General Factor Research Articles

P-Factor(s) for Youth Psychopathology Across Informants and Models in 24 Societies

ABSTRACT Objective Although the significance of the general factor of psychopathology (p) is being increasingly recognized, it remains unclear how to best operationalize and measure p. To test variations in the operationalizations of p and make practical recommendations for its assessment, we compared p-factor scores derived from four models. Methods We compared p scores derived from principal axis (Model 1), hierarchical factor (Model 2), and bifactor (Model 3) analyses, plus a Total Problem score (sum of unit-weighted ratings of all problem items; Model 4) for parent- and self-rated youth psychopathology from 24 societies. Separately for each sample, we fitted the models to parent-ratings on the Child Behavior Checklist for Ages 6–18 (CBCL/6–18) and self-ratings on the Youth Self-Report (YSR) for 25,643 11–18-year-olds. Separately for each sample, we computed correlations between p-scores obtained for each pair of models, cross-informant correlations between p-scores for each model, and Q-correlations between mean item x p-score correlations for each pair of models. Results Results were similar for all models, as indicated by correlations of .973–.994 between p-scores for Models 1–4, plus similar cross-informant correlations between CBCL/6–18 and YSR Model 1–4 p-scores. Item x p correlations had similar rank orders between Models 1–4, as indicated by Q correlations of .957–.993. Conclusions The similar results obtained for Models 1–4 argue for using the simplest model – the unit-weighted Total Problem score – to measure p for clinical and research assessment of youth psychopathology. Practical methods for measuring p may advance the field toward transdiagnostic patterns of problems.

Postoperative outcomes in patients with diabetes after enhanced recovery thoracoscopic lobectomy

BackgroundDiabetes is considered a general surgical risk factor, but with few data from enhanced recovery (ERAS) otherwise known to improve outcome. Therefore, this study aimed to investigate postoperative outcomes of patients with diabetes who underwent video-assisted thoracoscopic surgery (VATS) lobectomy in an established ERAS setting.MethodsWe retrospectively analysed outcome data (hospital stay (LOS), readmissions, and mortality) from a prospective database with consecutive unselected ERAS VATS lobectomies from 2012 to 2022. Complete follow-up was secured by the registration system in East Denmark.ResultsWe included 3164 patients of which 323 had diabetes, including 186 treated with insulin and antidiabetic medicine, 35 with insulin only and 102 with antidiabetic medicine only. The median LOS was 3 days, stable over the study period. There were no differences in terms of LOS, postoperative complications, readmissions or 30 days alive and out of hospital. Patients with diabetes had significantly higher 30- and 90-day mortality rates compared to those without diabetes (p < .001), but also had higher preoperative comorbidity. Preoperative HbA1c levels did not correlate with postoperative outcomes.ConclusionIn an ERAS setting, diabetes may not increase the risk for prolonged LOS, complications, and readmissions after VATS lobectomy, however with higher 30- and 90-day mortality probably related to more preoperative comorbidities.

General psychopathology factor in Chinese adolescents and its correlation with trans-diagnostic protective psycho-social factors

BackgroundComorbidity in mental disorders is prevalent among adolescents, with evidence suggesting a general psychopathology factor (“p” factor) that reflects shared mechanisms across different disorders. However, the association between the “p” factor and protective factors remains understudied. The current study aimed to explore the “p” factor, and its associations with psycho-social functioning, in Chinese adolescents. Methods2052 students, aged 9–17, were recruited from primary and secondary schools in Shanghai, China. Multiple rating scales were used to assess psychological symptoms and psycho-social functioning. Confirmatory factor analysis was conducted to verify the fit of models involving different psychopathology domains such as externalizing, internalizing, and the “p” factor. Subsequently, structural equation models were used to explore associations between the extracted factors and psycho-social functioning, including emotion regulation, mindful attention awareness, self-esteem, self-efficacy, resilience, and perceived support. ResultsThe bi-factor model demonstrated a good fit, with a “p” factor accounting for 46 % of symptom variation, indicating that the psychological symptoms of Chinese adolescents could be explained by internalizing, externalizing, and the “p” factor. Psychologically, a higher “p” was positively correlated with emotion suppression and negatively correlated with mindful attention awareness, emotion reappraisal, self-esteem, and resilience. Socially, a higher “p” was associated with decreased perceived support. LimitationsOnly common symptoms were included as this study was conducted at school. Furthermore, the cross-sectional design limited our ability to investigate causal relationships. ConclusionsA “p” factor exists among Chinese adolescents. Individuals with higher “p” factor levels were prone to experience lower levels of psycho-social functions.

Loneliness and social isolation of ethnic minority/immigrant older adults: a scoping review

Abstract Loneliness and social isolation among older adults are emerging public health concerns. Older adults from ethnic minority communities or with immigration backgrounds may be particularly vulnerable when encountering loneliness and social isolation due to the double jeopardy of their old age and minority status. The goal of this study is to conduct a scoping review of published journal articles on ethnic minority/immigrant older adults' loneliness and social isolation experiences to show the extent, range and nature of empirical studies in this area across several high-income countries (i.e. European countries, United States of America (USA), Canada, Australia and New Zealand). This review uses Arksey and O'Malley's five-state framework, a well-established scoping review method. We identify and analyse 76 articles published between 1983 and 2021. This evidence base is largely US-focused (54%) with the vast majority (76%) having a quantitative design. We summarise and map factors of loneliness and social isolation into a multi-dimensional socio-ecological model. By doing so, we show how ethnicity/immigration-specific factors and general factors intersect in multiple dimensions across places and time, shaping ethnic minority/immigrant older adults' heterogeneous experiences of loneliness and social isolation. Several critical gaps that should be at the forefront of future research are highlighted and discussed.

Osteoporosis and fracture risk are multifactorial in patients with inflammatory rheumatic diseases.

Patients with inflammatory rheumatic and musculoskeletal diseases (iRMDs) such as rheumatoid arthritis, connective tissue diseases, vasculitides and spondyloarthropathies are at a higher risk of osteoporosis and fractures than areindividuals without iRMDs. Research and management recommendations for osteoporosis in iRMDs often focus on glucocorticoids as the most relevant risk factor, but theylargely ignore disease-related and general risk factors. However, the aetiopathogenesis of osteoporosis in iRMDs has many facets, including the negative effects on bone health of local and systemic inflammation owing to disease activity, other iRMD-specific risk factors such as disability or malnutrition (for example, malabsorption in systemic sclerosis), and general risk factors such as older age and hormonal loss resulting from menopause. Moreover, factors that can reduce fracture risk, such as physical activity, healthy nutrition, vitamin D supplementation and adequate treatment of inflammation, are variably present in patients with iRMDs. Evidence relating to general and iRMD-specific protective and risk factors for osteoporosis indicate that the established and very often used term 'glucocorticoid-induced osteoporosis' oversimplifies the complex inter-relationships encountered in patients with iRMDs. Osteoporosis in these patients should instead be described as 'multifactorial'. Consequently, a multimodal approach to the management of osteoporosis is required. This approach should include optimal control of disease activity, minimization of glucocorticoids, anti-osteoporotic drug treatment, advice on physical activity and nutrition,and prevention of falls, as well as the management of other risk and protective factors, thereby improving the bone health of these patients.

Impulsivity is a stable, measurable, and predictive psychological trait

Impulsivity is a personality construct frequently employed to explain and predict important human behaviors. Major inconsistencies in its definition and measurement, however, have led some researchers to call for an outright rejection of impulsivity as a psychological construct. We address this highly unsatisfactory state with a large-scale, preregistered study (N = 1,676) in which each participant completed 48 measures of impulsivity derived from 10 self-report scales and 10 behavioral tasks and reported frequencies of seven impulsivity-related behaviors (e.g., impulsive buying and social media usage); a subsample (N = 196) then completed a retest session 3 mo later. We found that correlations between self-report measures were substantially higher than those between behavioral tasks and between self-report measures and behavioral tasks. Bifactor analysis of these measures exacted one general factor of impulsivity I, akin to the general intelligence factor g, and six specific factors. Factor I was related mainly to self-report measures, had high test-retest reliability, and could predict impulsivity-related behaviors better than existing measures. We further developed a scale named the adjustable impulsivity scale (AIMS) to measure I. AIMS possesses excellent psychometric properties that are largely retained in shorter versions and could predict impulsivity-related behaviors equally well as I. These findings collectively support impulsivity as a stable, measurable, and predictive trait, indicating that it may be too early to reject it as a valid and useful psychological construct. The bifactorial structure of impulsivity and AIMS, meanwhile, significantly advance the conceptualization and measurement of construct impulsivity.

Digital determinants of the technological development of economy

Methods. The general scientific approach is the basis of the analysis of prerequisites, trends and regularities of the technological development of the economy. The dialectical approach made it possible to form the general principles, factors and conditions of digital technological changes in the economy. In order to conduct bibliometric analysis, an online platform for monitoring and analyzing international scientific research using visualization tools and modern citation metrics was used, as well as tools for building and visualizing bibliometric networks VOSviewer. The application of the software made it possible to reveal the main connections between the existing concepts of data visualization and to identify new and little-researched aspects of the digital determinants of the technological development of the economy. Results. Changes in the development of the economy from Industry 1.0 to the digital ecosystem are studied. The emergence of new technologies indicates the transformation of economic systems, as well as their role as drivers of social progress. The risks arising as a result of digitalization of the economy are characterized. Due to the inept management of information flows and data, the most common problem is cyber-attacks which pose threats to national security in the critical infrastructure sector. Digital activators of technological development are identified in order to overcome the risks that arise in the process of digital transformation of the economy. The presented components will ensure the development of digital ecosystems and create the basis for compliance with the rules of digital security in the conditions of technological development. Novelty. A bibliometric review of publications with the keyword «digital technology» was carried out, which made it possible to identify scientific clusters, branch specifics of digital technologies, as well as strategic directions of digitalization. It has been proven that bibliometric analysis is an effective tool for carrying out a generalized research of published works by a certain keyword. Practical value. Digital technologies are fundamentally modifying the field of retail trade, advertising and publishing, management and marketing, as well as increasing the possibility to collect data about changes in market conditions. This modernization process affects not only the world economy, but also the new stage of industrial transformation. In recent years, almost every sphere of the economy has changed significantly under the influence of digitalization.

Exploratory Structural Equation Modeling Analysis of the Anxiety Sensitivity Index 3.

Anxiety sensitivity is associated with the onset and progression of various emotional disorders. The Anxiety Sensitivity Index 3 (ASI-3) is a self-report scale for anxiety sensitivity. This study aims to resolve the ongoing controversy about the factorial structure of the ASI-3 using exploratory structural equation modeling (ESEM), a newly advanced technique. Confirmatory factor analysis (CFA), ESEM, bifactor-CFA, and bifactor-ESEM were used to investigate the factorial structure of the ASI-3. Three hundred Korean college students (female = 195, age: 21.74 ± 2.34) filled out the ASI-3 and the Distress Intolerance Index. The bifactor-ESEM model exhibited a model fit superior to the 4 alternative models. The general factor showed higher loadings and reliability and explained common variance than the 3 specific factors in the bifactor-ESEM model. Most items reflected the global factor, but 6 items (Items 2, 3, 5, 7, 10, and 17) from the specific factors had insufficient loadings. Moreover, the global factor of the ASI-3 was associated with distress intolerance scores, indicating adequate criterion-related validity. The factorial structure of the ASI-3 is best described as a bifactor-ESEM model for Korean college students. Additionally, the bifactor-ESEM model of the ASI-3 includes a strong global factor that explains a large amount of the observed variance in the ASI-3 items.

The Deficiency within the Existing Literature on Comparative Regionalism and the Quest for a General Framework

There exists a huge body of research within the field of regionalism and comparative regionalism that seeks to define the crucial concepts of region, regionalism, and regional integration, as well as identify the factors required for regional integration. The research question of this paper is: do the scholars working in the field of comparative regionalism present a comprehensive, intelligible framework for studying regionalism based on a common conceptualization of the essential ideas and identification of the general factors required for successful regional integration in different settings? By reviewing the primary literature, this paper argues that the literature in the field of comparative regionalism lacks a coherent framework for facilitating the study of regional integration in different settings. This deficiency is due to a failure to conceptualize these fundamental phenomena from a general perspective and identify the common factors that affect successful regional integration.

Beliefs About Cannabis Use Among Male and Female Andalusian Adolescents.

Objectives: This study assessed potential differences between girls and boys in the prevalence rates of cannabis use, sociodemographic factors, and beliefs about cannabis use. Methods: 1,896 Andalusian adolescents aged 14-18 participated in an online survey based on the I-Change model. The survey assessed their beliefs about cannabis use, including attitudes, social influences, self-efficacy, action planning, and intention to use. Multivariate analyses of variance were then conducted to examine potential gender differences in these beliefs, while controlling for last month's cannabis use. Results: Significantly more boys used cannabis in the last month, had boyfriends/girlfriends, and had more pocket money compared to girls. Additionally, girls - in comparison to boys - were more convinced of the disadvantages of cannabis use, but were also more convinced of some of the advantages (such as freedom from boredom, and medicinal use), reported having less favorable social norms for cannabis use, had more female best friends using cannabis, and felt pressure to use cannabis from their female peers. Conclusion: These findings highlight the need for cannabis prevention programs to consider gender differences in beliefs about cannabis use. Programs should not only address general risk factors for cannabis use but also evaluate if their interventions effectively target beliefs that are particularly important for girls and boys.

Do measures of social support and social distress share general factors associated with suicidal ideation and attempts?

Aspects of social relationships have variably been associated with suicidal ideation (SI) and suicide attempts (SAs). This study assessed whether social support and social distress measures have general factors versus measure-specific factors that are associated with suicide risk. Adults (N = 455, 60.0% female), admitted to psychiatric inpatient units following a recent suicide attempt or active SI, completed assessments of social support (emotional support, instrumental support, friendship, perceived support from significant others, friends, family) and social distress (loneliness, perceived rejection, perceived burdensomeness, thwarted belongingness). Bifactor modeling examined general and specific factors of social support and distress in relation to SI (week prior to hospitalization, via the Beck Scale for SI) and SAs (past 30 days, via the Columbia Suicide Severity Rating Scale). SI was significantly associated with the general social support (B = -1.51), the general social distress (B = 1.67), and the specific perceived burdensomeness (B = 1.57) factors. SAs were significantly associated with the specific Perceived Rejection (OR = 1.05) and Thwarted Belongingness (OR = 0.91) factors. General social support and social distress were associated with SI but not recent SAs. Specific social distress factors were also related to SI and SAs controlling for general social distress, suggesting areas for future interventions.

CDK7 kinase activity promotes RNA polymerase II promoter escape by facilitating initiation factor release

Cyclin-dependent kinase 7 (CDK7), part of the general transcription factor TFIIH, promotes gene transcription by phosphorylating the C-terminal domain of RNA polymerase II (RNA Pol II). Here, we combine rapid CDK7 kinase inhibition with multi-omics analysis to unravel the direct functions of CDK7 in human cells. CDK7 inhibition causes RNA Pol II retention at promoters, leading to decreased RNA Pol II initiation and immediate global downregulation of transcript synthesis. Elongation, termination, and recruitment of co-transcriptional factors are not directly affected. Although RNA Pol II, initiation factors, and Mediator accumulate at promoters, RNA Pol II complexes can also proceed into gene bodies without promoter-proximal pausing while retaining initiation factors and Mediator. Further downstream, RNA Pol II phosphorylation increases and initiation factors and Mediator are released, allowing recruitment of elongation factors and an increase in RNA Pol II elongation velocity. Collectively, CDK7 kinase activity promotes the release of initiation factors and Mediator from RNA Pol II, facilitating RNA Pol II escape from the promoter.

The study demands and resources scale: psychometric properties, longitudinal invariance, and criterion validity

The Study Demands and Resources Scale (SDRS) has shown promise as a valid and reliable measure for measuring students’ specific study demands and -resources. However, there is no evidence as to its psychometric properties outside of the original context in which it was developed. This study aimed to assess the psychometric properties of the SDRS in a cross-national student population through examining its longitudinal factorial validity, internal consistency, and temporal invariance as well as criterion validity through its association with study engagement and task performance over time. Results showed that a Bifactor Exploratory Structural Equation Model (ESEM) with one general factor (overall study characteristics) and five specific factors (workload, growth opportunities, lecturer support, peer support, information availability) fitted the data, showed strong measurement invariance over time, and was reliable at different time points. The study further established criterion validity for the overall study characteristics factor through its concurrent and predictive associations with study engagement and task performance. However, the specific factors’ concurrent and predictive capacity could only partially be established when controlling for the general study characteristics factor. These findings suggest that study characteristics should be measured as a dynamic interaction between study demands and resources, rather than a hierarchical model.

Receptivity to Instructional Computer-Based Feedback (RIF)

Abstract: Feedback can play a pivotal role in learning but is only effective when students use it. However, the use of feedback varies greatly from student to student and these differences must be explained. Hence, the construct receptivity to instructional feedback (RIF) was introduced to assess students’ attitudes towards and engagement with human-provided feedback in multiple English-speaking countries. However, RIF scales have not yet been used in computer-based assessment contexts nor in German-speaking countries; their application is thus limited. This study examined an adapted and translated RIF scale using confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM). We capitalized on data sets comprising German-speaking university ( N = 464) and secondary school ( N = 1,207) students. The bifactor-CFA model showed a good model fit and revealed a general receptivity factor alongside the four specific factors: experiential attitudes, instrumental attitudes, cognitive engagement, and behavioral engagement with feedback. Scalar measurement invariance allowed for cross-gender and educational level comparisons. The relationships with broader personality characteristics were consistent with other contexts, thus indicating discriminant validity. General receptivity, cognitive engagement, and experiential attitudes positively correlated with GPA, suggesting convergent validity. Results support the stability of the RIF scale’s adaptation and translation. Assessment implications are discussed.

Epidemiology, etiopathogenesis, and management of MRONJ: A European multicenter study

IntroductionThe purpose of this European multicenter study was to describe the general characteristics and risk factors of MRONJ lesions as well as their clinical diagnosis and management at different European Oral and Maxillofacial Surgery centers, in order to minimize selections biases and provide information about the epidemiology, etiopathogenesis, and the current trends in the treatment of MRONJ across Europe. Materials and methodsThe following data were registered for each patient: gender; age at MRONJ diagnosis; past medical history; indication for antiresorptive or antiangiogenic therapy; type of antiresorptive medication; local risk factor for MRONJ; MRONJ Stage; anatomic location and symptoms; treatment; surgical complications; recurrence. ResultsA total of 537 patients (375 females, 162 males) with MRONJ were included. Statistically significant associations were found between patients with metastatic bone disease and recurrences (P < 0.0005) and between advanced MRONJ stages (stages 2 and 3) and recurrences (P < 0.005). Statistically significant associations were also found between male gender and recurrences (P < 0.05), and between MRONJ maxillary sites and recurrences (P < 0.0000005). ConclusionsA longer mean duration of antiresorptive medications before MRONJ onset was observed in patients affected by osteoporosis, whereas a shorter mean duration was observed in all metastatic bone cancer patients, and in particular in those affected by prostate cancer with bone metastases or multiple myeloma. Surgery plays an important role for the management of MRONJ lesions.

Attitudes Towards Economic Inequality in a Global Perspective: Evidence from the World Value Survey

Scholars have explored the factors responsible for shaping people’s attitudes towards economic inequality. Yet, this research has focused exclusively on Western countries. This is an important limitation: only by looking at the different world regions, scholars can fully elucidate the major factors involved. To address this, the paper examines data from the World Value Survey, a database of representative samples drawn from more than one hundred countries. The analyses reveal that people tolerate economic inequalities more when they have higher salary, are better educated, are male, and live in poorer countries. The data also indicates that a country’s level of income inequality has no impact on the attitude towards economic inequality reported by citizens. Altogether, these findings elucidate the general factors shaping people’s views on inequality worldwide, contributing to understanding in which conditions people support egalitarian policies.

Minimal-Effect Testing, Equivalence Testing, and the Conventional Null Hypothesis Testing for the Analysis of Bi-Factor Models

A necessary step in applying bi-factor models is to evaluate the need for domain factors with a general factor in place. The conventional null hypothesis testing (NHT) was commonly used for such a purpose. However, the conventional NHT meets challenges when the domain loadings are weak or the sample size is insufficient. This article proposes using minimal-effect testing (MET) and equivalence testing (ET) to analyze bi-factor models. A key element in conducting MET and ET is the minimal size of factor loadings that can be regarded as noteworthy in practice, termed as minimal noteworthy size. This article presents two approaches to formulating the minimal noteworthy size and compares the pros and cons of MET, ET, and the conventional NHT. Analysis shows that MET, ET, and the conventional NHT are complementary. Combining them to test the noteworthiness of domain loadings can help researchers make a comprehensive judgment. Real and simulated datasets illustrate the applications of the three methods. Monte Carlo results show that MET and ET can control type I errors reasonably well while maintaining good statistical power.

Disruption of pulmonary microvascular endothelial barrier by dysregulated claudin-8 and claudin-4: uncovered mechanisms in porcine reproductive and respiratory syndrome virus infection

The pulmonary endothelium is a dynamic and metabolically active monolayer of endothelial cells. Dysfunction of the pulmonary endothelial barrier plays a crucial role in the acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), frequently observed in the context of viral pneumonia. Dysregulation of tight junction proteins can lead to the disruption of the endothelial barrier and subsequent leakage. Here, the highly pathogenic porcine reproductive and respiratory syndrome virus (HP-PRRSV) served as an ideal model for studying ALI and ARDS. The alveolar lavage fluid of pigs infected with HP-PRRSV, and the supernatant of HP-PRRSV infected pulmonary alveolar macrophages were respectively collected to treat the pulmonary microvascular endothelial cells (PMVECs) in Transwell culture system to explore the mechanism of pulmonary microvascular endothelial barrier leakage caused by viral infection. Cytokine screening, addition and blocking experiments revealed that proinflammatory cytokines IL-1β and TNF-α, secreted by HP-PRRSV-infected macrophages, disrupt the pulmonary microvascular endothelial barrier by downregulating claudin-8 and upregulating claudin-4 synergistically. Additionally, three transcription factors interleukin enhancer binding factor 2 (ILF2), general transcription factor III C subunit 2 (GTF3C2), and thyroid hormone receptor-associated protein 3 (THRAP3), were identified to accumulate in the nucleus of PMVECs, regulating the transcription of claudin-8 and claudin-4. Meanwhile, the upregulation of ssc-miR-185 was found to suppress claudin-8 expression via post-transcriptional inhibition. This study not only reveals the molecular mechanisms by which HP-PRRSV infection causes endothelial barrier leakage in acute lung injury, but also provides novel insights into the function and regulation of tight junctions in vascular homeostasis.

XPD stalled on cross-linked DNA provides insight into damage verification.

The superfamily 2 helicase XPD is a central component of the general transcription factor II H (TFIIH), which is essential for transcription and nucleotide excision DNA repair (NER). Within these two processes, the helicase function of XPD is vital for NER but not for transcription initiation, where XPD acts only as a scaffold for other factors. Using cryo-EM, we deciphered one of the most enigmatic steps in XPD helicase action: the active separation of double-stranded DNA (dsDNA) and its stalling upon approaching a DNA interstrand cross-link, a highly toxic form of DNA damage. The structure shows how dsDNA is separated and reveals a highly unusual involvement of the Arch domain in active dsDNA separation. Combined with mutagenesis and biochemical analyses, we identified distinct functional regions important for helicase activity. Surprisingly, those areas also affect core TFIIH translocase activity, revealing a yet unencountered function of XPD within the TFIIH scaffold. In summary, our data provide a universal basis for NER bubble formation, XPD damage verification and XPG incision.

Inter-organizational alignment and implementation outcomes in integrated mental healthcare for children and adolescents: a cross-sectional observational study.

Integrated care involves care provided by a team of professionals, often in non-traditional settings. A common example worldwide is integrated school-based mental health (SBMH), which involves externally employed clinicians providing care at schools. Integrated mental healthcare can improve the accessibility and efficiency of evidence-based practices (EBPs) for vulnerable populations suffering from fragmented traditional care. However, integration can complicate EBP implementation due to overlapping organizational contexts, diminishing the public health impact. Emerging literature suggests that EBP implementation may benefit from the similarities in the implementation context factors between the different organizations in integrated care, which we termed inter-organizational alignment (IOA). This study quantitatively explored whether and how IOA in general and implementation context factors are associated with implementation outcomes in integrated SBMH. SBMH clinicians from community-based organizations (CBOs; nclinician = 27) and their proximal student-support school staff (nschool = 99) rated their schools and CBOs (clinician only) regarding general (organizational culture and molar climate) and implementation context factors (Implementation Climate and Leadership), and nine common implementation outcomes (e.g., treatment integrity, service access, acceptability). The levels of IOA were estimated by intra-class correlations (ICCs). We fitted multilevel models to estimate the standalone effects of context factors from CBOs and schools on implementation outcomes. We also estimated the 2-way interaction effects between CBO and school context factors (i.e., between-setting interdependence) on implementation outcomes. The IOA in general context factors exceeded those of implementation context factors. The standalone effects of implementation context factors on most implementation outcomes were larger than those of general context factors. Similarly, implementation context factors between CBOs and schools showed larger 2-way interaction effects on implementation outcomes than general context factors. This study preliminarily supported the importance of IOA in context factors for integrated SBMH. The findings shed light on how IOA in implementation and general context factors may be differentially associated with implementation outcomes across a broad array of integrated mental healthcare settings.