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

Introduction Studies 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.

Objectives To develop a novel measure of adolescent mental health based on the dual-factor model and test its construct validity.

Design Cross-sectional analysis of national health survey data.

Setting and participants Nationally 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.

Measures Self-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.

Results Proportions 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%).

Conclusions We 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.