Development of a dual-factor measure of adolescent mental health: an analysis of cross-sectional data from the 2014 Canadian Health Behaviour in School-aged Children (HBSC) study

Abstract

IntroductionStudies of adolescent mental health require valid measures that are supported by evidence-based theories. An established theory is the dual-factor model, which argues that mental health status is only fully understood by incorporating information on both subjective well-being and psychopathology.ObjectivesTo develop a novel measure of adolescent mental health based on the dual-factor model and test its construct validity.DesignCross-sectional analysis of national health survey data.Setting and participantsNationally weighted sample of 21 993 grade 6–10 students; average age: 14.0 (SD 1.4) years from the 2014 Canadian Health Behaviour in School-aged Children study.MeasuresSelf-report indicators of subjective well-being (life satisfaction, positive and negative affect), and psychopathology (psychological symptoms and overt risk-taking behaviour) were incorporated into the dual-factor measure. Characteristics of adolescents families, specific mental health indicators and measures of academic and social functioning were used in the assessment of construct validity.ResultsProportions of students categorised to the four mental health groups indicated by the dual-factor measure were 67.6% ‘mentally healthy’, 17.5% ‘symptomatic yet content’, 5.5% ‘asymptomatic yet discontent’ and 9.4% ‘mentally unhealthy’. Being mentally healthy was associated with the highest functioning (greater social support and academic functioning) and being mentally unhealthy was associated with the worst. A one-unit increase (ranges=0–10) in peer support (OR 1.19; 95% CI 1.15 to 1.22), family support (OR 1.32; 95% CI 1.28 to 1.36), student support (OR 1.20; 95% CI 1.17 to 1.24) and average school marks (OR 1.18; 95% CI 1.10 to 1.27) increased the odds of being symptomatic yet content versus mentally unhealthy. Mentally healthy youth were the most likely to live with both parents (77% vs ≤65%) and report their family as well-off (62% vs ≤53%).ConclusionsWe developed a novel, construct valid dual-factor measure of adolescent mental health. This potentially provides a nuanced and comprehensive approach to the assessment of adolescent mental health that is direly needed.

Development of a novel continuous measure of adolescent mental health inspired by the dual-factor model

“…In a secondary analysis we examined whether average mental health scores differed by indicators of academic and social functioning, and self-rated health in the mentally health group defined by the categorical dual-factor model (King et al, 2021).…”

“…Future studies might also consider whether internalized and externalized symptoms should be treated equally, as they were in this study. Internalized symptoms (e.g., anxiety (1) Values are weighted, (2)*All p-values obtained from mixed effects multivariable linear regression models that adjusted for age and sex, and clustering by school, and (3) †A description of the categorical dual-factor measure is described elsewhere (King et al, 2021).…”

“…Assuming a standard deviation of 10 the analysis was 80% powered to detect differences between means of 0.5 to 2.5, two-sided alpha = 0.05. The above analysis was repeated in the "Mentally Healthy" group as defined according to the four-category Dual-factor Model (King et al, 2021), to examine within group variation in average mental health scores.…”

“…The purpose of this study was therefore to develop and test a novel measure of adolescent mental health for use in public health research, based on our adaptation of the Dual-factor Model (King et al, 2021) and in a continuous form (Figure 2). Such a continuous measure could potentially comprehensively and more accurately capture varying mental health states than traditional approaches.…”

Exploring an Applied Ecological Model of the Effects of Household, School, and Community Environments on Adolescent Mental Health in Japan

“…Waza et al [ 21 ] found a strong correlation between vitality and depression in a sample of 660 Swedish young people aged 14–20 years. Several studies [ 20 , 21 , 22 , 23 ] suggest that mood and anxiety disorders and vitality are important aspects of mental health status in adolescence. King et al [ 23 ] studied a national sample of 21,993 grade 6–10 students in Canada and emphasized that mental health status can be fully determined with two dimensions: subjective well-being and psychopathology.…”