Mental health checklist: How are you, really?

NEW YORK – We know we should get a physical exam every year, we have annual reviews at work, and some couples do periodic relationship audits. Yet, many of us do not check in regularly with our emotional health, though it is arguably the most important contributor to overall well-being.

The New York Times talked to experts in clinical psychology, positive psychology, flourishing, thriving, resilience and burnout about what contributes to a sense of well-being and how to evaluate it. Then, the Times came up with a series of questions adapted from these conversations, as well as from prompts in four common psychological assessments.

This self-guided exercise will not give you a “wellness score” or ranking, and it should not be used as a diagnostic tool or a substitute for professional help.

Instead, these questions are meant to get you thinking about different aspects of your life and mental health, and identify what is working and where you might make adjustments, said Dr Tyler VanderWeele, director of the Human Flourishing Programme at Harvard University.

While some aspects of well-being are out of one’s control, many are within it. And the first step towards improving something is to assess it.

1. Mood

How would you describe your mood on most days? Is it generally positive, negative or a mix? Do you tend to feel more positive or negative emotions throughout the day?

Why these questions matter: To gauge how someone is doing, sometimes the simplest question – “How happy are you?” – is the best one, said Dr Rong Su, an associate professor of management and entrepreneurship at the Tippie College of Business at the University of Iowa. Dr Su helped develop the Comprehensive Inventory Of Thriving, one of the assessments these questions are based on.

If a person mostly feels happy or experiences positive emotions more often than negative ones, that is a sign of greater overall well-being.

Of course, everyone experiences a range of emotions. “The message isn’t to get rid of all our negative emotions,” said Dr Laurie Santos, a professor of psychology at Yale University and the host of The Happiness Lab podcast. “Our negative emotions are important signals.”

But if your mood generally leans more negative, there are ways to shift into a more positive state of mind. Dr Martin Seligman, director of the Positive Psychology Center at the University of Pennsylvania, recommends an easy ritual: Every evening for one week, write down three things that went well that day, and why. The goal is to train your attention away from the bad things in life and focus on the good ones.

2. Inner monologue

Is your inner monologue more self-critical or self-compassionate? When trying something new, do you think you will succeed, or are you sure you will fail? If you make a mistake, do you beat yourself up afterwards, or do you give yourself the benefit of the doubt?

Why these questions matter: “Our thought patterns affect our emotions and well-being a lot,” Dr Santos said.

Dr Lynn Bufka, a clinical psychologist and a spokeswoman for the American Psychological Association, added that if your inner monologue tells you, “‘You always screw things up. I can’t believe you did that’, you’re never going to be in a position to then challenge that and have a more helpful, accurate sense of who you are and what you’re capable of.”

With some practice, you can change your inner dialogue. To do this, try talking to yourself as you would a friend. Remind yourself of moments when you have succeeded. When you are struggling or have made a mistake, acknowledge it, but be gentle with yourself.

3. Physical health

How is your physical health, generally? How often do you sleep for seven to nine hours a night? How much physical activity do you do each week?

Why these questions matter: Physical and mental health are inextricably linked, and there is extensive research on how sleep and exercise, in particular, affect one’s mood. “Those are the kinds of things that matter a lot for our happiness,” Dr Santos said.

Not getting enough sleep for just a night or two can leave you feeling irritable and anxious. More extreme sleep deprivation can lead to feelings of depression, loneliness and isolation. The US Centers for Disease Control and Prevention (CDC) recommends that adults get at least seven hours a night, but estimates that about one-third of Americans do not achieve that regularly.

As for exercise, studies consistently show that it can improve a person’s mood. Some research suggests that it is as effective as medication in treating depression. The CDC advises 150 minutes of moderate-intensity aerobic exercise, plus two days of strength training, each week.

4. Relationships

Do you feel that you have strong relationships with family, friends, neighbours or co-workers? How often do you see people socially every week? Do you have someone you could call in an emergency?

Why these questions matter: There has been a ton of research that links the quantity and, more importantly, the quality of someone’s social relationships and social support to well-being, Dr Su said.

For example, the Harvard Study Of Adult Development, one of the longest-running studies on human happiness, encompassing more than 1,300 people over a span of 86 years, found that social ties were the biggest predictor of a happy life.

5. Meaning and purpose

Are there things in your life that give you a sense of meaning or purpose? Do you have a sense of responsibility to something or someone other than yourself? Do you feel that your contributions matter?

Why these questions matter: There is a large body of research that shows “the more meaning you have in life, the happier you are, the more productive you are, the higher your life satisfaction”, Dr Seligman said.

Meaning and purpose can also act as a buffer against the more challenging aspects of life. Having a sense of meaning contributes to a person’s resilience and his or her ability “to withstand stress when it’s excessive”, said Dr Michael Ungar, director of the Resilience Research Centre at Dalhousie University in Canada.

6. Competence

Do you feel as if there are things in your life that you are good at? Are there parts of your life that give you a sense of accomplishment? Do you feel as if you are generally a capable person?

Why these questions matter: People need to feel “they have some mastery over the demands of their day-to-day life”, Dr Bufka said. And, she added, if someone initially fails when taking on a new challenge, learning from – and ultimately mastering – that challenge can lead to a sense of accomplishment.

Believing that you are capable is partly about boosting your self-confidence, but it is also about using your talents “so that others see us for what we can contribute in value”, Dr Ungar said.

In a professional setting, not feeling competent can be a sign of burnout, said Dr Christina Maslach, a professor emeritus of psychology at the University of California, Berkeley, and an expert on burnout.

“There’s a sense in which you’re beginning to question whether you’re doing a good job”, or whether you’re capable, she added. And when you have negative feelings about your work, you may begin to feel badly about yourself.

7. Flow

How often do you feel completely absorbed in what you are doing? Do you ever lose track of time while you are working or doing a hobby? Do you look forward to participating in those activities?

Why these questions matter: Psychologist Mihaly Csikszentmihalyi thought that the secret to happiness was “flow”. He developed the theory after speaking with artists and scientists who reported that the experience of being completely immersed in their work filled them with feelings of pleasure and satisfaction.

The key to achieving a state of flow is working on a task that is interesting and meaningful to you, challenging enough to keep you engaged but not so hard that you get frustrated, and where you have a clear sense of what the goals and correct steps are so that you can assess how you are doing as you go. Hobbies such as gardening or playing an instrument can tap this feeling.

Flow – or engagement, as Dr Seligman calls it – is one of the five pillars of his theory of positive psychology, and it is also included in Dr Su’s thriving inventory.

8. Control and autonomy

Do you feel as though you are generally in control of your life? Do you feel as though you have autonomy and agency at work and at home? Do you make the major decisions about your life, or does someone else?

Why these questions matter: Sometimes, when your life does not seem to be going well, it is because things feel out of your control, Dr Su said. Maybe you do not have control of your time or you just generally feel overwhelmed. Or you might feel as if you do not have control over your finances and are not able to do or buy the things you need.

In a work setting, feeling that you do not have autonomy is a key contributor to burnout, Dr Maslach said. People “just have to do what they’re told, they can’t improvise, they can’t make things better, especially when something unexpected happens”.

In short, having “some direction and control over what’s happening, some capacity to be autonomous”, contributes to one’s overall well-being, Dr Bufka said.

9. Money and resources

Do you have enough financial resources to support yourself and your family? Do you worry about necessities, such as food or housing? Do you have the resources and support you need to do your job well?

Why these questions matter: Positive psychology research often focuses on a person’s internal state, but several experts said that your external environment is just as important.

The flourishing scale asks about people’s financial and material stability because meeting your basic needs makes other aspects of well-being more attainable, Dr VanderWeele said. It is still possible to thrive without sufficient resources, he added, but people’s material circumstances can make it easier.

10. Fairness

Do you feel that the world is generally a fair place? Are there systems that stymie you? Do you feel as though you have as many opportunities as the next person?

Why these questions matter: On a micro level, fairness, or the lack thereof, can influence people’s daily lives. For example, fairness comes up when Dr Maslach talks about diminished well-being at work. “When people feel that they’re being treated unfairly, when the wrong people, in a sense, are getting rewarded rather than the ones who deserve it”, that can lead to burnout, she said.

On a macro level, fair treatment by larger systems greatly affects one’s ability to thrive. In an unfair system, it is still possible to flourish in parts of your life, but it can be harder.

“You really do need to have an environment that is somewhat just and rewards you for your exertion, for your efforts,” Dr Ungar said. “And that, of course, involves fair treatment or social justice.”

11. Life satisfaction

Generally speaking, how satisfied are you with your life? Have you achieved, or are you on the path to achieve, most of the important things you wanted? Are there major aspects of your life that you would change?

Why these questions matter: According to the experts, these final questions are in some ways the most fundamental – and the most illuminating – way to evaluate how your life is going as a whole.

Asking about a person’s general life satisfaction “is probably the most widely used well-being question in the literature”, Dr VanderWeele said. It is pretty open-ended, he added, and gets people to reflect on their lives.

If, after moving through these questions, you feel as though things in your life are not going as well as you want them to, consider reaching out to a professional. Try talking to your primary care provider about your mental health, or search for a local therapist or psychiatrist. NYTIMES