International Delphi Consensus Defines 19 Core Dimensions of Positive Mental Health

A new study in *Nature Mental Health* used a three-round Delphi process with 122 scholars from 26 countries to identify nineteen dimensions of positive mental health. The framework aims to standardize terminology that has varied across fields such as psychology, public health and economics.

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Fragmented definitions have hindered comparison of research and policy decisions about what to measure and fund. A shared vocabulary is intended to streamline evaluation of interventions.

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• Matthew Iasiello – Head of data and research translation at Be Well Co and lead coordinator of the Delphi panel.

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• Delphi Panel – 122 senior academics from clinical psychology, psychiatry, public health, philosophy, nursing, economics and related disciplines.

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• Participants: 122 experts; 84 % identified as Caucasian/European, primarily based in the US, UK or Australia.

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• Response Rate: About 10 % of invited scholars responded.

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• Consensus Threshold: >= 75 % agreement required for a dimension.

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• Top Six Dimensions (>= 90 % agreement): meaning and purpose, life satisfaction, self-acceptance, connection with others, autonomy, happiness.

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• Remaining Dimensions (13): optimism, competence, engagement, calmness, vitality, sense of belonging, acceptance, achievement, activities and functioning, development, fun, self-congruence, sense of safety.

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• Driver vs. Outcome Ratings: Autonomy and sense of safety scored low (? 30/100), indicating they are viewed mainly as drivers; happiness and life satisfaction scored high (? 73–74), suggesting they function as outcomes.

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Iasiello described the taxonomy as a starting point and outlined three immediate priorities:

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1. Expand the panel to include non-Western perspectives and groups such as people managing chronic illness.

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2. Clarify structural relationships among dimensions, distinguishing drivers from outcomes.

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3. Map positive mental health against mental illness, recognizing they are not simple opposites.

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He warned the current list reflects a predominantly Western, English-speaking viewpoint, potentially overlooking concepts like the Japanese “ikigai.”

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• “Put very simply, there is very little agreement on what we mean when we say mental wellbeing, flourishing, positive mental health, or related terms,” — Matthew Iasiello

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• “The main misinterpretation is thinking that this work is a finished product,” — Matthew Iasiello

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• Cultural Representation: Heavy Western weighting may miss dimensions valued in other cultures.

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• Physical Health Factors: Items such as physical health and personal circumstances fell short of the 75 % threshold (? 62 % agreement), suggesting they are seen as peripheral.

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• Driver/Outcome Ambiguity: Mixed scores indicate difficulty separating cause from effect; the panel noted many dimensions can function as both.

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The authors will:

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• Test the taxonomy with a more diverse, global sample, incorporating non-Western concepts.

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• Develop a hierarchical model specifying primary drivers and emergent outcomes.

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• Conduct comparative research linking the framework to measures of mental illness.

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These steps aim to refine the taxonomy into a robust tool for researchers, clinicians, policymakers and community organizations seeking consistent targets for mental-health promotion.

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