In Proceedings of the annual meeting of the American statistical association, August 5–9 2001, Washington, DC, USA.

Fredrickson

B. L.

(2001). The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. The American Psychologist, 56(3), 218–226. https://doi.org/10.1037//0003-066x.56.3.218

Harvard Medical School . (2007). National comorbidity survey (NCS). National Comorbidity Survey. https://www.hcp.med.harvard.edu/ncs/index.php

Hayes

L. L.

Ciarrochi

J. V.

(2015). The thriving adolescent: Using acceptance and commitment therapy and positive psychology to help teens manage emotions, achieve goals, and build connection. New Harbinger Publications.

Jeste

D. V.

Palmer

B. W.

Rettew

D. C.

Boardman

(2015). Positive psychiatry: Its time has come. The Journal of Clinical Psychiatry, 76(6), 675–683. https://doi.org/10.4088/JCP.14nr09599

10.

Kamp

Wyatt

Dudley-Brown

Brittain

Given

(2018). Using cognitive interviewing to improve questionnaires: An exemplar study focusing on individual and condition-specific factors. Applied Nursing Research, 43, 121–125. https://doi.org/10.1016/j.apnr.2018.06.007

11.

Kelly-Hedrick

Rodriguez

M. M.

Ruble

A. E.

Wright

S. M.

Chisolm

M. S.

(2020). Measuring flourishing among internal medicine and psychiatry residents. Journal of Graduate Medical Education, 12(3), 312–319. https://doi.org/10.4300/JGME-D-19-00793.1

12.

Kern

M. L.

Waters

L. E.

Adler

White

M. A.

(2015). A multidimensional approach to measuring well-being in students: Application of the PERMA framework. Journal of Positive Psychology, 10(3), 262–271. https://doi.org/10.1080/17439760.2014.936962

13.

Keyes

C. L. M.

(2002). The mental health continuum: From languishing to flourishing in life. Journal of Health and Social Behavior, 43(2), 207–222. https://doi.org/10.2307/3090197

14.

Krok

(2018). When is meaning in life most beneficial to young people? Styles of meaning in life and well-being among late adolescents. Journal of Adult Development, 25(2), 96–106. https://doi.org/10.1007/s10804-017-9280-y

15.

Lee

M. T.

Weziak-Bialowolska

Bialowolski

Chen

McNeely

VanderWeele

(2019). Cultural differences in flourishing among workers. Technical Report.

16.

Lianov

L. S.

Fredrickson

B. L.

Barron

Krishnaswami

Wallace

(2019). Positive psychology in lifestyle medicine and health care: Strategies for implementation. American Journal of Lifestyle Medicine, 13(5), 480–486. https://doi.org/10.1177/1559827619838992

17.

Lim

M. W.

Remington

Lee

(2017). Personal recovery in serious mental illness: Making sense of the concept. Annals of the Academy of Medicine, Singapore, 46(1), 29–31. https://doi.org/10.47102/annals-acadmedsg.V46N1p29

18.

Lindert

Bain

P. A.

Kubzansky

L. D.

Stein

(2015). Well-being measurement and the WHO health policy Health 2010: Systematic review of measurement scales. European Journal of Public Health, 25(4), 731–740. https://doi.org/10.1093/eurpub/cku193

19.

Lippman

L. H.

Anderson Moore

Guzman

Ryberg

McIntosh

Ramos

M. F.

Caal

Carle

Kuhfeld

(2014). Flourishing children: Defining and testing indicators of positive development. Springer.

20.

Lyubomirsky

Lepper

(1999). A measure of subjective happiness: Preliminary reliability and construct validation. Social Indicators Research, 46, 137–155. https://doi.org/10.1023/A:1006824100041

21.

Macaskill

(2016). Review of positive psychology applications in clinical medical populations. Healthcare, 4(3), 66. https://doi.org/10.3390/healthcare4030066

22.

Marino

Crimi

Carrozza

Failla

Sfrazzetto

S. T.

Chilà

Bianco

Arnao

A. A.

Tartarisco

Cavallaro

Ruta

Vagni

Pioggia

(2019). A novel third wave contextual approach of positive behavior support in school for adolescent at high psychosocial risk: Rationale, feasibility, and first pilot outcomes. Frontiers in Psychology, 10, 2635. https://doi.org/10.3389/fpsyg.2019.02635

23.

Merikangas

K. R.

J. P.

Burstein

Swanson

S. A.

Avenevoli

Cui

Benjet

Georgiades

Swendsen

(2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the national comorbidity survey replication--adolescent supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 980–989. https://doi.org/10.1016.j.jaac.2010.05.017

24.

Orth

Van Wyk

(2021). Measuring mental wellness among adolescents living with a physical chronic condition: A systematic review of the mental health and mental well-being instruments. BMC Psychology, 9(1), 176. https://doi.org/10.1186/s40359-021-00680-w

25.

Patrick

D. L.

Edwards

T. C.

Topolski

T. D.

(2002). Adolescent quality of life, part II: Initial validation of a new instrument. Journal of Adolescence, 25(3), 287–300. https://doi.org/10.1006/jado.2002.0471

26.

Pustilnik

(2019). Adapting well-being into outpatient child psychiatry. Child and Adolescent Psychiatric Clinics of North America, 28(2), 221–235. https://doi.org/10.1016/j.chc.2018.11.006

27.

Sawicki

G. S.

Garvey

K. C.

Toomey

S. L.

Williams

K. A.

Chen

Hargraves

J. L.

Leblanc

Schuster

M. A.

Finkelstein

J. A.

(2015). Development and validation of the adolescent assessment of preparation for transition: A novel patient experience measure. The Journal of Adolescent Health, 57(3), 282–287. https://doi.org/10.1016.j.jadohealth.2015.06.004

28.

Seligman

M. E. P.

(2002). Positive psychology, positive prevention, and positive therapy. In Snyder

C. R.

Lopez

S. J.

(Eds.), Handbook of positive psychology (pp. 3–9). Oxford University Press.

29.

Seligman

M. E. P.

(2011). Flourish. Simon & Schuster.

30.

Shiyanbola

O. O.

Bolt

Tarfa

Brown

Ward

(2019). A content validity and cognitive interview process to evaluate an Illness Perception Questionnaire for African Americans with type 2 diabetes. BMC Research Notes, 12(1), 308. https://doi.org/10.1186/s13104-019-4342-9

31.

Tsangaris

D’Agostino

Rae

Breakey

Klassen

A. F.

(2019). Development and psychometric evaluation of the cancer distress scales for adolescent and young adults. Journal of Adolescent and Young Adult Oncology, 8(5), 566–580. https://doi.org/10.1089.jayao.2019.0005

32.

VanderWeele

T. J.

McNeely

Koh

H. K.

(2019a). Reimagining health—flourishing. JAMA, 321(17), 1667–1668. https://doi.org/10.1001/jama.2019.3035

33.

VanderWeele

T. J.

(2019b). Measures of community well-being: A template. International Journal of Community Well-Being, 2(3), 253–275. https://doi.org/10.1007/s42413-019-00036-8

34.

VanderWeele

T. J.

(2017). On the promotion of human flourishing. Proceedings of the National Academy of Sciences, 114(31), 8148–8156. https://doi.org/10.1073/pnas.1702996114

35.

Venning

Wilson

Kettler

Eliott

(2013). Mental health among youth in south Australia: A survey of flourishing, languishing, struggling, and floundering. Australian Psychologist, 48(4), 299–310. https://doi.org/10.1111/j.1742-9544.2012.00068.x

36.

Wȩziak-Białowolska

McNeely

VanderWeele

T. J.

(2019a). Human flourishing in cross cultural settings. Evidence from the United States, China, Sri Lanka, Cambodia, and Mexico. Frontiers Psychology, 10, 1269. https://doi.org/10.3389/fpsyg.2019.01269

37.

Weziak-Bialowolska

McNeely

VanderWeele

T. J.

(2019b). Flourish index and secure flourish index – validation in workplace settings. Cogent Psychology, 6(1), 1598926. https://doi.org/10.1080/23311908.2019.1598926

38.

Whiteford

H. A.

Degenhardt

Rehm

Baxter

A. J.

Ferrari

A. J.

Erskine

H. E.

Charlson

F. J.

Norman

R. E.

Flaxman

A. D.

Johns

Burstein

Murray

C. J.

Vos

(2013). Global burden of disease attributable to mental and substance use disorders: Findings from the global burden of disease study 2010. Lancet, 382(9904), 1575–1586. https://doi.org/10.1016/S0140-6736(13)61611-6

39.

Willis

G. B.

(2004). Cognitive interviewing: A tool for improving questionnaire design. Sage Publications.

40.

Willis

G. B.

Artino

A. R.

Jr. (2013). What do our respondents think we're asking? Using cognitive interviewing to improve medical education surveys. Journal of Graduate Medical Education, 5(3), 353–356. https://doi.org/10.4300/JGME-D-13-00154.1

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.06 MB