Conceptualising and measuring the well-being of people with psychosis: Systematic review and narrative synthesis

Well-being has become a prominent term in the political arena in recent years. However, in research the concept and use of well-being has been unclear, especially in the context of severe mental illness such as psychosis. This systematic review aims to characterise the evidence base relating to well-being in people with psychosis, by reviewing how well-being is measured, developing a new conceptual framework, and summarising empirical evaluations of psychosocial interventions to improve well-being. We conducted a systematic review and narrative synthesis of controlled trials of interventions investigating well-being in people with psychosis. The 28 studies meeting the inclusion criteria used 20 different measures of well-being. Five dimensions of well-being emerged: non-observable, observable, proximal, distal, and self-defined. Interventions to improve well-being vary widely. The investigated interventions have been targeted at non-observable, observable and proximal levels, while evaluation measures span all five dimensions. This review offers an evidence based conceptual framework of well-being which can provide an empirical basis for organising future well-being research in psychosis. The review also shows that the evidence base for interventions is small and methodologically weak. Recommendations are made for choosing well-being measures for future research.