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Published by Oxford University Press on behalf of the International Epidemiological Association International Journal of Epidemiology 2014;43:330–340

ß The Author 2014; all rights reserved. Advance Access publication 28 February 2014 doi:10.1093/ije/dyt188

Cross-national and historical differences in


subjective well-being
Anthony F Jorm* and Siobhan M Ryan

Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
*Corresponding author. Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Carlton,
Victoria 3010, Australia. E-mail: ajorm@unimelb.edu.au

Accepted 13 August 2013

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Background There is a growing body of population survey data on national
subjective well-being which allows comparisons across countries
and across periods. Key issues in this work are as follows. Can
response to questions on well-being be meaningfully compared
across countries and periods? What social conditions are associated
with greater well-being both between countries and across periods?
Are there lessons for how global well-being might be improved?
This review aims to give an overview of this area and its relevance
to psychiatric epidemiology.
Methods Systematic searches of the literature were carried out using eight
academic databases between August 2012 and January 2013.
Results Subjective well-being involves multiple components, including cog-
nitive evaluation of satisfaction with life and emotional state, and
these are separable from mental ill health. Although there are dif-
ficulties in measuring subjective well-being in comparable ways
cross-culturally, there is sufficient evidence of validity to make
comparisons meaningful. The subjective well-being of nations in-
creases with income per capita, but gains are smaller in higher-
income countries. Other national factors that affect well-being
include income inequality, social welfare, individualism, democracy
and freedom, social capital and physical health.
Conclusions Economic growth of lower-income nations will improve global sub-
jective well-being. However, this needs to be sustainable or it will
reduce the well-being of future generations. Higher-income nations
need to focus on other determinants of well-being. Research on
cross-national well-being suggests a number of directions that
may be profitably pursued in psychiatric epidemiology.
Keywords Subjective well-being, happiness, life satisfaction, mental health,
national differences, historical change

Introduction focus on a specific area, namely the determinants of


There is now a very large literature on what has been national well-being from a global perspective. This is
termed subjective well-being (SWB), some of which is an area of research which is mainly pursued within
labelled under the rubric of happiness research or psychology, economics and political science, rather
positive psychology. Given the size and diversity of than within psychiatric epidemiology. Nevertheless,
this field, it is not possible to provide a comprehensive the issues investigated are of broad relevance to psy-
systematic review in this paper. Rather the aim is to chiatric epidemiologists. One of the aims of this

330
SUBJECTIVE WELL-BEING 331

review is to make national well-being research better extent to which a person’s life is in accordance with
known to an epidemiological readership and to con- deeply-held values and the person is fully engaged.1
sider what lessons might be learned for psychiatric Measures derived from the hedonic and eudaimonic
epidemiology. views are moderately correlated, indicating that the
Thus, we are interested in ecological studies that constructs are different but overlapping.
investigate SWB with the nation as the unit of ana- SWB is clearly related to, but different from, the
lysis. Some studies examine both SWB and its pre- constructs of mental ill health investigated by psychi-
dictors using national aggregates as data, whereas atric epidemiologists. People who experience mental
others examine predictors of well-being at both indi- disorders or are suicidal score lower on measures of
vidual and national levels, and consider whether SWB.3 The strongest associations are with the nega-
national characteristics are predictors of SWB after tive affect component of SWB. Depression and anxiety
adjustment for individual characteristics. For ex- show strong correlations with negative affect.
ample, does the income of a nation predict SWB Depression is also related to lower positive affect,
over and above the income of the individuals who but to a lesser degree.4 These associations are to be
make up the nation? Some predictors (e.g. democracy, expected, given that depressive disorders are defined

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political upheavals, inflation) can only exist at the as involving sad mood and loss of the ability to ex-
national level, whereas others can exist at both perience pleasure. It is also notable that depression
levels (e.g. income, education). Some studies also in- screening questionnaires sometimes include items
vestigate historical changes in SWB within nations, that are closely related to measures of SWB. For
looking at whether changes in various national char- example, the Center for Epidemiologic Studies
acteristics predict any changes in SWB. There are also Depression (CES-D) scale includes the reversed-
differences in analytical approach between such stu- scored item, ‘I was happy’.5 Similarly, the General
dies. An important one is whether nation fixed effects Health Questionnaire, which is a screening test for
are included in models.1 These capture unchanging common mental disorders, contains a number of
cultural and institutional influences within nations, items that tap happiness, satisfaction and other
so that the correlations are basically between the aspects of positive well-being.6
change in a nation’s characteristic and change in There are many measures of SWB and its compo-
the nation’s SWB, making most cross-sectional pat- nents. However, most of the national data come from
terns disappear and reducing spurious correlations. large social surveys which have included very brief
SWB is not a unidimensional construct. Factor ana- measures. The main ones are summarized in
lytical studies indicate that there is a cognitive com- Table 1. The most commonly used measures are
ponent to SWB which involves an evaluation of single items measuring life satisfaction and happi-
satisfaction with life, and an affective component ness. Life satisfaction items measure the cognitive
which involves positive affect and the absence of aspect of SWB and correlate more highly with positive
negative affect.2 Whereas these components are cor- affect than with absence of negative affect, whereas
related at both individual and national levels, they are happiness measures correlate more specifically with
partly independent and may have somewhat different positive affect.7 Eudaimonic concepts of SWB have
determinants. Positive affect, negative affect and life not featured much in the study of cross-national dif-
satisfaction are constructs associated with what has ferences, although some work crosses both hedonic
been called the hedonic view of SWB. An alternative and eudaimonic concepts.8 Despite their brevity, the
to this is the eudaimonic view, which focuses on the reliability of the measures in Table 1 is surprisingly

Table 1 Commonly used measures of subjective well-being

Measure Example item content


Single item, self-rated life All things considered, how satisfied are you with your life these days? (Response made on
satisfaction 10-point scale)
Single item, self-rated Taking all things together, how would you say things are these days—would you say
happiness you’re very happy, fairly happy, or not too happy these days?
Cantril’s ladder Please imagine a ladder with steps numbered from zero at the bottom to 10 at the top.
The top of the ladder represents the best possible life for you and the bottom of the
ladder represents the worst possible life for you.
On which step of the ladder would you say you personally feel you stand at this time?
Positive affect Respondents report whether they experienced specified feelings a lot on the previous day,
including ‘enjoyment’, ‘love’, and ‘smile or laugh a lot’.
Negative affect Respondents report whether they experienced specified feelings a lot on the previous day,
including ‘worry’, ‘sadness’, ‘depression’, and ‘anger’.
332 INTERNATIONAL JOURNAL OF EPIDEMIOLOGY

good at the individual level, e.g. 0.70 over 1 year for were searched using a search term relating to SWB
life satisfaction.9 When aggregated at the national (‘wellbeing’ or ‘well-being’ or ‘life satisfaction’ or
level, it is much higher. For example, mean life satis- ‘positive affect’ or ‘happiness’) as well as a term relat-
faction of nations has been found to correlate 0.93 ing to national differences (‘national differences’ or
over 1 year in the same survey series, and 0.97 ‘nations’ or ‘across nations’) and/or historical change
across different survey datasets.3 The correlation (‘historical change’ or ‘historical differences’ or ‘across
across different SWB measures is also high, with life history’ or ‘history’). Reference lists of articles identi-
satisfaction and happiness levels correlating 0.85–0.87 fied as relevant from the initial search were hand-
across nations.10,11 These national summary measures searched for additional relevant sources. To be
of SWB also correlate to some degree with psychiatric included in this review, a study had to include a
indicators. Across nations, the percentage who are measure of SWB as an outcome (not as a predictor),
very happy was found to correlate 0.37 with the and examine the data at the country level, either
suicide rate,12 whereas two indicators of national across countries or within a country over time.
SWB correlated 0.46 and 0.66, respectively, with Studies were excluded if they were reviews that did
national means on the Beck Depression Inventory.13 not report novel analyses, used measures of mental ill

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Similarly, a composite measure of national SWB cor- health rather than SWB or focussed on SWB of a
related 0.60 with a composite measure of mental ill specific age group (e.g. students or older people). No
health.14 limitations regarding publication dates were applied.
In comparing the responses to such simple questions Using these criteria, our initial search located 367
across nations, the issue inevitably arises of whether publications, which was reduced to 78 after applying
the measures can be validly compared across different the inclusion and exclusion criteria.
language and cultural groups. Supporting cross-
cultural comparability, there is evidence that different
measures of SWB tend to give comparable national
rankings; for example, experience sampling of mo- Results
mentary mood, frequency of smiling and memory Key datasets and the problem of replication
for good vs bad events have been compared with There are many studies reporting novel analyses of
more commonly used questionnaire measures.15 national SWB data, but this number is deceptive.
Furthermore, bilinguals give similar ratings in each Most studies are based on a relatively small number
language, and countries with multiple national lan- of datasets, the main ones being summarized in
guages give similar ratings for each language Table 2. These datasets all provide one or more meas-
group.16 Comparable factors of positive and negative ures of national SWB. Studies using these datasets
affect have also been found across cultures.7 On the often pair them with data on national characteristics
other hand, there is evidence that people from indi- derived from other datasets. Because these other data-
vidualist cultures assess SWB somewhat differently sets may not cover the same range of countries, the N
from people in collectivist cultures, with emotions for analyses may differ across publications even when
more important in the former and social norms in using the same SWB data. Furthermore, some of the
the latter.17 There is also some evidence for differen- datasets involve repeat surveys over time, so similar
tial use of response scales across nations, which is analyses may be carried out on the same issue at dif-
revealed when anchoring vignettes are used to ferent time points. For these reasons, it is difficult to
assess comparability of ratings.18 Studies that exam- regard publications as independent or to say that a
ine change in SWB over time within a nation would finding has been replicated.
seem less susceptible to these problems than cross- Another notable feature of this literature is that the
national studies, because changes in the interpret- predictors of national SWB tend to be highly corre-
ation of items are likely to be small over a few lated. Although many predictors show strong associ-
decades. However, it remains possible that exposure ations when examined individually, these tend to
to greater education or television could have subtly reduce or disappear in multivariate analyses. For
altered the meanings of words in recent times.19 The this reason, predictors may give very different results
change in meaning of the word ‘gay’ over a gener- depending on what other factors are adjusted for. The
ation shows that rapid semantic changes can occur. major predictor that is consistently found in the lit-
erature is national income, as measured by GDP per
capita or other indicator. Therefore, all other pre-
Methods dictors examined in this review consider findings
that have, at a minimum, been adjusted for national
Searches for relevant studies were carried out using income.
eight academic databases (Academic Search
Complete, Google Scholar, Medline, PsycARTICLES,
PsycINFO, Psychological and Behavioural Sciences, Alternative measures of SWB
Scopus and SocINDEX) between August 2012 and As described earlier, national SWB is most commonly
January 2013, depending on the database. Databases measured by summary statistics on life satisfaction,
SUBJECTIVE WELL-BEING 333

Table 2 Commonly used multinational datasets of subjective well-being

No. of
countries
Dataset Measurement used included Years of assessment
Euro-barometer Survey Series Self-report happiness item 79 Annually 1975–2002
Self-report life satisfaction item
European Values Survey Self-report happiness item 33 1981, 1990, 1999/2000
Self-report life satisfaction item
Gallup poll Cantril’s ladder 132 Annually 2005–07
Self-report life satisfaction item
Positive affect (PA)
Negative affect (NA)

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German Socio Economic Self-report happiness item 1 Annually 1984–90
Panel Study (GSOEP)
United States General Social Self-report happiness item 1 Annually 1972–2006
Survey
World Values Study Group Self-report happiness item 97 1981, 1990–93, 1995–97,
Self-report life satisfaction item 2000–02, 2005–07
World Database of Happiness Composite of multiple measurement tools 292 Annually 1973–2006
(composite of multiple re-scaled on a 10-point scale (includes:
national surveys) self-report happiness items, self-report life
satisfaction items, Cantril’s ladder)
Diener dataset (1995) 4 measures of SWB: 55 Dataset included data
(combines data from 4 collected between 1980 &
datasets) (1) Combined self-report single-item 1985
measures of happiness and life
satisfaction
(2) The last measure of happiness
recorded for each nation reported
in the 1993 ‘World Database of
Happiness’
(3 & 4) Measures of life satisfaction &
happiness where available

happiness or affect. However, a number of alternative National income


measures have been proposed, which are not reviewed The predictor examined most often in cross-national
in any detail here given the limited attention they studies has been national income, as indicated by real
have received in the literature. These include flourish- income per capita. Consistent associations with
ing (which combines hedonic and eudaimonic aspects national SWB have been found across different data-
of well-being),8 inequality in SWB,20 inequality-ad- sets and adjusting for a wide range of other
justed happiness,21,22 and happy life expectancy.23,24 predictors.12,20,26–32 Although most of the evidence
Such measures may have much to offer and require has been from nation-level studies, national income
further research. is also a predictor after adjusting for individual
income in multi-level analyses.11,33,34 When the asso-
ciation is plotted, there is a stronger association
Norms for national SWB among poorer countries and a levelling off of gains
A notable finding in national surveys is that people at higher levels of national income. If a logarithmic
tend to rate themselves as happy or satisfied with life. transformation is applied to income, the association
For example, when life satisfaction is scaled from 0 to becomes linear35(as illustrated in Figure 1). The asso-
100, most people in highly developed countries score ciation with national income may be stronger for life
between 40 and 100 and the mean score is around 75, satisfaction than for measures of affect.11,33
and even the lowest countries score above 50.25,26 This There has also been a substantial amount of re-
finding has been interpreted to imply that SWB may search on this issue using time series data. A seminal
be subject to a homeostatic mechanism.26 publication by Richard Easterlin in the 1970s argued
334 INTERNATIONAL JOURNAL OF EPIDEMIOLOGY

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Figure 1 Scatter plots showing the association between GDP per capita in US$ and SWB. Panel 1 shows the curvilinear
relationship and Panel 2 shows the linear relationship when GDP per capita is log transformed. Data on SWB are combined
data from 1995-2007 World Values Surveys (Source: http://www.nationmaster.com/graph/lif_lif_sat-lifestyle-life-satisfaction),
and data for GDP is for 2007 (Source: http://data.worldbank.org/indicator/NY.GDP.PCAP.CD?page¼1)
SUBJECTIVE WELL-BEING 335

that whereas income was associated with SWB in be argued that, with an ordinal scale, any monotonic
cross-sectional data, time series data from the USA transformation is acceptable.
showed no increase in national SWB over time, des-
pite steady growth in real income per person.36 This
happiness-income paradox, or Easterlin Paradox, con-
Income inequality
tinues to be a major source of debate. If true, this There have been a number of analyses examining
paradox implies that economic growth should not be whether income inequality contributes to SWB over
the main aim of policy. Subsequent research has sup- and above income per capita. Because high-income
ported Easterlin’s observation that SWB has not nations tend to have less inequality, it is necessary
improved in the USA despite economic growth,19,37 that income be adjusted for. For example, in one
but improvements have been observed in other nation-level study of 54 nations, there was a correl-
high-income countries, including in Europe and ation of 0.84 between GDP per capita and the Gini
Japan.38,39 However, there is also evidence that coefficient of income inequality, making it difficult to
rapid economic growth can have a negative effect separate these predictors in a regression analysis.51 In
on SWB (‘unhappy growth’) if it leads to greater in- this study, after adjusting for income, inequality had

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equality and aspirations that exceed achievements.40 no additional predictive power. By contrast, a more
This phenomenon has been observed, for example, in recent nation-level analysis of 51 nations found an
China from 1990 to the early 2000s.41 More sophisti- effect of inequality on SWB after adjusting for
cated time series analyses have found evidence that income, but in this analysis a different indicator of
economic growth is associated with greater SWB.35,42 income inequality was used which had a lower cor-
Easterlin and colleagues have also carried out more relation with GDP per capita (0.45).52 Multi-level
recent time series analyses on data from several coun- analyses have mainly supported a role for income in-
tries.43,44 They have concluded that income does affect equality. Two multi-level analyses of European data
found that inequality was associated with lower
SWB in the short term, but over the long term
SWB after adjusting for individual income53 and
(10 years or more) there is no gain. Another view is
after adjusting for both individual and national
that, whereas raising incomes does have a mainly
income.20 By contrast, a multi-level analysis of data
short-term effect on SWB, there is also a smaller
from 41 countries found that inequality predicted
long-term effect, so that there are lasting gains from
higher SWB after adjusting for individual and
economic growth.42
national income. However, this finding was due to
The benefits of economic growth for SWB continue
the inclusion of Latin American and post-Soviet coun-
to be debated, but there does appear to be good evi-
tries, the former of which have a high level of in-
dence that the gains from increases in income are
equality but high SWB, and the latter a low level of
greater in poorer than in richer countries.28,45 A
inequality but low SWB.11 A time series analysis of
number of explanations have been put forward to ex-
changes in SWB over 25 years in eight high-income
plain the diminishing returns. These include that
countries also found that decreases in inequality were
SWB is influenced more by relative income (‘keeping
associated with increases in SWB.50
up with the Joneses’) rather than absolute income,46
that people in rich countries adapt to increases in
their income,46 that changes in other domains Social welfare and progressive taxation
(greater working hours) offset the gains from Other variables closely related to income inequality
increases in income47 and that income is important are the extent of social welfare and progressive tax-
because it allows us to satisfy basic needs and there is ation. A nation-level analysis of 40 nations found no
less to gain once these needs are met.48,49 It has been association between social security expenditure and
argued that further economic growth will only in- SWB. By contrast, a time series analysis of data
crease SWB in high-income countries if it allows from 12 European nations found that unemployment
people to pursue rewarding activities in pursuit of benefits helped ameliorate the impact of unemploy-
meaningful goals, such as improving close relation- ment on SWB.1 Similarly, a time series analysis of
ships or the quality of working life.49 There have data from 18 industrial democracies found that wel-
also been suggestions that national SWB could be im- fare state generosity (as indicated by pensions, sup-
proved by changing the reference group with which port for the ill and disabled and unemployment
people compare themselves (e.g. their ancestors or benefits) had a positive effect on SWB.54 A multilevel
people who are worse off), and that people need to analysis of 41 nations found that welfare expenditure
be better informed about the value of seeking happi- was associated with greater life satisfaction, but not
ness in non-pecuniary domains (e.g. family life)50 with greater happiness.11
which are less subject to adaptation and social com- A nation-level analysis of 54 nations found that pro-
parison than is income.46 Finally, it is possible that gressive taxation was associated with greater SWB
the form of the association between national income after adjusting for national income and income
and SWB cannot be meaningfully determined because inequality.55 A mediation analysis found that this as-
of the use of ordinal scales to measure SWB. It could sociation with progressive taxation was mediated by
336 INTERNATIONAL JOURNAL OF EPIDEMIOLOGY

greater public satisfaction with services like education Political factors


and public transportation. A number of analyses have examined the association
of national SWB with ratings of democracy, political
freedom, human rights or economic freedom. Again,
Other economic factors these factors are hard to examine independently in
Given the interests of economists in this area of cross-sectional nation-level studies because of very
research, a number of other economic factors have high correlations with national income and
been investigated, but will only be mentioned briefly individualism.32,64
here. Unemployment is known to be associated with In cross-sectional nation-level studies the findings
lower SWB at the individual level. Surprisingly, it are mixed, some finding no association after adjusting
does not appear to be associated with SWB in for national income31,32,65 and others finding some
nation-level studies, after adjustment for a range of residual association.12,30,62 However, a clearer pattern
other predictors, including national income.31,56 emerges when the cross-sectional associations are
compared across points in time. The association was
However, time series studies do find that unemploy-
high around 1981, then became low in the 1990s after

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ment is associated with lower SWB.1,47,57,58 The find-
the democratization of Communist countries, but has
ings are similar to inflation, with time series
risen slightly since 2000.66 These findings indicate
studies47,57–59 showing more consistent associations
that the association may alter during times of major
than cross-sectional nation-level studies.27,31 political change.67 It has also been suggested that big
drops in national SWB might be a cause rather than
an effect of political change.67 In the only time series
Individualism versus collectivism study, covering the period 1981–2007, SWB was
Nations have been distinguished according to the found to increase along with the extent to which
value they place on individualism vs collectivism. societies allow free choice, which was driven by eco-
Individualist nations put more emphasis on individ- nomic development, democratization and increasing
uals taking care of themselves and their immediate social tolerance.68
families, whereas collectivist ones put more emphasis
on people looking after each other and loyalty to the Social capital
group. This dimension has been measured by expert Social capital refers to a community’s social networks
rating of nations or summary statistics from surveys and the associated norms of reciprocity and trust. In
of values held by employees in various countries. One studies reviewed here, it has been measured in vari-
of the difficulties with evaluating this predictor is that ous ways, but most commonly by the extent of mem-
it correlates around 0.8 with GDP per capita, making bership in voluntary organizations. In ecological
the two hard to separate in multiple regressions.32,51 studies, measures of social capital are associated
Individualism is also strongly associated with the with SWB69 even after adjusting for economic pre-
extent of a nation’s human rights and gender equal- dictors.27 Average number of memberships is also
ity.32 A further complicating factor in comparing na- found to be a predictor in a multilevel analysis,70,71
tions on this variable is that people in individualistic and growth in memberships was associated with
nations may evaluate their satisfaction with life dif- growth in SWB in a times series analysis of a range
ferently from those in collectivist ones, giving greater of countries.72
weight to affect when making ratings.17
Several cross-sectional nation-level studies have Physical health
examined individualism. Despite the problems Physical health is a reliable predictor of SWB at the
caused by multicollinearity with other national individual level, so might be expected to be a pre-
characteristics, a number of these studies have dictor at the national level as well. The major national
found that individualism predicts national SWB indicator that has been investigated is life expectancy.
even after adjusting for income and other vari- When the simple nation-level association is examined,
ables.25,51,60 However, other cross-sectional nation- life expectancy is very highly correlated with life sat-
level studies have not found an independent effect isfaction and happiness,30,60,73 but not with affect.60,74
of individualism.32,61,62 The one multi-level study Fewer studies have examined the association adjust-
also supported a role for individualism, after adjusting ing for other predictors. Where this has been done,
for a range of individual and national variables.63 the association persisted in one nation-level analysis31
There is some evidence that individualism may and one multi-level analysis,47 but not in another
relate more strongly to SWB when the association is multi-level analysis.70 An association has also been
examined only within high-income nations.32 There is reported between happiness and life satisfaction and
also evidence that it may be more strongly associated self-reported hypertension in European nations.75
with life satisfaction than with affect,60 and that it Given that both SWB and life expectancy are im-
may relate more to lower negative affect than to posi- portant national indicators in their own right,
tive affect.7 Veenhoven has proposed that they should be
SUBJECTIVE WELL-BEING 337

combined into an index of happy life-expectancy,23 self-expression values’, such as personal autonomy
somewhat analogous to the concepts of disability- and job creativity.82
and quality-adjusted life-years. When examining predictors other than national
income, it is striking that these predictors tend to be
Other predictors highly correlated both with income and with each
other. It appears that national SWB is associated
This review has covered the predictors that have been with a package involving higher income, relative
investigated most consistently in the literature.
equality, individualism, social welfare, political stabil-
However, there is limited evidence for a range of
ity and democracy, and high life expectancy.
other factors. Positive influences include business cli-
Regression analyses attempt to tease these apart, but
mate,56 quality of government,70 average importance
may be attempting to answer an artificial question. It
of god/religion,71 length of time a society has been
may not be meaningful to ask about the effects of one
democratic,76 literacy,77 national personality tending
predictor holding others constant, because the others
towards high extraversion and low neuroticism,10
may be conditions required for changes in this
value placed on leisure and thrift,12 fulfilment of so-
predictor.

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cietal needs,78 the natural environment,65 Christian
A major aim of this review is to examine lessons
majority,79 having a bicameral parliament79 and open-
that can be learned for psychiatric epidemiology.
ness to trade.79 Negative influences include environ-
mental degradation,47 crime,47 average number of Psychiatric epidemiology has largely focused on risk
hours worked,47 extreme climates,31 Buddhist reli- factors within a nation and very little is known about
gion31 and living in a post-Communist society.79 national determinants. Given that mental disorders
are associated with lower SWB, we might expect
that some of these national factors may also be rele-
vant to national mental ill health. The limited evi-
Discussion dence available supports this. One study found that
There is clear evidence from nation-level studies that anxiety was lower in more individualistic countries
social, economic and political features of nations are and was more protective than national income.83
associated with their SWB, and clear evidence from Another study found that mean depression scores
multilevel analyses that these national features con- were lower in nations that were high in income,
tribute to SWB over and above characteristics of the more highly educated, having a high level of informa-
individuals that make up the nation. However, given tion available through media, egalitarian and more
the nature of the methodologies used, definite caus- democratic, and had more civil, human and political
ality is difficult to establish. It is generally assumed rights.13 On the other hand, a study of depression
that the national features drive SWB, but reverse prevalence rates from the World Health Organization
causality is a possibility. For example, drops in SWB World Health Surveys found no association with gross
could lead to political change in a nation,67 or SWB national income or nation-level inequality.84 However,
could lead to economic growth.80 given that the construct of SWB has only partial over-
In this literature, the most researched national vari- lap with constructs of mental ill health, there are
able has been income. It is clear that increases in likely to be differential patterns of association with
income improve the SWB of a nation, but the returns national characteristics and there would be merit in
appear to diminish at higher levels. These findings looking at both types of outcomes in the same study.
underscore the importance of further economic devel- Another lesson may be in the use of brief survey
opment for poorer nations. However, the dilemma for items to allow comparisons across nations and
the world is that economic growth which is based on across time. In psychiatric epidemiology, the emphasis
non-renewable resources will not be sustainable. If has been on using diagnostic instruments to arrive at
nations use up resources to produce short-term im- disorder prevalence rates, as exemplified by World
provements in SWB, then this will be at the expense Health Organization’s World Mental Health
of the SWB of future generations. Such short-term Initiative.85 These surveys involve complex interviews
strategies have been used by human populations in and scoring algorithms, and the cross-cultural port-
the past with unfortunate consequences, and have ability of the methods can be questioned.86 For
been called ‘future eating’.81 Fortunately, there are example, it seems hard to accept that Nigeria and
other income-related strategies for increasing national China could have a much lower prevalence of
SWB, including reducing the range or skew of income mental disorders than The Netherlands or New
distribution and changing the reference group with Zealand, given that such findings seem inconsistent
which people compare their wealth.50 It is also im- with findings on SWB. By contrast, SWB research has
portant for high-income nations to examine strategies used very brief measures that can be easily incorpo-
for increasing SWB which go beyond income. Indeed, rated in social surveys. Simple measures have also
it has been argued that high-income nations are proved useful in general health surveys, with a
undergoing a change in values away from single question about self-rated health known to be
reducing material scarcity towards ‘postmaterialist a predictor of mortality.87 It may be possible to
338 INTERNATIONAL JOURNAL OF EPIDEMIOLOGY

develop similarly simple measures that are cross-cul- epidemiology, there is also potential for transfer in the
turally portable for mental ill health. These would not other direction. Some of the central risk factors that
give prevalence estimates, but could be used to meas- dominate psychiatric epidemiology have received little
ure national and historical trends at a population attention as potential determinants of national SWB.
level. For example, using the single-item happiness These include factors such as childhood adversity
rating from SWB research, responses can be scored (including child abuse), parenting practices, traumatic
to examine the percentage who are very unhappy and other adverse life events, working conditions,
in addition to the percentage who are very happy, social support and substance use.
and the correlates are somewhat different.12 If such
measures were used in national surveys on a regular
basis, they could provide a complement to use of the Funding
suicide rate, which has been the major available The lead author is funded by an NHMRC Australia
indicator for cross-national and time series analysis. Fellowship.
Although the emphasis of this review has been on
what the study of national SWB can teach psychiatric Conflict of interest: None declared.

Downloaded from http://ije.oxfordjournals.org/ at Eccles Health Sci Lib-Serials on November 27, 2014
KEY MESSAGES
 A number of socio-economic factors are associated greater national well-being, including income per
capita, income inequality, social welfare, individualism, democracy and freedom, social capital and
physical health.
 Economic growth of poorer nations will improve global well-being.
 To achieve sustainability, wealthier nations need to focus on other determinants of subjective well-
being.
 Research on cross-national well-being has lessons for psychiatric epidemiology, in terms of the types
of determinants studied and the use of brief cross-culturally portable measures.

11
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