Bright

Futures

A Health Care Provider’s Guide To Promoting Women’s Emotional Wellness

Bright Futures for Women’s Health and Wellness
This resource is part of a series of materials called “Bright Futures for Women’s Health and Wellness.” This series also

includes a promotional flyer for health care providers, two consumer booklets, and a guide for community organizations.

These materials were developed by the U.S. Department of Health and Human Services, Health Resources and Services

Administration, Office of Women’s Health, with the guidance of a 10-member panel of predominantly female mental

health experts (medical doctors, psychiatrists, and researchers) from across the country. The aim of the Bright Futures

project is to help women of all ages achieve better physical, mental, social, and spiritual health by encouraging healthy

practices.

Like physical health, mental health exists along a spectrum. At one end are feelings of thriving and flourishing, and at the

other are depressed and anxious feelings. For a variety of reasons, the field of mental health has historically focused on

the negative end of this spectrum. The Bright Futures project is different. It is not about avoiding or treating depression:

It is about helping women to thrive. Health care professionals can be an important part of this effort.

This guide contains information for health care professionals on the latest research about emotional wellness as well as

tips and ideas for how you can discuss wellness issues with the female patients you serve. It is important to note that

this guide focuses on women’s emotional wellness with some discussion on the more common types of depression and

anxiety that many women can face from time to time. It does not discuss more serious clinical diagnoses of unipolar

and/or bipolar disorders that can occur among some women, nor the treatment and care that is warranted in these

cases.
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Table of Contents

Introduction ................................................................................................................................ ii

Current Research on Mental Health and Emotional Wellness ............................................................ 1

How to Talk to Patients about Emotional Wellness .......................................................................... 4

Conversation Starters .................................................................................................................. 5

Companion Patient Education Tools ................................................................................................ 6

Additional Resources .................................................................................................................... 7

Works Cited ................................................................................................................................ 8

Endnotes .................................................................................................................................... 11
ii

Introduction

Emotional wellness promotes physical wellness and plays a major role in patients’ adherence to medical advice

and recovery from medical conditions. Research has linked depression and its negative affect to a wide range of

serious health conditions, including diabetes, heart disease, and chronic pain, as well as risky behaviors like

smoking and poor eating habits.1 This booklet helps health care providers address the important link between

physical and emotional health. 

Promoting emotional wellness may be especially important for women. Depressive disorders affect nearly twice

as many women as men each year in the United States, and increasing numbers of women continue to suffer

from a wide range of chronic illnesses including cancer, heart disease, and diabetes.2 Women’s mental health

may be related to the ability to balance multiple roles and responsibilities, including the often-competing

demands of work, relationships with friends and family members, and children. While women appear to be more

susceptible to depression than men are, they also experience more joy.3

As a health care provider, you can help promote positive mental health in your female patients by helping them

understand the relationship between their physical and emotional health. By promoting simple steps, you can

help them appreciate themselves, find their balance and purpose in life, and connect with others. These

factors will help women of all ages increase their well-being, satisfaction, and overall quality of life, and may also

improve their physical health. You can help your patients think of emotional wellness as a goal for their overall

health, just like fitness or nutrition goals.

This booklet provides:

A short overview of current research on mental health and emotional wellness

Information on how talk to your patients about emotional wellness

Conversation starters to use with your patients

Information about companion patient education tools

Additional resources

Works cited
1

Current Research on Mental Health and Emotional Wellness

Like physical health, mental health exists along a spectrum. At one end are feelings of thriving and flourishing,

and at the other are depressed and anxious feelings. While the field of mental health has historically focused on

the negative end of this spectrum, a growing body of research is examining the factors that support positive

mental health. This research suggests that mental health can be improved through the development of skills

such as flexibility, strength, and optimism, enhanced personal traits such as high self-esteem and a sense of

purpose, and expanded personal resources such as spiritual practices and support from family and friends. 

People who are emotionally well feel good about themselves, their relationships, and their purpose in life.

Emotional wellness is not the absence of sadness, anger, or confusion. All people will feel these emotions from

time to time. However, people who are emotionally well may have fewer emotional lows and will be able to

recuperate faster from such lows. Emotional wellness may also increase feelings such as happiness and joy

during positive times. Emotional wellness has many components, including:

Healthy emotional, cognitive, and physical habits (such as physical activity, healthy eating, and developing

good sleep habits) that reflect the practice of valuing self 

Identification and/or connection with others 

Rewarding and supportive relationships 

Rewarding activities 

A sense of balance and purpose in life (which allows for opportunities to engage in pleasurable activities) 

A strong sense of self and compassion for personal life experience 

Compassion for others 

The ability to adapt to change and cope successfully with adversity 

Meaningful spiritual and/or cultural beliefs, traditions, and practices 

Mental health is shaped by the interaction of multiple factors and processes, some of which are within the

individual’s control and some of which are not. Environmental factors such as safe and clean living conditions,

access to quality medical care, and good nutrition can decrease an individual’s risk for psychological problems.

Conversely, crowded or dangerous living conditions, lack of access to medical care, inadequate nutrition, or

discrimination or social stigma based on race, ethnicity, gender, religion, spirituality, or other factors can
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increase this risk. Likewise, a family history of positive relationships and nurturing activities decrease risk, while

depression or substance abuse, chronic illness, or stresses such as divorce or the death of a loved one

increase risk. 

To understand emotional wellness, it is helpful to know the characteristics of people who are emotionally well.

One review of scientific studies on happiness4 found that happy people tend to:

Be optimistic, outgoing, and agreeable 

Have close relationships (e.g., friendships or marriages) 

Have work and leisure activities that engage their skills 

Have meaningful faith traditions 

Sleep well 

Exercise 

Have high self-esteem 

Likewise, positive subjective well-being (including life satisfaction, happiness, and optimism), positive traits

(creativity, compassion, courage, and integrity), and positive institutions (healthy relationships, communities, and

schools) are related to overall wellness.5 Positive mental health also has been linked to a sense of competence,

autonomy, and relatedness.6

Emotional wellness both promotes and maintains emotional and mental health. For example, positive emotions

buffer resilient people against depression and help them to thrive,7 as well as “trigger upward spirals toward

emotional well-being.”8 In addition, several components of emotional wellness have been linked to positive physical

health outcomes. Promoting emotional wellness may be one way to promote self-management of diseases.
3

For example:

Coping: Effective coping skills can enable individuals to exercise some control over their mental and

physical health.9 Coping styles are associated with significant positive and negative health outcomes as

early as mid-adolescence.10 Moreover, coping styles are important determinants of how well individuals

adjust to serious illnesses.11

Optimism: Optimism is consistently related to positive physical health outcomes,12 and optimism provides

protective benefits to people who are suffering from severe illnesses.13

Self-esteem: Self-esteem is linked to positive health outcomes throughout the lifespan.14

Social support: Health-promotion behaviors are more frequent among individuals with positive and strong

social support networks.15

Spirituality: Spirituality is an additional resource for coping.16

The good news is that women can build positive emotional health and counteract negative forces through the

development of positive skills, traits, and resources. Qualities such as resiliency, hardiness, and optimism can

help individuals be healthier and thrive.17 As importantly, these skills can be learned.18 For example, optimism

has been successfully increased via clinical interventions.19 This suggests that emotional wellness can be learned

and strengthened.
How to Talk to Patients about Emotional Wellness

Health care providers have a unique opportunity to promote emotional wellness. When patients come in for

regular checkups or with specific health concerns, providers can briefly discuss emotional wellness in addition to

physical wellness. Talking with patients about emotional wellness emphasizes providers’ overall commitment to

patients’ well-being and recognizes the important connection between physical and emotional health.

In most clinical settings, health information is conveyed by multiple staff members, including primary care

providers, psychologists, nurses, social workers, case managers, receptionists, pharmacists, or health

educators. Take some time to think about the people who can promote emotional wellness in your clinical

setting. Keep in mind that it might be more effective for multiple team members to provide information. Try to

coordinate the effort across team members so that messages remain consistent.

Wellness information should be provided at an appropriate literacy level for the patient and in the patient’s

preferred language, if possible. Wellness messages also should be culturally responsive and sensitive to the

influence of cultural and social contexts on what is healthy and appropriate. Attributes that may be considered

desirable in one culture (for example, assertiveness) may be viewed as inappropriate and, thus, not related to

emotional wellness in another.20 One way to approach these variations is to ask women to examine what cultural

values they grew up with and if these values are helpful and healthy for them, and then help them to make

decisions about negotiating these values while staying connected to their culture of origin.

If you do not have the resources or time to adapt emotional wellness messages culturally, you can target

messages around universal themes related to emotional wellness. For example:

Emotional wellness is linked to better physical health and greater life satisfaction. 

Every woman can learn how to improve her emotional wellness. 

Women can improve their emotional wellness through simple tips and activities to appreciate

themselves, find their balance and purpose, and connect with others. 

4
Conversation Starters

Most clinical encounters are brief, allowing little time for lengthy provider-patient interaction unrelated to the

main purpose for the appointment. Fortunately, conversations about emotional wellness do not need to be

lengthy. Because emotional wellness is closely related to physical health and overall well-being, there are many

opportunities for health care providers to talk to patients about these issues. You can discuss any concept

related to emotional wellness (such as balance, self-esteem, or relationships) in your interactions with patients.

Your patients might initiate these conversations, or you can bring up the topic in a neutral and non-judgmental

way, and then actively listen for cues related to emotional wellness. Your initial goal may be simply to start a

dialogue to encourage patients to begin thinking about these issues. Here are some potential conversationstarters:

“It is important to find time for yourself, even when you are busy. Let’s talk about how you are doing that.” 

“Many women have multiple roles and responsibilities. Are you finding balance in your own life?” 

“I’d like to help you set a goal related to your emotional wellness.” 

“Every woman deals with some stress in her life. Tell me how you relax and recharge yourself.” 

“Strong connections are important to our overall health. Tell me about some of your connections with

your friends, family, or community.” 

“One of the best ways to manage your [insert diagnosis] is to make sure you’re taking care of your

emotional health. Can we talk about some of the ways you can do this?” 

You can use a flyer or a handout (such as the one in this series) as a cue for you or your patients to initiate a

conversation about emotional wellness. If your patients have further questions or would like a resource to take

home, you could recommend “A Woman’s Guide to Emotional Wellness,” “A Young Woman’s Guide to Emotional

Wellness,” or other materials, as appropriate. If you recommend a resource to a patient, make note of it and

ask about it on subsequent visits. 

5
Companion Patient Education Tools

Two tools you can review and recommend to promote emotional wellness are “A Woman’s Guide to Emotional

Wellness” and “A Young Woman’s Guide to Emotional Wellness.” These documents are comprehensive,

evidence-based resources about emotional wellness and can be downloaded for free at

www.hrsa.gov/womenshealth. These guides help women of all ages improve their emotional wellness. Each

guide provides tips and ideas around basic wellness themes:

Appreciating Oneself: Provides ideas on building self-respect; building self-confidence; building 

self-esteem; setting expectations; taking care of yourself; thinking positively; making time for activities you

enjoy; and learning skills to cope with difficult emotions and situations. 

Finding Balance and Purpose: Provides ideas on learning about yourself; developing a purpose

statement; setting goals; being able to change; learning how to deal positively with stress; increasing

confidence; and nurturing the spirit. 

Connecting with Others: Provides tips about finding a connection; identifying with racial, ethnic, or

cultural backgrounds; learning about healthy relationships; learning about empathy and its importance in

relationships; learning how to be more mindful of other people; developing patience; connecting with

children; being safe in relationships, and helping others in need. 

When appropriate, encourage your patients to find suggestions in the guides to adopt before their next visit. At

their next visit, discuss what changes they have made to enhance their emotional wellness. You might also

consider keeping copies of these guides in your waiting room or exam rooms as reading material, and let

women know where they can obtain their own free copy. 

To help you promote these materials and to introduce the concept of emotional wellness, a free one-page flyer

can be downloaded at www.hrsa.gov/womenshealth. You can give the flyer to your female patients to

encourage them to obtain these guides or display it as an additional conversation starter. 

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Additional Resources

The following resources provide general information about women’s and girls’ health:

GirlsHealth.gov: Promotes emotional and physical health for teenage girls and provides information about body,

fitness, nutrition, bullying, and other issues. WEB www.girlshealth.gov 

National Women’s Health Information Center: Lists health organizations, campaigns, events, publications, and

more. TEL 800-994-9662 TTY 888-220-5446 WEB www.womenshealth.gov 

U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and

Child Health Bureau, Office of Women’s Health: Provides leadership and guidance in developing policy and in

establishing goals and priorities for women’s health issues across the lifespan.

TEL 888-ASK-HRSA (275-4772) TTY 888-877-4TY-HRSA (489-4772)

WEB www.hrsa.gov/womenshealth

This booklet is designed to promote emotional wellness among your female patients. However, some women might need

help overcoming anxiety, depression, or a more serious mental illness. If you think one of your patients might be

depressed, the following resources can help:

Anxiety Disorders Association of America: Provides information about anxiety disorders and treatment. 

TEL 240-485-1001 WEB www.adaa.org

Freedom From Fear: Provides information about anxiety and depression and information and resources to obtain

help. TEL 718-357-1717 ext. 24 WEB www.freedomfromfear.org

National Mental Health Association: Provides information about mental health, including programs, news, and

advocacy. TEL 800-969-6642 WEB www.nmha.org

National Suicide Prevention Lifeline: Trained crisis counselors assist callers with emotional distress.

TEL 800-273-8255 

U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental

Health: Provides information about mental health and mental illness, news releases, clinical trials, and more.

TEL 866-615-6464 WEB www.nimh.nih.gov

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration

Provides information on:

— substance abuse problems - National Clearinghouse for Alcohol and Drug Information

TEL/TTY 800-729-6686 En Español 877-767-8432 WEB www.ncadi.samhsa.gov

— mental health problems - National Mental Health Information Center

TEL 800-789-2647 TTY 800-433-5959 WEB www.mentalhealth.samhsa.gov 

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Ai AL, Tice TN, Peterson C, & Huang B. (2005). “Prayers, Spiritual Support, and Positive Attitudes in Coping With the September 11

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in middle-aged and older cardiac patients.” Journal of Health Psychology, 9(3), 435-450.

Ball J, Tannenbaum L, Armistead L, Maguen S, & Family Health Project Research Group. (2002). “Coping and HIV infection in African

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Ball K, Crawford D, & Kenardy J. (2004). “Longitudinal relationships among overweight, life satisfaction, and aspirations in young

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Breslau N, Peterson EL, Schultz LR, Chilcoat HD, & Andreski P. (1998). “Major depression and stages of smoking. A longitudinal

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Cieslak R, Widerszal-Bazyl M, Luszczynska-Cieslak A. (2000). “The moderating role of hardiness and social support in the relation

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Cox, E. (2002). Psychology for the AS Level. Oxford University Press.

de Groot M, Anderson R, Freedland KE, Clouse RE, & Lustman PJ. (2001). “Association of Depression and Diabetes Complications: A

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Ferketich AK, Schwartzbaum JA, Frid DJ, & Moeschberger ML. (2000). “Depression as an Antecedent to Heart Disease Among

Women and Men in the NHANES I Study.” Archives of Internal Medicine, 160(9), 1261-1268.

Fishbain DA, Cutler R, Rosomoff HL, & Rosomoff RS. (1997). “Chronic pain-associated depression: antecedent or consequence of

chronic pain? A review.” The Clinical Journal of Pain, 13(2),116-37.

Frederickson B. (2003). “Positive emotions and upward spirals in organizations.” In Positive Organizational Scholarship, BerrettKoehler Publishers.

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Endnotes

1 de Groot, Anderson, Freedland, Clouse, & Lustman, 2001; Ferketich, Schwartzbaum, Frid, & Moeschberger, 2000; Fishbain, Cutler,

Rosomoff, & Rosomoff, 1997; Breslau, Peterson, Schultz, Chilcoat, & Andreski, 1998; Heatherton & Baumeister, 1991.

2 Nolen-Hoeksema & Girgus, 1994; Piccinelli 2000; U.S. Department of Health and Human Services, 2006.

3 Myers, 1993.

4 Ibid.

5 Seligman, 2002.

6 Ryan & Deci, 2000.

7 Frederickson, 2003.

8 Frederickson & Joiner, 2002.

9 McEwen & Lasley, 2002.

10 Steiner, Erickson, Hernandez, & Pavelski, 2002.

11 Schnoll, Harlow, Stolbach, & Brandt, 1998; Ball, Tannenbaum, Armistead, & Maguen, 2002.

12 Gillham, 2000; Lauriola, Laicardi, Artistico, & Baldassarri, 2000.

13 Rodriguez, 2001; Abend & Williamson, 2002; Jones, O’Connell, Gound, Heller, & Forehand, 2004.

14 Mann, Hosman, Schaalma, & deVries, 2004; Lucas, Orshan, & Cook, 2000.

15 Yarchestki, Mahon, & Yarcheski, 2003; Stuifbergen, Seraphine, & Roberts, 2000; Willoughby, Kee, & Demi, 2000; Tangeman &

Weaver-Robuck, 1999.

16 Ai, Tice, Peterson, & Huang, 2005; Ai, Peterson, Tice, Bolling, & Koenig, 2004; Ball, Crawford, & Kenardy, 2004.

17 Luthar, Cichetti, & Becker, 2000; Kahn, 2000; Cieslak, Widerszal-Bazyl, & Luszczynska-Cieslak, 2000.

18 Shatte & Reivich, 2002; Hill, 1998.

19 Kovacs, 2003; Mann, 2001.

20 Cox, 2000.

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Bright Futures for Women’s Health and Wellness

2007