Abstract
Little is known about the underlying relationships between self-reported mental health items measuring both positive and negative emotional and behavioural symptoms at the population level in young people. Improved measurement of the full range of mental well-being and mental illness may aid in understanding the aetiological substrates underlying the development of both mental wellness as well as specific psychiatric diagnoses. A general population sample aged 14 to 24 years completed self-report questionnaires on anxiety, depression, psychotic-like symptoms, obsessionality and well-being. Exploratory and confirmatory factor models for categorical data and latent profile analyses were used to evaluate the structure of both mental wellness and illness items. First order, second order and bifactor structures were evaluated on 118 self-reported items obtained from 2228 participants. A bifactor solution was the best fitting latent variable model with one general latent factor termed ‘distress’ and five ‘distress independent’ specific factors defined as self-confidence, antisocial behaviour, worry, aberrant thinking, and mood. Next, six distinct subgroups were derived from a person-centred latent profile analysis of the factor scores. Finally, concurrent validity was assessed using information on hazardous behaviours (alcohol use, substance misuse, self-harm) and treatment for mental ill health: both discriminated between the latent traits and latent profile subgroups. The findings suggest a complex, multidimensional mental health structure in the youth population rather than the previously assumed first or second order factor structure. Additionally, the analysis revealed a low hazardous behaviour/low mental illness risk subgroup not previously described. Population sub-groups show greater validity over single variable factors in revealing mental illness risks. In conclusion, our findings indicate that the structure of self reported mental health is multidimensional in nature and uniquely finds improved prediction to mental illness risk within person-centred subgroups derived from the multidimensional latent traits.
Highlights
Very few studies have concurrently investigated the underlying structure of mental ill health and mental well-being in young people
Failing to account for mental well-being when examining the structure of thoughts, feelings and behaviours in young people, is likely to provide a skewed view of mental health in the population at large [3]
As this study focused on measuring psychotic-like experiences, endorsement on the Schizotypal Personality Questionnaire (SPQ) items was compared with positive ratings of psychotic-like experiences on the semi-structured PLIKS interview (PLIKSi) using a subsample of the total sample
Summary
Very few studies have concurrently investigated the underlying structure of mental ill health and mental well-being in young people. The psychopathology literature on mental illness symptom structure has, on the whole, remained distinct from the wider concepts of the structure of mental well-being. The absence of mental illness symptoms cannot be taken as either necessary or sufficient evidence of positive mental health. Mental health or well-being has been defined as a state of positive feelings and functioning, which can either be present or absent without necessarily having any implications on an individual’s mental illness status [2]. Failing to account for mental well-being when examining the structure of thoughts, feelings and behaviours in young people, is likely to provide a skewed view of mental health in the population at large [3]
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