Researching protective and promotive factors in mental health.

This issue of the Journal features two cohort studies which show a marked excess of schizophrenia in African Americans, and a dose–response relationship between perceived discrimination and excess rates of schizophrenia in different minority groups in The Netherlands. These studies mirror one another, and numerous other studies carried out in developed countries, in inferring that minority groups are at elevated risk for schizophrenia, and that social factors—particularly discriminationrelated disadvantages—are partially responsible. That these elevated rates have been the subject of scientific investigations is fully justified—if the higher rate of schizophrenia in minority groups were ignored, we would feel rightly outraged. Likewise, we believe ignoring the mental health needs of other disadvantaged groups—for example, women or conflict-affected people—is both scientifically and morally indefensible. It is scientifically indefensible because these groups are particularly vulnerable to suffering from poor mental health. It is morally indefensible because in the context of other important disadvantages across multiple axes, attempting to understand and address mental health inequalities becomes still more pressing as a matter of social justice. Nevertheless, in this editorial we add our voices to those who call for a broadening of the research agenda beyond the risk factors for poor mental health and the mental health problems of socially vulnerable groups. Instead, we propose that more attention needs to be paid to the protective factors which decrease the probability of suffering mental health problems, and to the promotive factors which actively enhance positive psychological well-being. Our argument is that protective and promotive factor epidemiology is not simply the converse of risk factor epidemiology, either conceptually, methodologically or in its potential public health benefits; and that a failure to investigate protective and promotive factors rigorously may therefore hamper our ability to understand mental health problems and to promote good mental health. Investigating protective factors at the group level