The utility of the International Classification of Functioning construct as a statistical tool – operationalizing mental health as an indicator of adolescent participation

Abstract

Background The ICF provides a common scientific language for the study of health and functioning. Adolescent mental health, operationalized as engagement in life situations, is one aspect of functioning. Engagement as mental health has a bi-directional relation with environmental factors. Aim To test the statistical utility of the International Classification of Functioning (ICF) classification in coding adolescent mental health and mental health problems. Methods Using data measuring mental health in a representative Swedish sample of 12–13-year-olds linking responses to the classification codes. The internal structure of the classification system constructs was tested using factor analysis. Results A factorial solution could be found for most chapters indicating that the ICF framework and coding system could be used; however, the variance explained was quite low. Linking worked better at code-level, rather than chapter level. Items measuring risk behavior or risk factors are loaded in separate constructs. Conclusions When coding items for statistical purposes, code-level rather than chapter level is to be preferred. Also, participation in risk behavior loads in separate factors indicating that these behaviors are separate from other types of participation. Implications for rehabilitation Considering some challenges with varying level of detail in the ICF-CY’s chapters, the framework can be used to identify the content of mental health questionnaires to be used in rehabilitation. To provide more detailed information in rehabilitation addressing mental health, a code-level solution is more appropriate than a chapter level solution. Despite the use of same ICF-CY codes, negative participation, i.e., risk behavior, measures a different dimension than positive participation, is especially relevant in rehabilitation addressing mental health.