The researcher-driven conceptualizations of mental health that undergird flourishing measures have not been extensively studied qualitatively for acceptance by people in low and middle income countries. We conducted in-depth interviews with caregivers of orphaned and separated children (OSC) in five geographic regions (Kenya; Ethiopia; Cambodia; Hyderabad, India; and Nagaland, India). Sixty-two participants answered open-ended questions including, “What does mental health mean to you? What does it mean to be mentally healthy?” We coded responses using a priori and data-driven codes and analyzed coded text for themes. Across regions, participants frequently articulated similar conceptualizations, which did not include orientations/values but spanned experiences, functioning, and behaviors, as well as the eudaimonic and hedonic traditions of happiness. Functioning included good states of mind (peaceful mind, thinking clearly, thinking positively) and being physically healthy. Behaviors were contributing to the community and spending enjoyable time in groups. For experiences, participants universally indicated happiness, which was the most prominent feature of good mental health, using terms such as “happy,” “jovial,” and “joy.” Across all geographic regions, mental health was not articulated merely as the absence of mental illness. A two continua model of good mental health emerged spontaneously among half of Kenyan and one-third of Cambodian participants. Altogether, the lay conception of ‘a person who is mentally healthy’ across these diverse non-western cultures supports multiple existing conceptions and measurements of flourishing. Researchers may consider adding to their conceptualizations good functioning in the form of clear and peaceful thinking and the behavior of enjoyable socializing.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Aggarwal, P., & Sriram, S. (2018). Exploring well-being among mental health professionals in India. Psychological Studies, 63(4), 335–345.
Asian Development Bank. (2019). Poverty Data: Cambodia. https://www.adb.org/countries/cambodia/poverty Accessed 25 March 2020.
Battambang Province. (n.d.). In Wikipedia. https://en.wikipedia.org/wiki/Battambang_Province. Accessed 25 March 2020
Benatuil, D. (2003). El bienestar psicológico en adolescentes desde una perspectiva cualitativa. Psicodebate. Psicología, Cultura y Sociedad, 3, 43–58.
Canadian Institute for Health Information. (2009). Improving the health of Canadians: Exploring positive mental health. Ottawa: Author.
Census of India 2011: Andhra Pradesh. (2012). District Census Handbook – Hyderabad, Village and Town Directory, Series-29, Part XII-A. https://www.censusindia.gov.in. Accessed 25 March 2020.
Census of India 2011: Nagaland. (2011). District Census Handbook – Nagaland, Village and Town Directory. https://www.censusindia.gov.in/2011census/dchb/DCHB.html. Accessed 25 March 2020.
ConCERT Cambodia. (n.d.). Orphanages. https://concertcambodia.org/useful-information/orphanages/. Accessed 25 March 2020.
County Government of Bungoma. (n.d.) First Bungoma County integrated development plan: 2013- 2017. https://cog.go.ke/downloads/category/82-county-integrated-development-plans-2013-2017. Accessed 25 March 2020.
Denegri Coria, M., Garcia Jara, C., Gonzalez Rivera, N., Orellana Calderon, L., Supulveda Maldonado, J., & Schnettler Morales, B. (2014). Subjective well-being and satisfaction with food-related life in university students in southern Chile: A qualitative study. Summa Psicológica UST, 11(1), 51–63.
Diener, E., Wirtz, D., Tov, W., Kim-Prieto, C., Choi, D. W., Oishi, S., et al. (2010). New well-being measures: short scales to assess flourishing and positive and negative feelings. Social Indicators Research, 97(2), 143–156. https://doi.org/10.1007/s11205-009-9493-y.
Directorate of Economics and Statistics, Government of Telengana, Hyderabad. (2015). Statistical Year Book 2015. https://www.indiaenvironmentportal.org.in/files/file/Statistical%2520Year%2520Book%25202015.pdf. Accessed 25 March 2020.
Doré, I., O’Loughlin, J. L., Sabiston, C. M., & Fournier, L. (2017). Psychometric evaluation of the mental health continuum–Short form in French Canadian young adults. The Canadian Journal of Psychiatry, 62(4), 286–294.
Echeverría, G., Torres, M., Pedrals, N., Padilla, O., Rigotti, A., & Bitran, M. (2017). Validation of a Spanish version of the mental health continuum-short form questionnaire. Psicothema, 29(1), 96–102.
Ekman, P. (1992). An argument for basic emotions. Cognition and Emotion, 6(3–4), 169–200.
Ethiopia Population Census Commission. (2008). Summary and Statistical Report of the 2007 Population and Housing Census: Population Size by Age and Sex. https://www.ethiopianreview.com/pdf/001/Cen2007_firstdraft(1).pdf. Accessed 25 March 2020.
Guo, C., Tomson, G., Guo, J., Li, X., Keller, C., & Söderqvist, F. (2015). Psychometric evaluation of the Mental Health Continuum-Short Form (MHC-SF) in Chinese adolescents–a methodological study. Health and quality of life outcomes, 13(1), 198.
Hart, G. D. (1965). Asclepius, god of medicine. The Canadian Medical Association Journal, 1965(92), 232–236.
Hone, L. C., Jarden, A., Schofield, G. M., & Duncan, S. (2014). Measuring flourishing: The impact of operational definitions on the prevalence of high levels of wellbeing. International Journal of Wellbeing, 4(1), 62–90. https://doi.org/10.5502/ijw.v4i1.4.
Huppert, F. A., & So, T. C. (2013). Flourishing across Europe: Application of a new conceptual framework for defining well-being. Social Indicators Research, 110(3), 837–861. https://doi.org/10.1007/s11205-011-9966-7.
Huta, V., & Waterman, A. S. (2014). Eudaimonia and its distinction from hedonia: developing a classification and terminology for understanding conceptual and operational definitions. Journal of Happiness Studies, 15, 1425–1456.
Iasiello, M., van Agteren, J., & Muir-Cochrane, E. (2020). Mental health and/or mental illness: A scoping review of the evidence and implications of the dual-continua model of mental health. Evidence Base, 2020(1), 1–45. https://doi.org/10.21307/eb-2020-001.
Joshanloo, M., & Jovanović, V. (2017). The factor structure of the Mental Health Continuum-Short Form (MHC-SF) in Serbia: An evaluation using exploratory structural equation modeling. Journal of Mental Health, 26(6), 510–515.
Jowell, R., & The Central Coordinating Team. (2003). European Social Survey 2002/3: Technical report. London: Centre for Comparative Social Surveys, City University.
Infotrak Research and Consulting. (2017). Bungoma County popularity survey. https://infotrakresearch.com/wp-content/uploads/2017/07/BUNGOMA-COUNTYTRAK-_JULY-27-2017_MEDIA-RELEASE.pdf. Accessed 25 March 2020.
Kenya National Bureau of Statistics. (2013). Exploring Kenya’s inequality: pulling apart or pooling together?https://inequalities.sidint.net/kenya/wp-content/uploads/sites/3/2013/10/Preliminary%2520pages.pdf. Accessed 25 March 2020.
Kenya National Bureau of Statistics. (2019, May 2). Economic survey 2019. https://www.theelephant.info/documents/kenya-national-bureau-of-statistics-economic-survey-2019/. Accessed 25 March 2020.
Karas, D., Cieciuch, J., & Keyes, C. L. M. (2014). The Polish adaptation of the Mental Health Continuum-Short Form (MHC-SF). Personality and Individual Differences, 69, 104109.
Keyes, C. L. M. (2002). The mental health continuum: From languishing to flourishing in life. Journal of Health and Social Behavior, 43, 207–222.
Keyes, C. L. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73(3), 539–548.
Keyes, C. L. M., Shmotkin, D., & Ryff, C. D. (2002). Optimizing well-being: The empirical encounter of two traditions. Journal of Personality and Social Psychology, 82, 1007–1022.
Keyes, C. L. M., Wissing, M., Potgieter, J. P., Temane, M., Kruger, A., & Van Rooy, S. (2008). Evaluation of the Mental Health Continuum-Short Form (MHC–SF) in Setswana-speaking South Africans. Clinical Psychology & Psychotherapy, 15(3), 181–192.
Kim, J., & Ko, Y. (2016). The relationship between positive mental health type and daily physical health in adolescents. Korean Journal of Youth Studies, 23(2), 25.
KnightxxArrow. (2013, June 25). File: Religions of Cambodia. In Wikimedia.https://commons.wikimedia.org/wiki/File:Religions_of_Cambodia.png. Accessed 25 March 2020.
Lamers, S. M., Westerhof, G. J., Bohlmeijer, E. T., ten Klooster, P. M., & Keyes, C. L. M. (2011). Evaluating the psychometric properties of the Mental Health Continuum-Short Form (MHC-SF). Journal of Clinical Psychology, 67(1), 99–110.
Lee, Y. C., Lin, Y. C., Huang, C. L., & Fredrickson, B. L. (2013). The construct and measurement of peace of mind. Journal of Happiness Studies, 14(2), 571–590.
Lindwall, M., Ljung, T., Hadžibajramović, E., & Jonsdottir, I. H. (2012). Self-reported physical activity and aerobic fitness are differently related to mental health. Mental Health and Physical Activity, 5(1), 28–34.
Lu, L. (2001). Understanding happiness: A look into the Chinese folk psychology. Journal of Happiness Studies, 2(4), 407–432.
Machado, W. D. L., & Bandeira, D. R. (2015). Positive mental health scale: validation of the Mental Health Continuum-Short Form. Psico-USF, 20(2), 259–274.
Mathews, G. (1996). The pursuit of a life worth living in Japan and the United States. Ethnology, 35(1), 51–62.
Mathews, G. (2012). Happiness, culture, and context. International Journal of Wellbeing, 2(4), 299–312.
Meyn, C. (2013, November 29). Report says more than 10 percent of children are ‘laborers.’ The Cambodia Daily.https://www.cambodiadaily.com/news/report-says-more-than-10-percent-of-children-are-laborers-48198/. Accessed 25 March 2020.
Miles, M. B., Huberman, A. M., & Saldaῇa, J. (2014). Qualitative data analysis: A methods sourcebook (3rd ed.). Thousand Oaks, CA: Sage Publications Inc.
Monteiro, N. M., & Balogun, S. K. (2014). Perceptions of mental illness in Ethiopia: a profile of attitudes, beliefs and practices among community members, healthcare workers and traditional healers. International Journal of Culture and Mental Health, 7(3), 259–272.
National AIDS Control Council. (2020). Kenya AIDS Indicator Survey 2012. https://nacc.or.ke/kais-2012-final-report/. Accessed 25 March 2020.
National Planning Commission. (2017, June). Ethiopia 2017 Voluntary National Review on SDGs. https://www.et.undp.org/content/dam/ethiopia/docs/2017/The%25202017%2520VNRs%2520on%2520SDGs_Ethiopia%2520(Eng)%2520Web%2520version%2520.pdf. Accessed 25 March 2020.
Orpana, H., Vachon, J., Dykxhoorn, J., & Jayaraman, G. (2017). Measuring positive mental health in Canada: Construct validation of the Mental Health Continuum—Short Form. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 37(4), 123.
Perugini, M. L. L., de la Iglesia, G., Solano, A. C., & Keyes, C. L. M. (2017). The Mental Health Continuum-Short Form (MHC–SF) in the Argentinean context: Confirmatory factor analysis and measurement invariance. Europe's Journal of Psychology, 13(1), 93.
Petrillo, G., Capone, V., Caso, D., & Keyes, C. L. (2015). The Mental Health Continuum-Short Form (MHC–SF) as a measure of well-being in the Italian context. Social Indicators Research, 121(1), 291–312.
PopulationStat. (2020). Addis Ababa urban area population graph. Data used for 2017. https://populationstat.com/ethiopia/addis-ababa. Accessed 22 July 2020
QSR International Pty Ltd. (2017). NVivo Qualitative Data Analysis Software; Version 11.
Rafiey, H., Alipour, F., LeBeau, R., Amini Rarani, M., Salimi, Y., & Ahmadi, S. (2017). Evaluating the psychometric properties of the Mental Health Continuum-Short Form (MHC-SF) in Iranian earthquake survivors. International Journal of Mental Health, 46(3), 243–251.
Ryan, R. M., & Deci, E. L. (2001). On happiness and human potentials: A review of research on hedonic and eudaimonic well-being. Annual Review of Psychology, 52, 141–166.
Ryan, R. M., Huta, V., & Deci, E. L. (2008). Living well: A self-determination theory perspective on eudaimonia. Journal of Happiness Studies, 9, 139–170.
Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological wellbeing. Journal of Personality and Social Psychology, 57, 1069–1081.
Seligman, M. E. (2011). Flourish: A visionary new understanding of happiness and well-being (1st Free Press hardcover ed.). New York, NY: Free Press
Strümpfer, D. J. W. (1995). The origins of health and strength: From ‘salutogenesis’ to ‘fortigenesis’. South African Journal of Psychology, 25, 81–89.
Tamburrino, I., Getanda, E., O’Reilly, M., & Vostanis, P. (2018). “Everybody’s responsibility”: Conceptualization of youth mental health in Kenya. Journal of Child Health Care. https://doi.org/10.1177/1367493518814918.
Teo, A. R., Choi, H., & Valenstein, M. (2013). Social relationships and depression: Ten-year follow-up from a nationally representative study. PLoS ONE, 8(4), 62396.
Tough, H., Siegrist, J., & Fekete, C. (2017). Social relationships, mental health and wellbeing in physical disability: A systematic review. BMC Public Health, 17(1), 414–414.
UNICEF. (2006, January 24). Ethiopia: Steady increase in street children orphaned by AIDS https://www.unicef.org/protection/ethiopia_30783.html. Accessed 25 March 2020.
United Nations Development Programme, Kenya. (2018). UNDP Kenya 2017 Annual Report.https://www.undp.org/content/dam/kenya/docs/UNDP%2520Reports/UNDPKE%25202017%2520Annual%2520Report_Interactive.pdf. Accessed 25 March 2020.
Van Dierendonck, D. (2012). Spirituality as an essential determinant for the good life, its importance relative to self-determinant psychological needs. Journal of Happiness Studies, 13(4), 685–700.
Whetten, K., Ostermann, J., Whetten, R. A., Pence, B. W., O’Donnell, K., Messer, L. C., et al. (2009). A comparison of the wellbeing of orphans and abandoned children ages 6–12 in institutional and community-based care settings in 5 less wealthy nations. PLoS ONE, 4(12), e8169. https://doi.org/10.1371/journal.pone.0008169.
World Bank. (2019). GDP per capita: All countries and economies. https://data.worldbank.org/indicator/NY.GDP.PCAP.CD. Accessed 25 March 2020.
World Population Review. (2020, February 17). Addis Ababa Population 2020. https://worldpopulationreview.com/world-cities/addis-ababa-population/. Accessed 25 March 2020.
World Health Organization. (1948). World Health Organization constitution. In Basic Documents; retrieved https://www.who.int/governance/eb/who_constitution_en.pdf Geneva, Switzerland: Author. Accessed 25 March 2020.
We would like to thank: Augustine Wasonga, Ira Madan, Misganaw Eticha, and Mao Lang for their leadership at international child well-being NGOs; Chimdi Temesgen and Wosene Molla, for data collection, as well as for tailoring the data collection to their site’s cultures and language; Dean Lewis, Tewodros Abera, and Lynn Akinyi for their financial oversight; the study participants for their time and insight; and Morgan Barlow, Blen Biru, and Andy Elkins for project coordination and data coding and organization. This study was funded by a grant from Saint Louis University and the John Templeton Foundation as part of their Happiness & Well-Being: Integrating Research Across the Disciplines Project.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Keyes, C.L.M., Sohail, M.M., Molokwu, N.J. et al. How Would You Describe a Mentally Healthy Person? A Cross-Cultural Qualitative Study of Caregivers of Orphans and Separated Children. J Happiness Stud 22, 1719–1743 (2021). https://doi.org/10.1007/s10902-020-00293-x
- Hedonic well-being
- Eudaimonic well-being