Introduction
Mental health is a complex construct intending to come up with optimal psychological experience and action. The subject known as mental health and its influencing factors are one of the most critical issues [1]. Besides, mental health as one of these dimensions, not only means lack of mental disorders, but also includes the ability of an individual to face life challenges and adapt to various experiences. This dimension of health considers flexibility and giving meaning to life experiences [2]. In fact, mental health also includes a person’s ability to enjoy life, “to strike a balance between life activities and to make efforts for resilience” [3].
Today, another dimension of health called social health has been considered as the concept including the dimensions of mind’s positive functioning in social relationships, which include self-acceptance, personal development, positive relationships with others, environmental mastery, purposefulness in life, and independence [4]. Focusing on this dimension is clearly visible among other societies since it is especially important in the health of whole society. However, it can be stated that in Iranian society, this dimension of health has not been given the importance it deserves, and this trend is still more or less continuing. Since social health plays a significant role in ensuring the dynamism and efficiency of any society, a critical condition for the prosperity of any society is the existence of knowledgeable, efficient, and successful individuals [5]. The social platform of health includes social skills, social performance, and the ability of each person to recognize himself/herself as a member of the larger society [6].
On the other hand, one of the variables that can be affected by mental and social health skills is optimism. Optimism is one of the topics of positive psychology. Positive psychology aims to create change in psychology, and its intention goes beyond fixing traumas and seeks to optimize the quality of life (QoL) [7]. Optimism and pessimism affect the way individuals adapt to life events. These two factors affect individuals’ mental expectations when facing problems and their behavior when overcoming them [8]. Besides its positive impacts on the individual, optimism can also cause procrastination, lack of educational and career development, and decreased knowledge and awareness of healthcare staff and the public [9]. However, among healthcare staff, it can result in negative outcomes such as decreased proficiency in interventional skills, increased stress in dealing with patients, and positive outcomes like lower levels of stress and depression, greater willingness to practice in clinical skills workshops, and a willingness to do teamwork.
In this respect, Smith et al [10] in a study on 120 couples found interpersonal perspective as a practical integrative framework for examining social processes that can help optimism-pessimism association with physical health and emotional adjustment [10]. Qiu et al [11] in a study investigated mental health and psychological stress in medical the results show that self-risk perception has an effect on the severity of the epidemic in hospitals. also the mental health of the medical staff. Social identity has no effect between self-risk perception and mental health.
The research gap concerning mental and social health skills induced effect on patients’ optimism levels is particularly critical in clinical and psychological settings. Despite the increased focus on the significance of mental and social health in recent years, few studies have addressed the direct relationship between such skills and patients’ optimism levels. Many studies have surveyed the general impacts of mental health on individuals’ lives and their challenges, but more rigorous research is required in order to better grasp how specific skills can enhance patients’ optimism and positive attitude. This gap could help therapists and clinicians develop more effective tools and techniques to support their patients.
On the other hand, the previous studies indicated that mental and social health can influence patients’ recovery, but the impact on patients’ optimism is not fully identified yet. This uncertainty about the mental and social health induced effects on patient optimism may bring about unknown outcomes. Part of the existing research gap is related to lack of precise and coherent definitions of mental and social health skills. Many studies indicated the impact of optimism on patients’ QoL and recovery; however, considering specific skills such as empathy, communication skills, and stress management potential in the context of the effects of optimism has been taken for granted. Moreover, clarifying how such skills are formed and associated with optimism can lead to the development of evidence-based methods in the field of treatment and prevention of mental-social problems in patients. The urgent need for more research in this field highlights the importance and necessity of in-depth and comprehensive studies in this area. Thus, we came to this decision to answer the question by conducting the present study: Do mental and social health skills play a role in patients’ optimism?

Materials and Methods
This literature review was carried out in, Scopus, PubMed and Institute for Science Citation (ISC) using “ mental health, social health and optimism ” keywords, and Iranian databases Scientific Information Database (SID), Magiran, and IranMedex using the Farsi equivalent of these keywords. Studies were included if they were published in English or Farsi language; were qualitative and quantitative from 2010 to 2024. After the systematic search, the records were screened: 1) evaluation of the search results and remove the duplications; 2) evaluation of titles (261 titles) to select the eligible abstracts; 3) evaluation of abstracts (51 abstracts) to select articles (Figure 1).
Results
From 51 abstract 11 article were excluded after review and selection based on the topic of the study. And 40 papers got to the screening stage, and after crossing out 6 duplicates, the abstracts of 34 ones were studied. Eight articles were removed due to lack of full text, which were published in conferences and the abstract of them were at hand, and their full text could not be accessed through various methods. Twenty-six full-text papers were retrieved and 4 papers were excluded after reviewing the full text because of not meeting the due criteria. Finally, 22 relevant retrieved articles were reviewed (Table 1).





Discussion
The current narrative review study was conducted aiming mental and social health skills and their role on patients’ optimism. Mental and social health skills contribute to patients’ optimism. Mental health affects patients’ optimism through social health and physical activity. This article reviewed the papers between 2010 and 2024 in Persian and English databases with the keywords mental health, social health, and optimism. A review of numerous articles in this field indicates that through its positive impact on the mind, social health can promote patients’ optimism by creating positive relationships. Optimistic individuals have positive expectations and perceptions of life. They believe that the future contains their desired outcomes. Optimism is associated with mental and social health.
Concerning this, Kalani and Najafian [12] in a study as the relationship between mental health and self-efficacy of teachers in Mashhad indicated a significant positive relationship of 0.74 between mental health and self-efficacy of teachers in Mashhad. Furthermore, Khandan Pourarani [13] revealed that mental health has many evaluation factors. The students with no mental problems, stress, sadness, depression, fear, etc. have a better QoL [13]. 
Apart from affecting mood, this mental health will also impact the physical health of students. On the other hand, Taghavi et al. [14] in their study displayed that due to the existence of mental health disorders in nurses during several pandemics in many countries, this class of society requires particular attention because in case not dealing with such problems, the countrywide medical and health capacity will be attenuated and it will lack the potential to cope with upcoming pandemics [14]. Likewise, Atadokht et al. [15] carried out a research as” Investigating the Mediating Role of Optimism in the Relationship between Mental Health and Marital Satisfaction of Women in Mianeh County” using the correlation method. Pursuant to its derived results, the dimension of social dysfunction and depression was a negative and significant predictor of marital satisfaction. Depression was also a negative and significant predictor of optimism. And Dahim [16] found the mediating role of mental health in the relationship between optimism and happiness. In general, optimism led to happiness by promoting mental health. Also, the optimism variable indicated a direct effect on happiness. In other words, by affecting the individual’s feelings and emotions, optimism results in a positive attitude and consequently, happiness. Zhang et al. [3] in there study show that adolescents’ mental health literacy, have relationship with subjective socioeconomic status, psychological resilience psychological distress and could reduce distress in adolescents. Similarly, Kim et al. [17] concluded that smart mental health intervention could potentially be an important supplement to the treatment of depression due to its applicability and comprehensive nature of interventions consisting of various stress reduction models. Qiu et al. [11] demonstrated the severity of the epidemic in the hospital and the intensity of work as important psychological stressors for frontline medical staff. The perception of self-risk had a mediating effect on the severity of the epidemic in hospitals and the mental health of the medical staff. Social identity revealed no moderating effect between the perception of self-risk and mental health.
This finding can be elaborated this way that mental health is a key concept in human life contributing to individuals’ well-being and happiness. This concept goes beyond the absence of mental illnesses and it includes a wide range of mental states that affect individuals’ ability to face life challenges, discover their talents, and participate in society. Mental health is an inherent right of every person and is the foundation for progress in all aspects of life, from individual decision-making to social interactions and community development. It is not merely the absence of mental health problems, but rather a complex and diverse spectrum that is unique to each individual. Mental illnesses include mental disorders, social disabilities, and conditions associated with severe anxiety, poor functioning, or the risk of self-harm. People encountering such challenges may experience problems with mental well-being, but this connection is not always direct and definite. Mental health as a vital aspect of life requires attention and care so that people get to fulfill their true potential. On the other hand, human’s personality traits, directly or indirectly, affect their health and illness. One of these tangible characteristics is optimism or pessimism. Intrinsic optimism is considered a stable trait in a person’s personality that influences their behaviors and expectations of outcomes and consequences. According to the research, optimistic individuals have a variety of coping strategies, and this capability plays a key role in better adaptation and adjustment to different situations.
When patients are equipped with mental health skills, they are better able to cope with their illness and its limitations. These skills include self-awareness (perception of feelings and thoughts), self-regulation (managing emotions and behaviors), resilience (the ability to recover from adversity), problem-solving, and effective communication. The patients who have the above skills usually have a more realistic view of their condition. They are able to better grasp the symptoms of the disease and engage with the treatment process. Ultimately, mental health skills not only help patients get along with their illness, but also change their perspective on the future and nurture optimism in them. This optimism itself acts as a protective factor and can play a remarkable role in the recovery process and the QoL of patients.
Considering this point, Li et al. [6] discovered that the first-line healthcare workers performed worse than the second-line healthcare workers during both waves. The second-line healthcare workers expressed a greater willingness to search for COVID-19 relevant information than the first-line healthcare workers during the first wave and were more likely to maintain social distancing during the second wave. Our results highlight the significance of assessing the social and mental health burden of healthcare workers, especially the frontline workers. Applebaum et al. [18] also indicated higher levels of optimism being tangibly associated with lower anxiety and depression symptoms, less hopelessness, and better QoL. Higher levels of perceived social support were also meaningfully associated with better QoL. Furthermore, optimism moderated the relationship between social support and anxiety, such that there was a strong negative relationship between social support and anxiety among the participants with lower optimism. As implied by Niazi et al. [19], the 5 dimensions of citizens’ social health are mostly devoted to the dimensions of social cohesion, social integration, social prosperity, social participation and social adaptation, each of which has several subcategories. Bakhshi et al. [20] concluded that among the main sub-criteria, the indicator of establishing the customer need assessment system with weight 0.073 got the first rank. Organizational factors had the highest direct effect on the social health of customers, as 0.268. Following that, the variable of management factors is involved which affects social health by about 0.245, and then the customers-related factor impacts the social health of customers by 0.185 %. The variable exerting the least impact on social health is communication and information technology. Gharehdaghi et al. [21] found out some significant relationships and correlations between the social health variable and its indicators (social acceptance, prosperity, cohesion, integrity, and participation) and the mental health of students. Moreover, among the social health subscales, a meaningful relationship and negative correlation were observed between the indicators of social cohesion and participation and depressive disorder and suicidal tendencies. So that the higher the level of social health of students, the less these disorders among the students.
In other words, social health is a substantial key aspect of the overall concept of human health. This concept goes beyond physical and mental health and focuses on the role of individuals in society and their interactions with others. Social health means an individual’s successful and adaptive functioning in society, including the ability to establish healthy and effective relationships with others and grasp one’s place in social groups. This dimension of health assesses the quality of an individual’s social relationships and interactions with their environment and is considered a measure of overall health in society. Social health is a pervasive issue that influences various aspects of life. This concept is closely related to several factors that affect people’s mental and physical health. Poverty, as one of such factors, can jeopardize people’s mental health. Poverty-stricken people are susceptible to mental disorders and may face plenty of obstacles in the path to treatment. Homelessness can also be a stressor and influence people’s physical and mental health, leading to further problems in this area. One of the issues being widely associated with social health is optimism. People who are optimistic tend to look on the bright side of life, and this attitude impacts various aspects of their lives. They believe that good things are awaiting them, and this optimism permeates various aspects of their lives. Optimism is a tendency which depends on a person’s positive expectations of the future. These people expect favorable and successful outcomes to occur in their lives, and these positive expectations are not limited to a specific area. They generally envision a bright and hopeful future. To measure this optimistic tendency, psychologists employ a variety of tests, including the life orientation test (LOT) as a 12-item scale assessing a person’s optimism level. These tests help to better understand the relationship between optimism and individuals’ mental and social health.
Of the key aspects of the role of social health skills in optimism is the capability to build and maintain positive and supportive relationships. Those with good communication skills can easily communicate with others, effectively express their needs and feelings, and listen to the opinions and feelings of others. Such abilities lead to the formation of deeper and more meaningful relationships as a valuable source of emotional and practical support during tough times. The existence of these support networks reassures individuals that they are not alone and that they can count on the help and support of others if problems arise. This sense of security and support plays a critical role in strengthening optimism and reducing hopelessness and despair. Besides, social health skills help people deal constructively with conflicts and social challenges. The ability to negotiate, problem-solve, and compromise allows individuals to resolve conflicts peacefully and prevent them from escalating into larger problems. These skills not only curb tension and stress in relationships, but also give people a greater sense of control over their circumstances. Once individuals feel capable to confront and overcome challenges, they are more likely to have a positive outlook on the future and to trust their potentials to achieve their goals.
In another study Li et al. [6] demonstrated that disability-related stress was inversely related to optimism, life satisfaction and mental health. Similarly, as proposed by Lai et al. [22], optimism affects anxiety and depression through direct and indirect pathways.
As predicted, parallel mediation analysis revealed that the effect of optimism on anxiety and depression was mediated by stress and sleep quality. Thus, optimism was negatively correlated with poor sleep quality, stress, anxiety, and depression. Increased optimism was associated with high sleep quality and lower stress, anxiety, and depression. Uribe et al. [23] in a research displayed optimism playing a role in adolescent mental health. Identifying the impact of positive personal assets such as optimism on adolescent mental health will have important implications for the development of initial interventions and the configuration of clinical and public health practices based on scientific evidence. Chen et al. [24] concluded that cultural adaptation moderated the relationship between optimism, self-efficacy, and life satisfaction. Therefore, optimism and mental health are closely related, and cultural adaptation tangibly contributes to the effect of self-efficacy on regulating depression and life satisfaction among Tibetan students in China.
Taking mental health into account as an essential component of health care is highly critical. Health experts should pay attention to this point that treating physical illnesses without considering mental health may be in vain. For this reason, treatment plans have to include mental health assessment and management, too. This approach can help improve patients’ treatment outcomes and QoL. Social determinants of health (SDOH) account for more than 50% of morbidity, mortality, and diseases worldwide. Evidence suggests that major health inequities result from the asymmetric effects of such SDOH. Today, health perspectives have got broader and inevitably focused on non-medical factors of health. Each of these determinants, either by itself or through their interaction with each other, strongly influences health status and causes inequities in health status. These determinants encompass heredity, lifestyle, environment, social status, etc. which tangibly affect health and its outcomes, including optimism. Although medical care can prolong life or boost recovery from a serious illness, what matters for population health is the social conditions that cause people to become ill or require medical care. This means that SDOH, such as income, education, occupation, nutrition, and social class, bring about diseases much more than the factors like the biological ones and play such a critical role in human health that in case of being overlooked,it becomes unimaginable to achieve health goals and establishing justice in health. 

Conclusion
Pursuant to the review of the aforementioned studies, it is concluded that mental health and social skills are closely associated with patients’ optimism. These two factors function as the main keys in raising hope and positive thinking in individuals. Mental health can help strengthen positive mentality via promoting social status and encouraging physical activity. When social health improves, people are able to build more positive relationships, which in turn increases optimism. Optimism is an outlook in which a person expects favorable and positive outcomes in life and sees the future with hope. This characteristic is directly linked with mental and social health and can enhance the individuals’ overall QoL. Alternatively, health, as a key factor in the progress of society, exerts a critical impact on human development indicators. Therefore, identifying and dealing with the SDOH that create health inequalities is not only a priority for every society, but also an important responsibility for the government. The societies in which children and adults are not healthy enough and are unable to participate effectively in society cannot be regarded sustainable and dynamic. Individuals’ living environment, working conditions, and age all affect public health and need to be addressed. The inequalities in societies have consequences for individual health, leading to health inequalities. Despite this, the good news is that most of such health inequalities, whether internationally and domestically, are preventable. To upgrade health status and reduce the pertinent inequities, it is necessary to pay particular and deep attention to social determinants. Although technical solutions in the health sector are important, they are not sufficient and SDOH must also be tackled.
This requires an optimistic view of the impact of social determinants of individual health. Across the globe, social challenges like poverty, unemployment, and illiteracy exist as the obstacles for societies on the path to progress and well-being. Governments are constantly striving to provide effective solutions to deal with such problems and help create a healthier, safer, and happier society for their citizens. The ultimate goal is to overcome these obstacles and ensure well-being and optimism among the people.

Limitations
The present research limitations involve:
1) Overlooking or inadequately controlling important confounding and moderating factors such as socioeconomic status, social support, and disease severity; 2) limited focus of studies on specific patient groups and difficulty in generalizing the extracted results to general populations or other patient groups. To counterbalance the limitations, it is suggested that:
1) Studies with more complex structural models be designed. 2) comparative studies that evaluate different groups of patients (e.g. the patients with different chronic diseases, mental patients, cancer patients) be performed.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Ardabil Branch, Islamic Azad University, Ardabil, Iran (Code: IR.IAU.ARDABIL.REC.1403.160). The researcher considered all scientific and ethical principles and considerations in terms of trustworthiness, confidentiality, informed consent, and honesty. Besides, The researchers tried to comply with the ethical issues such as gaining consent for the research, reviewing the results during the research, and taking responsibility for the implementation of the research. The participants were informed about the objective, and the advantages and shortcomings of the study and their informed consent was achieved.

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

Authors' contributions
Conceptualization and supervision: Azra Ghaffari and Somaye Fallah; Methodology: Ali Jafari and Yousef Namvar; Investigation and writing: All authors.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The Research Deputy of Mazandaran University of Medical Sciences, Sari, Iran, is gratefully appreciated for supporting the project.


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