Causal and mediating factors for anxiety, depression and well-being.

Background The relationship between well-being and mental ill health is complex; people may experience very low levels of well-being even in the absence of overt mental health problems. Aims This study tested the hypothesis that anxiety, depression and well-being have different causal determinants and psychological mediating mechanisms. Method The influence of causal and mediating factors on anxiety, depression and well-being were investigated in a cross-sectional online questionnaire survey hosted on a UK national broadcasting website. Results Multivariate conditional independence analysis of data from 27 397 participants revealed different association pathways for the two constructs. Anxiety and depression were associated with negative life events mediated by rumination; low levels of subjective well-being were associated with material deprivation and social isolation, mediated by adaptive coping style. Conclusions Our findings support the 'two continua' model of the relationship between psychological well-being and mental health problems, with implications for both treatment and prevention.