Validation of the Mental Health Continuum-Short Form (MHC-SF) for Multidimensional Assessment of Subjective Well-Being in Spanish Adolescents.

BACKGROUND: The Mental Health Continuum-Short Form (MHC-SF) is a multidimensional instrument designed to capture emotional, psychological, and social well-being. It is one of the self-report measures of international use in clinical practice and research, although so far it has no validation in Spanish-Speaking adolescents. Therefore, the objective of this study was to analyze the reliability and validity evidence (structure, convergent and criterion), and the temporal and gender invariance of the MHC-SF in Spanish adolescent population. METHOD: Two assessment moments with a 6-month time interval were used, with an initial sample of 5,479 adolescents and a later sample of 2,129. RESULTS: The CFA showed optimal fit for the bi-factor model, and an adequate fit for correlated three-factor model. The results of the gender and temporal invariance analysis showed optimal fit. Reliability coefficients were all higher than .77. The MHC-SF presented significant positive associations (p < .001) with indicators of well-being (r > .60) and negative associations with indicators of psychological distress (r > -.21). CONCLUSIONS: The MHC-SF shows evidence of reliability and validity in Spanish adolescents, being the bi-factor model invariant through time and across gender groups.

Validation of the Mental Health Continuum-Short Form (MHC-SF)for Multidimensional Assessment of Subjective Well-Being in SpanishAdolescents / Validación de la Versión Abreviada del Mental Health Continuum (MHC-SF) para la Evaluación Multidimensional del Bienestar Subjetivo enAdolescentes Españoles

Background: The Mental Health Continuum-Short Form (MHC-SF) is amultidimensional instrument designed to capture emotional, psychological,and social well-being. It is one of the self-report measures of internationaluse in clinical practice and research, although so far it has no validationin Spanish-Speaking adolescents. Therefore, the objective of this studywas to analyze the reliability and validity evidence (structure, convergentand criterion), and the temporal and gender invariance of the MHC-SF inSpanish adolescent population. Method: Two assessment moments with a6-month time interval were used, with an initial sample of 5,479 adolescentsand a later sample of 2,129. Results: The CFA showed optimal fit for thebi-factor model, and an adequate fit for correlated three-factor model. Theresults of the gender and temporal invariance analysis showed optimal fit. Reliability coefficients were all higher than .77. The MHC-SF presented significant positive associations (p < .001) with indicators of well-being (r> .60) and negative associations with indicators of psychological distress(r > -.21). Conclusions: The MHC-SF shows evidence of reliability andvalidity in Spanish adolescents, being the bi-factor model invariant throughtime and across gender groups.

Antecedentes: el Continuo de Salud Mental-Versión Abreviada del Mental Health Continuum (MHC-SF) es uninstrumento multidimensional que evalúa el bienestar emocional, psicológicoy social. Es una de las medidas de autoinforme más utilizadas a nivelinternacional en clínica e investigación, aunque hasta el momento no dispone de validación en adolescentes hispanohablantes. El objetivo de este estudio fue analizar la fiabilidad y la evidencia de validez (estructural, convergente y de criterio), así como la invarianza temporal y de género del MHC-SF enpoblación adolescente española.Método: se utilizaron dos momentos deevaluación con un intervalo temporal de 6 meses, con una muestra inicial de5.479 adolescentes y una muestra posterior de 2.129. Resultados: los CFA mostraron un ajuste óptimo para el modelo bifactorial y adecuado para elmodelo de factores correlacionados. Los resultados del análisis de invarianza de género y temporal mostraron un buen ajuste. Se observaron coeficientesde consistencia interna superiores a .77. El MHC-SF presentó asociaciones positivas significativas (p < .001) con los indicadores de bienestar (r > .60) y negativas con los de malestar psicológico (r > -.21). Conclusiones: el MHC-SFmuestra evidencias de fiabilidad y validez en adolescentes españoles, siendoel modelo bifactorial invariante en el tiempo y entre grupos de género

Suboptimal baseline mental health associated with 4-month premature all-cause mortality: Findings from 18 years of follow-up of the Canadian National Population Health Survey.

OBJECTIVE: To investigate: 1) whether baseline non-flourishing mental health is associated with a higher probability of all-cause mortality over 18-year follow-up after controlling for many risk factors for premature mortality; and 2) what other factors, independent of mental health status, are associated with all-cause mortality after adjustment for known risk factors. METHODS: Data were derived from waves 1 and 9 (1994/1995; 2010/2011) of the Canadian National Population Health Survey. An analytic sample of 12,424 participants 18 years and above was selected. Baseline information on flourishing and predictors of all-cause mortality was from wave 1 and mortality data was ascertained by the Canadian Vital Statistics-Death Database in wave 9. Mean time to all-cause mortality was estimated using Kaplan-Meir procedure. Cox proportional hazards models were used to assess the association of baseline non-flourishing mental health and potential predictors with time to all-cause mortality. RESULTS: About one in five participants was classified as non-flourishing at baseline. At the end of the study period 2317 deaths were observed. Baseline non-flourishing mental health was associated with a 19% higher probability of all-cause mortality during 18-year follow-up (HR = 1.19; 95% CI 1.08-1.32), corresponding to a 4.7-month shorter survival time. After controlling for baseline chronic health conditions, past-year depression, sociodemographics, health behaviors, social support, pain and functioning, baseline non-flourishing mental health status was associated with a 14% higher probability of death (HR = 1.14; 95% CI 1.02-1.27). CONCLUSIONS: Suboptimal mental health is associated with premature mortality even after accounting for many risk factors for early death. Future research should explore the physiological pathways through which non-flourishing influences mortality.

Are changes in positive mental health associated with increased likelihood of depression over a two year period? A test of the mental health promotion and protection hypotheses.

This paper investigates the mental health promotion and protection (MHPP) model of reducing depression. Data are from the Clergy Health Initiative Longitudinal Survey of United Methodist ministers in North Carolina that included the Mental Health Continuum Short Form (MHC-SF) for positive mental health and the Patient Health Questionnaire (PHQ-9) for depression in 2014 and 2016 (N = 955). The promotion hypothesis predicts reduced risk of depression in 2016 among clergy whose mental health increased to flourishing and the increased risk of depression in 2016 for clergy who stayed not flourishing. The protection hypothesis predicts increased risk of depression in 2016 for clergy who were flourishing in 2014 but went down to 'not flourishing' in 2016. The reference group is clergy who stayed flourishing. We used modified Poisson regression models for binary outcomes to estimate Prevalence Ratios (PR) and to estimate Incidence Rate Ratios (IRR) of depression in 2016 associated with changes in mental health status. Results support both hypotheses. Compared to clergy who stayed flourishing, clergy who improved to flourishing were as likely, while clergy who stayed not flourishing were nearly seven times more likely, to have depression in 2016. Clergy who declined to not flourishing were six times more likely to have depression in 2016 compared to those who stayed flourishing. Similar patterns were observed when the sample was restricted to clergy without depression in 2014. These findings suggest focusing on MHPP as a complementary approach to treatment to reduce the incidence, prevalence and burden of depression.

Attitudes and behaviors that differentiate clergy with positive mental health from those with burnout.

Clergy provide significant support to their congregants, sometimes at a cost to their mental health. Identifying the factors that enable clergy to flourish in the face of such occupational stressors can inform prevention and intervention efforts to support their well-being. In particular, more research is needed on positive mental health and not only mental health problems. We conducted interviews with 52 clergy to understand the behaviors and attitudes associated with positive mental health in this population. Our consensual grounded theory analytic approach yielded five factors that appear to distinguish clergy with better versus worse mental health. They were: (1) being intentional about health; (2) a "participating in God's work" orientation to ministry; (3) boundary-setting; (4) lack of boundaries; and (5) ongoing stressors. These findings point to concrete steps that can be taken by clergy and those who care about them to promote their well-being.

The Portuguese Adaptation of the Mental Health Continuum-Short Form for Adult Population.

The Mental Health Continuum-Short Form (MHC-SF) is a self-report questionnaire that allows the assessment of positive mental health, including three well-being components-emotional, psychological and social-as well as the categorical diagnosis of the presence or absence of mental health. The purpose of this study is to describe the adaptation and validation of the Portuguese version of MHC-SF and to examine whether this is an adequate measure of positive mental health for the Portuguese context. The participants included 1448 respondents between the ages of 18 and 94 (M = 33.15; SD = 16.3), 70.1% of which were females. Results confirm the reliability (α = .93), tripartite factor structure, and the external and internal validity of the MHC-SF. Data also supported the two-continuum model, with positive mental health and mental illness belonging to two correlated but distinct dimensions. These findings indicated that the Portuguese MHC-SF is valid instrument to measure well-being and positive mental health.

Does Socio-structural Context Matter? A Multilevel Test of Sexual Minority Stigma and Depressive Symptoms in Four Asia-Pacific Countries.

In the Asia-Pacific region, individual sexual stigma contributes to elevated rates of depression among sexual minority men. Less well understood is the role of socio-structural sexual stigma despite evidence that social context influences the experience of stigma. We use data from the United Nations Multi-country Study on Men and Violence to conduct a multilevel test of associations between individual- and cluster unit-level indicators of sexual stigma and depressive symptoms among sexual minority men (n = 562). In the full model, individual-level sexual stigma is not associated with depressive symptoms, although there is significant variation in the association between individual stigma and depressive symptoms across clusters. Contrary to expectation, at the community level, homophobic injunctive norms are negatively associated with depressive symptoms. We discuss the implications for policies, programs, and future research to improve mental health among sexual minority men in the region.

Recovery from mood and anxiety disorders: The influence of positive mental health.

BACKGROUND: Mood and anxiety disorders are associated with growing burden of disease. Recent evidence shows that monitoring and enhancing positive mental health might be one direction to reduce this burden. The aim was to determine whether positive mental health predict recovery from mental disorders. METHODS: The study population consisted of 414 participants with a 12-month disorder from the representative general population Netherlands Mental Health Survey and Incidence Study-2. Independent positive mental health indicators were mental well-being, its subscales emotional, social and psychological well-being and the category flourishing mental health. Recovery was defined as no longer fulfilling DSM-IV criteria of the index disorder 3 years later. RESULTS: Despite meeting the criteria of a 12-month mental disorder, 19% with anxiety disorder were flourishing and 14% with mood disorder. Logistic regression analyses controlled for sociodemographics, physical health, life-events, service use, psychotropic medication, comorbidity and clinical severity showed that positive mental health positively influenced recovery from anxiety disorder (mainly by emotional and psychological well-being) and did not influence recovery from mood disorder. LIMITATIONS: The results are not generalizable to psychiatric patients in treatment settings and might differ for specific disorders within each DSM-IV category. CONCLUSIONS: Clinicians are encouraged to measure positive mental health in their patients and to improve positive mental health particularly in people with an anxiety disorder. The non-significant relation between positive mental health and recovery from mood disorder warrants further research, for example through using more in-depth assessment of positive mental health components and by investigating recovery from less severe mood disorders.

Positive mental health as a predictor of recovery from mental illness.

BACKGROUND: High levels of positive mental health protect individuals from mental illness. This study investigates longitudinal change in positive mental health as a predictor of mental illness recovery in a cohort group. METHODS: Using data from the 1995 and 2005 Midlife in the United States cross-sectional surveys (n = 1,723), logistic regression was used to estimate the odds ratio that individuals diagnosed with a mental illness in 1995 would have recovered in 2005 based on whether their level of positive mental health changed over the 10-year period. RESULTS: Individuals who maintained or gained the highest levels of positive mental health were more than 27.6 and 7.4 times, respectively, more likely to recover when compared to those who maintained the lowest level of positive mental health. Those who maintained or gained moderate levels of positive mental health had more moderate likelihood of recovery, and those whose positive mental health declined to the lowest levels had no significantly different likelihood of recovery compared to participants whose positive mental health remained low. LIMITATIONS: This study was limited by the age of the data, and the inability to control for some predictors of recovery. CONCLUSIONS: This study suggests that positive mental health may be an important resource for individuals to recover from mental illness and stay mentally healthy. Results point to the need to include positive mental health assessment and interventions into mental health care systems.

Investigating the Goldilocks Hypothesis: The Non-Linear Impact of Positive Trait Change on Well-Being.

This paper attempts to reconcile two perspectives on the impact of positive trait change. The first perspective views positive trait change as salubrious because it reflects the process of self-enhancement, whereas the second perspective views positive change as costly because it disrupts the self-verification process. We propose that benefits and costs accrue at discrete rates, such that moderate positive trait change is more beneficial than too little and too much positive change. This constitutes a Goldilocks hypothesis. Using the MIDUS longitudinal dataset (N = 1,725) we test this hypothesis on four traits, namely, social extraversion, agentic extraversion (agency), conscientiousness, and neuroticism. The Goldilocks hypothesis was supported for social extraversion, agentic extraversion (agency), and conscientiousness. Reduction in neuroticism seemed uniformly predictive of higher well-being. Thus, not all amounts of positive trait change are beneficial. While we find no evidence for a limit to the benefits of reduced neuroticism, there is a "just right" amount of positive change in extraversion and conscientiousness that results in the highest level of well-being. Our findings suggest that non-monotonic models may be more valid in investigations of personality change and well-being.

A multidimensional perspective of the mental health of preclinical medical students.

Previous research on medical students' mental health has focused almost exclusively on students' emotional well-being and/or their personal psychological functioning, neglecting the more public side of medical training - the students' social health. A total of 237 preclinical students completed surveys at the beginning and the end of their academic year assessing their emotional, psychological, and social well-being, respectively, as well as the overall negative impact medical school stressors had on their lives. Although first and second year students were found to significantly decrease in emotional well-being, first year students were found to increase in social well-being, with further analysis showing an increase among first year students specifically in the feelings of social integration and social acceptance. The overall negative impact from the stressors was found to predict the change in emotional well-being, but not other dimensions of well-being. However, the negative impact from stressors was also found to indirectly impact students' emotional well-being through negatively affecting their psychological and social well-being. The authors present the value in measuring medical students' well-being from a multidimensional perspective as well as highlight the potential "condensing" of students' social world as early as their first year of training. Recommendations are made that researchers continue to focus on the promotion and protection of students' positive mental health in the preliminary stages of medical education, as well as endorse programs that cultivate the benefits of solidarity and integration experienced by first year students.

To flourish or not: positive mental health and all-cause mortality.

OBJECTIVES: We investigated whether positive mental health predicts all-cause mortality. METHODS: Data were from the Midlife in the United States (MIDUS) study (n = 3032), which at baseline in 1995 measured positive mental health (flourishing and not) and past-year mental illness (major depressive episode, panic attacks, and generalized anxiety disorders), and linked respondents with National Death Index records in a 10-year follow-up ending in 2005. Covariates were age, gender, race, education, any past-year mental illness, smoking, physical inactivity, physical diseases, and physical disease risk factors. RESULTS: A total of 6.3% of participants died during the study period. The final and fully adjusted odds ratio of mortality was 1.62 (95% confidence interval [CI] = 1.00, 2.62; P = .05) for adults who were not flourishing, relative to participants with flourishing mental health. Age, gender, race, education, smoking, physical inactivity, cardiovascular disease, and HIV/AIDS were significant predictors of death during the study period. CONCLUSIONS: The absence of positive mental health increased the probability of all-cause mortality for men and women at all ages after adjustment for known causes of death.

The relationship of level of positive mental health with current mental disorders in predicting suicidal behavior and academic impairment in college students.

OBJECTIVE: To investigate whether level of positive mental health complements mental illness in predicting students at risk for suicidal behavior and impaired academic performance. PARTICIPANTS: A sample of 5,689 college students participated in the 2007 Healthy Minds Study and completed an Internet survey that included the Mental Health Continuum-Short Form and the Patient Health Questionnaire screening scales for depression and anxiety disorders, questions about suicide ideation, plans, and attempts, and academic impairment. RESULTS: Just under half (49.3%) of students were flourishing and did not screen positive for a mental disorder. Among students who did, and those who did not, screen for a mental disorder, suicidal behavior and impaired academic performance were lowest in those with flourishing, higher among those with moderate, and highest in those with languishing mental health. CONCLUSIONS: Positive mental health complements mental disorder screening in mental health surveillance and prediction of suicidal behavior and impairment of academic performance.

Chronological and subjective age differences in flourishing mental health and major depressive episode.

Mental health is more than the absence of psychopathology, but few studies use positive mental health along with a measure of past year major depressive episode (MDE). This study addresses this gap by investigating the association of MDE and flourishing mental health (FMH) with chronological age and subjective (felt and ideal) age. Data are from the Midlife in the United States random digit dialing sample of adults ages 25 to 74, collected in 1995 (n = 3032). Rates of MDE were lowest, and FMH highest, among the three oldest age cohorts (45-54, 55-64, 65-74 years). Subjective age was linked with chronological age; with age, adults tend to feel younger, and want to be an age that is younger, than their actual age. As predicted by the model of subjective age as an adaptive strategy, feeling younger was related to a lower risk of MDE and a higher risk of FMH. However, wanting to be younger was related to a lower risk of FMH and unrelated to MDE.

The relationship between the genetic and environmental influences on common internalizing psychiatric disorders and mental well-being.

To determine the relationship between the genetic and environmental risk factors for common internalizing psychopathology (IP) and mental well-being (MWB), we examined detailed measures of emotional, social and psychological well-being, and a history of major depression (MD), generalized anxiety disorder (GAD) and panic attacks in the last year, in 1,386 twins from same-sex pairs from the MIDUS national USA sample assessed in 1995 and then again in 2005. Statistical analyses were performed with the Mx program. In the 1995 data, the best fit model contained one substantially heritable common factor for MD, GAD and panic attacks, and one strongly heritable common factor for the three well-being measures. Genetic and environmental risk factors for IP accounted for, respectively, 50 and 5%, of the genetic and environmental influences on MWB. We then constructed, using 1995 and 2005 data, two common factors that reflected temporally stable influences on (i) MD and GAD, and (ii) on emotional and psychological well-being. Genetic and environmental risk factors for the stable liability to IP accounted for 41 and 29% of the stable genetic and environmental influences, respectively, on MWB. This study suggests that genetic risk factors for IP make up 41-50% of the genetic influences on MWB. The overlap of environmental risk factors is more modest. Although low levels of IP on average reflect a high genetic propensity for MWB, other independent genetic influences play an important role in producing good mental health.

Evaluating the psychometric properties of the Mental Health Continuum-Short Form (MHC-SF).

There is a growing consensus that mental health is not merely the absence of mental illness, but it also includes the presence of positive feelings (emotional well-being) and positive functioning in individual life (psychological well-being) and community life (social well-being). We examined the structure, reliability, convergent validity, and discriminant validity of the Mental Health Continuum-Short Form (MHC-SF), a new self-report questionnaire for positive mental health assessment. We expected that the MHC-SF is reliable and valid, and that mental health and mental illness are 2 related but distinct continua. This article draws on data of the LISS panel of CentERdata, a representative panel for Longitudinal Internet Studies for the Social Sciences (N = 1,662). Results revealed high internal and moderate test-retest reliability. Confirmatory factor analysis (CFA) confirmed the 3-factor structure in emotional, psychological, and social well-being. These subscales correlated well with corresponding aspects of well-being and functioning, showing convergent validity. CFA supported the hypothesis of 2 separate yet related factors for mental health and mental illness, showing discriminant validity. Although related to mental illness, positive mental health is a distinct indicator of mental well-being that is reliably assessed with the MHC-SF.

The relationship between the genetic and environmental influences on common externalizing psychopathology and mental wellbeing.

To determine the relationship between the genetic and environmental risk factors for externalizing psychopathology and mental wellbeing, we examined detailed measures of emotional, social and psychological wellbeing, and a history of alcohol-related problems and smoking behavior in the last year in 1,386 individual twins from same-sex pairs from the MIDUS national US sample assessed in 1995. Cholesky decomposition analyses were performed withthe Mx program. The best fit model contained one highly heritable common externalizing psychopathology factor for both substance use/abuse measures, and one strongly heritable common factor for the three wellbeing measures. Genetic and environmental risk factors for externalizing psychopathology were both negatively associated with levels of mental wellbeing and accounted for, respectively, 7% and 21% of its genetic and environmental influences. Adding internalizing psychopathology assessed in the last year to the model, genetic risk factors unique for externalizing psychopathology were now positively related to levels of mental wellbeing, although accounting for only 5% of the genetic variance. Environmental risk factors unique to externalizing psychopathology continued to be negatively associated with mental wellbeing, accounting for 26% of the environmental variance. When both internalizing psychopathology and externalizing psychopathology are associated with mental wellbeing, the strongest risk factors for low mental wellbeing are genetic factors that impact on both internalizing psychopathology and externalizing psychopathology, and environmental factors unique to externalizing psychopathology. In this model, genetic risk factors for externalizing psychopathology predict, albeit weakly, higher levels of mental wellbeing.

The structure of the genetic and environmental influences on mental well-being.

OBJECTIVES: We sought to investigate the structure of the genetic and environmental influences on 3 measures of mental well-being. METHODS: Analyses focused on the subsample of 349 monozygotic and 321 dizygotic same-sex twin pairs from a nationally representative sample of twins who completed self-report measures of emotional, psychological, and social well-being. RESULTS: The best-fit model contained a common pathway to all 3 measures of well-being, no shared environmental effects, and 1 set of parameters for men and women. Heritability for the latent "mental well-being" factor was high (72%) and best indexed by psychological well-being. Moderate trait-specific genetic effects were seen for emotional and social well-being. Nonshared environmental effects for all measures were mostly trait specific. CONCLUSIONS: Genetic influences on the measures of mental well-being reflect a single, highly heritable genetic factor, although some trait-specific genetic influences were seen for emotional and social well-being. Moderate proportions of environmental influences were also shared, but the majority of unique environment was trait-specific.