Measuring Positive Mental Health and Depression in Africa: A Variable-Based and Person-Centred Analysis of the Dual-Continua Model

Abstract

The dual-continua model of mental health provides a contemporary framework for conceptualising and operationalising mental health. According to this model, mental health is distinct from but related to mental illness, and not the opposite or merely the absence of psychopathology symptoms. To examine the validity of the dual-continua model, previous studies have either applied variable-based analysis such as confirmatory factor analysis (CFA), or used predetermined cut-off points for subgroup division. The present study extends this contribution by subjecting data from an African sample to both CFA and latent class analysis (LCA) to test the dual-continua model in Africa. We applied CFA separately for the Mental Health Continuum—Short Form (MHC-SF) and Patient Health Questionnaire—9 (PHQ-9); and LCA on combined item responses. College students (N = 892; average age = 22.74, SD = 4.92; female = 58%) from Ghana (n = 309), Kenya (n = 262), Mozambique (n = 232), and South Africa (n = 89) completed the MHC-SF and PHQ-9. With minor modifications to the measurement models, the CFA results of this study confirm the three-factor structure of the MHC-SF, and a unidimensional solution for the PHQ-9. LCA results show the presence of three distinct latent classes: languishing with moderate endorsement of depressive symptoms (25.9%), flourishing with low endorsement of depressive symptoms (63.7%), and moderate mental health with high endorsement of depressive symptoms (10.4%). These findings further contribute to affirming the evidence for the dual-continua model of mental health, with implications for the assessment of mental health, to inform policy, practise, and future research in community and clinical settings in Africa.

An investigation of the dual continua model of mental health in the context of eating disorder symptomatology using latent profile analysis

“…Instead, we identified a partially symptomatic and content profile, with only moderate mental well-being and moderate ED symptomatology. While symptomatic but content profiles have been identified in previous research using different methods to derive mental health profiles (Keyes, 2005;Renshaw & Cohen, 2014), other LPA dual continua studies have found results similar to the present study (Khumalo et al, 2022;Moore et al, 2019aMoore et al, , 2019bThayer et al, 2021). For example, in a study of African and South African university students, Khumalo et al (2022) used LPA and found a profile of students who had moderate wellbeing and moderate depressive symptoms (i.e., partially symptomatic and content), and no profile where students endorsed high well-being and high depressive symptoms (i.e., symptomatic but content).…”

“…While symptomatic but content profiles have been identified in previous research using different methods to derive mental health profiles (Keyes, 2005;Renshaw & Cohen, 2014), other LPA dual continua studies have found results similar to the present study (Khumalo et al, 2022;Moore et al, 2019aMoore et al, , 2019bThayer et al, 2021). For example, in a study of African and South African university students, Khumalo et al (2022) used LPA and found a profile of students who had moderate wellbeing and moderate depressive symptoms (i.e., partially symptomatic and content), and no profile where students endorsed high well-being and high depressive symptoms (i.e., symptomatic but content). An alternative interpretation is that these individuals could be positioned on the mid-point of the unidimensional model, with moderate levels of mental well-being and mental illness that places them towards the centre of this continuum.…”

The Mental Illness‐Health Matrix and the Mental State Space Matrix: Complementary meta‐conceptual frameworks for evaluating psychological states

“…With (a), for example, Iasiello et al (2022) conducted a meta‐analysis of 46 studies that used the Mental Health Continuum—Short Form, and found the scale provides a robust measure of general mental well‐being, tapping into emotional, social, and psychological aspects of well‐being in both general and clinical populations. We are also seeing inroads using a person‐centered approach, some of which also combine construct validation, as per Khumalo et al's (2022) analysis above. However, the matrices have the potential to further enhance this line of research.…”

“…This recognition is reflected in certain work on the dual-continua model which, rather than the standard four categories discussed above, has explored more granular profiles of mental illness and health. Khumalo et al (2022), for example, used confirmatory factor analysis and latent class analysis to test the model in relation to the Mental Health Continuum-Short Form and Patient Health Questionnaire-9, and developed a profile featuring 23 different indicators, 9 pertaining to illness (loss of interest, depressed mood, sleep disturbance, fatigue, appetite change, self-reproach, concentration problems, psychomotor problems, and thoughts of suicide), and 14 to health (happiness, interest in life, satisfaction, social contribution, social integration, social acceptance, social coherence, self-acceptance, environmental mastery, positive relations with others, personal growth, autonomy and purpose in life). While in certain contexts the greater simplicity of the broad four-category classification may be preferable, a more granular approach inevitably provides a more detailed assessment of a person's mental illness and health.…”

No, Languishing is not the ‘Middle Child’ of Mental Health

“…The third component is social well-being, which is positive social functioning. The continuum model of mental health has been supported by considerable evidence base from across cultures (Khumalo et al, 2022;Żemojtel-Piotrowska et al, 2018;Zhang et al, 2021).…”