Dr Raj Rattan, Dental Director at Dental Protection, looks at the science behind wellbeing.

Happiness has been described as “the experience of joy, contentment, or positive wellbeing, combined with a sense that one’s life is good, meaningful, and worthwhile”. It is a complex, abstract social construct and because it is subjective in nature, it is difficult to measure, and desirable but often elusive. There is supporting evidence for the primacy of happiness and other goals are valued because it is believed that they add to human happiness.

References to the pursuit of happiness can be traced back nearly 2,500 years ago. Confucius, Buddha, Socrates, and Aristotle have all tackled some aspect of happiness and have many things in common. The Greek word that usually gets translated as ‘happiness’ is ‘eudaimonia’. It was Aristotle’s view that happiness was the ultimate purpose of human existence, and to lead a virtuous life and do what is worth doing. This is the exercise of virtue.

It is also important to distinguish between pleasure and happiness. Pleasure relies on external stimuli, which is why it is transitory, whereas happiness comes from within.

Professional mood

Our surveys suggest that our profession is not happy. Professional morale – how people are feeling as a collective whole – is low, work-related stress levels are high, and burnout is a growing concern.

The British Dental Association (BDA) reported that almost half of dentists surveyed experience burnout, and more than one in three reported symptoms of depression. In contrast, people who report higher levels of happiness find their work satisfying, less stressful, and enjoyable. They are less likely to make mistakes, are characterised by a growth mindset, and are also likely to be more successful. The quest for happiness should therefore remain a high priority.

Science of happiness

The science of happiness is the study of the factors that contribute to wellbeing. It is a relatively new field of research that focuses on the biological/chemical processes that contribute to feelings of wellbeing and happiness.

The psychological, social, and biological factors that contribute to wellbeing include positive emotions and experiences, a sense of purpose and meaning in life, a sense of self-worth and autonomy, and control of one’s life.

The chemicals and neurotransmitters that affect mood and happiness include:

Serotonin - mood regulation and positive emotions.

Dopamine - motivation, pleasure, and reward.

Endorphins - pain relief and positive emotions – so called ‘feel-good’ chemicals.

Oxytocin - associated with social bonding and positive emotions.

Physical and environmental factors such as sunlight, exercise, and diet also affect neurotransmitter levels, which determine our mood and happiness. Additionally, researchers have identified some personality traits that are associated with greater happiness such as extroversion, conscientiousness, and emotional stability. It is a complex area of research, details of which are beyond the scope of this article.

Measuring subjective happiness

The Subjective Happiness Scale (SHS) was one of the first developed by Lyubomirsky and Lepper (1999) to measure subjective happiness. It is short and reliable, and consists of four items indicating the degree of happiness scored on a 7-point Likert scale.

The SHS is a 4-item measure (Table 1) that asks respondents first to rate on 7-point Likert-type scales how generally happy they are (1 = not a very happy person, 7 = a very happy person) and how happy they are relative to their peers (1 = less happy, 7 = happier). The remaining two questions require participants to indicate the extent to which a description of a “very happy” and a “very unhappy” person, respectively, characterises them (1 = not at all, 7 = a great deal).

To score the SHS, the values from the first three items are scored between 1-7, while the fourth item is reverse scored (i.e. 7 is turned into 1, 6 into 2, 5 into 3, 3 into 5, 2 into 6, and 1 into 7). Then the scores for all four items are added together and averaged, to give the final score.

Most people score between 4.5 and 5.5.

A formula

In their model of happiness, Lyubomirsky, Sheldon, and Schkade (2005) proposed a framework in which three factors contribute to people’s sense of wellbeing and happiness. They suggest that genetics account for approximately 50% of the happiness equation, circumstances for approximately 10%, and intentional or volitional activity for the remaining 40% (see Figure 2). The strong association between happiness and personality may limit volitional activity, because personality traits are fixed and unlikely to change.

Determinants of happiness

Happiness is the sum of three factors. The formula that is often quoted is H = S + C + V where:

H stands for Happiness

S stands for Set Point (genetic predisposition)

C stands for Conditions of living, and

V stands for Voluntary actions and activities.

The key message in this model is that by focusing on the voluntary 40% a person can significantly improve their happiness. It is not that simple because the three factors are not independent and exert an influence on another.

The temptation is to accept this as a mathematical certainty when it is not.

In our member surveys, the 10% attributed to ‘circumstances and conditions’ seems a very low percentage. Our analysis of the responses to some questions would suggest that the true figure could be double or more that in the base formula. Sonia Lyubomirsky herself refers to the numbers as ‘averages and approximations’ in one of her presentations. In 2019, she reflected on her and her colleagues’ earlier research and acknowledges that “the pie chart diagram appears to have outlived its usefulness”. She suggests that volitional activities may influence happiness less than they thought - perhaps as low as 15% - and that “happiness can be successfully pursued, but it is not ‘easy’”.

Policy makers have an important role to play when it comes to promoting happiness, particularly when it comes to the ‘circumstances’ element of the happiness formula. Much of the angst and stress reported by our members can be attributed to work conditions, targets and clinical pressures – all of which are creations of policy makers or unintended consequences of failing systems. If we want to improve the professional mood and enjoy the benefits (for patients and practitioners alike), we must lessen the impact of the stressors.

In the first chapter of the 2023 world happiness report, it states: “Once happiness is accepted as the goal of government, this has other profound effects on institutional practices. Health, especially mental health, assumes even more priority, as does the quality of work, family life and community.” 

Summary

Happiness, wellbeing and the quality of professional life are closely related concepts. There is a positive relationship between happiness and altruistic behaviours where the wellbeing of the helper and the helped is improved. It has been shown that those who receive altruistic help are themselves more likely to help others. We need to be clear that feeling happy and being happy are not the same thing – there is a difference between momentary level of happiness and the enduring level of happiness. In the words of Professor Lord Richard Layard: “By provide evidence of what’s going to make a difference to people’s happiness, then the policymakers can’t make good policy.” There is now ample evidence of what will make a difference to people’s lives and so the profession can be forgiven for saying “over to you” without it sounding like a dereliction of responsibility.

References

Collin V, Toon M, O'Selmo E, Reynolds L, Whitehead P. A survey of stress, burnout, and well-being in UK dentists. Br Dent J 2019; 226: 40-49

Lyubomirsky, S., & Lepper, H. A measure of subjective happiness: Preliminary reliability and construct validation. Social Indicators Research. 1999;46, 137-155.

Kennon M. Sheldon & Sonja Lyubomirsky (2019): Revisiting the Sustainable Happiness Model and Pie Chart: Can Happiness Be Successfully Pursued? The Journal of Positive Psychology

Further reading

Wellbeing: Science and policy (2023) Richard Layard