Aarø Leif Edvard, Smith Otto Robert, Damsgaard Mogens Trab, Fismen Anne-Siri, Knapstad Marit, Lyyra Nelli, Samdal Oddrun, Thorsteinsson Einar Baldvin, Eriksson Charli
Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes Gt. 7, 5015, Bergen, Norway.
Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403, Oslo, Norway.
Health Qual Life Outcomes. 2025 Mar 12;23(1):23. doi: 10.1186/s12955-025-02351-5.
Mental wellbeing is an important focus in surveys among adolescents. Several relevant instruments are available. In the Nordic part of the Health Behaviour in School-aged Children (HBSC) study 2022, four different scales for the measurement of wellbeing, were employed: Cantril's Ladder, the WHO-5 Wellbeing Index, the seven-item Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS), and the HBSC Health Complaints Scale. This study aims to examine statistically to what extent these scales overlap or measure distinctly different aspects of mental wellbeing.
Data stem from the Nordic part of the HBSC 2022 study (n = 28 189). In all statistical analyses, data are weighted to ensure equal representation of genders, age groups (ages 11, 13, and 15 years), and countries (Denmark, Finland, Iceland, Norway, Sweden). Adjustments were made for cluster effects (school classes). The statistical analyses included factor analysis, general linear modeling, variants of latent variable analysis, and structural equation modeling including bifactor modeling.
Exploratory factor analysis produced three factors corresponding well to the three multi-item instruments, with the single item Cantril's ladder loading on the factor defined by the WHO-5 Wellbeing Index. Confirmatory factor analysis produced good fit for a model with one factor consisting of the three positively worded scales and a separate factor for health complaints, but with a high negative correlation between the two factors. Analyses of each of the four scales against gender, age, and 16 other covariates, showed strikingly similar patterns of associations. In an analysis based on a hierarchical model, adjustments for the general mental wellbeing (second-order) factor reduced associations between the first-order factors (one for each scale) and covariates substantially. Latent variable and bifactor modeling confirmed that most of the covariance among all items from all scales combined was captured by one general dimension. Information curve analysis showed that for all scales, the most reliable scores were obtained for participants with below average latent scores.
The study indicates that the four scales essentially reflect one underlying dimension. In studies such as HBSC, efforts should be made to use instruments that cover distinctly different aspects of mental health and wellbeing.
心理健康是青少年调查中的一个重要关注点。有几种相关工具可供使用。在2022年学龄儿童健康行为（HBSC）研究的北欧部分，采用了四种不同的幸福感测量量表：坎特里尔阶梯量表、世界卫生组织-5幸福感指数、七项简短的沃里克-爱丁堡心理健康量表（SWEMWBS）以及HBSC健康投诉量表。本研究旨在通过统计分析来检验这些量表在多大程度上重叠或测量了心理健康截然不同的方面。
数据来源于2022年HBSC研究的北欧部分（n = 28189）。在所有统计分析中，数据进行了加权处理，以确保性别、年龄组（11岁、13岁和15岁）以及国家（丹麦、芬兰、冰岛、挪威、瑞典）的均衡代表性。对聚类效应（班级）进行了调整。统计分析包括因子分析、一般线性模型、潜在变量分析的变体以及结构方程模型，包括双因子模型。
探索性因子分析产生了三个与三个多项目工具很好对应的因子，单项的坎特里尔阶梯量表加载在由世界卫生组织-5幸福感指数定义的因子上。验证性因子分析对一个模型产生了良好的拟合，该模型一个因子由三个正向表述的量表组成，另一个单独的因子用于健康投诉，但两个因子之间存在高度负相关。对四个量表分别针对性别、年龄和其他16个协变量进行的分析显示出惊人相似的关联模式。在基于层次模型的分析中，对一般心理健康（二阶）因子的调整大幅降低了一阶因子（每个量表一个）与协变量之间的关联。潜在变量和双因子模型证实，所有量表所有项目之间的大部分协方差由一个一般维度捕获。信息曲线分析表明，对于所有量表，潜在分数低于平均水平的参与者获得的分数最可靠。
该研究表明这四个量表本质上反映了一个潜在维度。在诸如HBSC这样的研究中，应努力使用涵盖心理健康和幸福感截然不同方面的工具。
