**5. Mental health: a significant happiness variable**

Aside from the above discussed variables, the most significant variable according to the World Happiness Reports for happiness is mental health. Mental illness is a worldwide health phenomenon. Mental illness does not only occur in wealthy countries as has been stereotypically believed. The most recent data from the World Gallup Poll and the World Happiness Reports demonstrates that the vast majority of individuals with mental illness live in low and middle-income regions of the world. The majority of these mental health conditions relate to anxiety and depression disorders. In 2013, at least 1 in 10 people suffered globally from these conditions at any one time. These numbers are even higher today. Furthermore, the 2013 statistic is likely to be lower than actual prevalence rates given stigma and cultural considerations in reporting, the understanding of mental illness and availability of access to data [13, 14].

Child and adolescent behavior and mental health issues further contribute to prevalence rates with an additional estimated 100 million cases worldwide. Prevalence rates are significant between countries but there is much less variation when groups of countries are clustered together by income level. In 2013, the World Health Organization estimated that 7.1% of adults in high income countries suffered from

depression, 7.6% in upper middle-income, 6.4% in lower middle income and 6% in low income. The data also reflects that among those with depression, there is a much higher number of women than men. Depression represents the greatest disability factor according to the World Health Organization. This data has been further supportive in identifying a relationship between mental illness and national levels of happiness. In Western, Eastern and Central Europe, those who suffer from anxiety and depression experience 12–14 years of lived disability due to their condition [13, 14].

A major consideration in the incredible burden of mental illness is the lack of adequate mental health care and treatment for those who are suffering. There is a significant worldwide treatment gap between identified need and actual service provision. In 2013, the treatment gap for schizophrenia for example was approximately 32%. However, even more telling, for all other conditions including more commonly identified issues such as anxiety, depression, and alcohol dependence, the treatment gap was greater than 50%. Worse than this, even when disability due to mental illness is severe, the treatment gap is still very significant. In 2013, only 10–30% of severe cases received services in low and middle-income countries compared to 25–60% in high income regions. The countries with the highest rates of treatment services included the United States, Spain, and Belgium for severe, moderate and mild mental illness [13, 14].

This treatment gap has severe consequences for society. Untreated mental illness creates major costs to society that come not only in monetary form but also through strained use of the healthcare system, lost productivity, educational underachievement, increased levels of violence, addiction, crime, less effective use of resources, breakdown of social and family relationships, worsening physical health and obesity, and lower overall development of human and societal potential. Treatment for mental illness has important implications for life expectancy, quality of life and the burden of disability. For example, admittance to the hospital for mental health reasons improves life expectancy by an estimated 15–20 years [13, 14].

Despite its demonstrated significance for health, economic and societal outcomes, no country in the world spends more than 15% of their health budget on mental healthcare. Mental health is one of the greatest factors for one's levels of happiness and is connected to one's closest relationships, experience of love, family and support. Positive outlier countries such as England and Wales spend close to 15% of their health budget on mental health. They have seen major improvements in years and cost due to disability as a result of increased access and use of mental health services. The mental health programs in England and Wales have demonstrated that there are lowcost and effective mental health treatments that can be made widely available. There is now a significant body of evidence for the societal and economic harm caused by the lack of mental health treatment in a population. It is economically progressive and increases national happiness levels to incorporate large scale mental health programs [13, 14].

### **6. Authentic connection: a significant happiness variable**

Another important variable for happiness is authentic connection and relationships. One of the most significant studies for understanding happiness has been the Harvard Study of Adult Development. This is one of the world's longest running studies on adult development and the factors that contribute to health and happiness. In 1938 during the Great Depression, researchers created the Harvard Study of Adult Development with Dr. Grant and Dr. Glueck. This was a study intended to track the happiness and health of adults throughout the lifespan. The first cohort consisted of 268 Harvard sophomores all approximately 19 years old, Caucasian, male and from the Harvard classes of 1939–1944. The second cohort consisted of a group of 456 Caucasian men from Boston neighborhoods. The men in the second cohort were selected at ages 11–16 years by Drs. Sheldon and Eleanor Glueck and many were from lower-income neighborhoods and families. At present, a majority of these participants have passed away and the study is being continued through participation from their children and grandchildren. With the original Harvard and Boston City cohorts there was physical and mental health testing done every 2 years, 5 years and 5–10 years. The participants completed questionnaires every 2 years on their physical and mental health, job enjoyment, the quality of their marriages, and other significant variables. The participants provided health data every 5 years regarding their physical health, and in-depth interviews every 5–10 years on their relationships, work and life changes [15, 16].

This study has been very significant and supports the Easterlin Paradox as well as the data found in the World Happiness Reports regarding Latin America and the United States for happiness. It found that the most important factor in happiness and well-being is the quality of our authentic connections and close relationships. Significant major themes identified from this study are that authentic connections are critical and loneliness causes significant mental and physical health concerns. Another important finding was that in our relationships the most relevant factor in our happiness is the quality of our closest relationships, not the number of social connections or whether you have a committed relationship. It was identified that the experience of loneliness was significant for levels of unhappiness. Loneliness here refers to the perception of isolation and experience of unwanted absence of social connection and closeness with others. It causes psychological pain and can result in depression, anxiety, and other physical and mental health concerns. At least 1 in 5 individuals in the U.S. experiences loneliness at any time and this has negative implications on longevity, well-being and happiness. This number is projected to increase globally in regions with growing elderly populations and decreased family support. The Harvard Study of Adult Development shows very clearly that close relationships are vital for protecting our bodies and our brains. In summary, according to this study, the most significant predictor of happiness is the experience of positive, authentic connection [15, 16].
