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The dimensionality and latent structure of mental health difficulties and wellbeing in early adolescence.
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Research with adults and older adolescents suggests a general factor may underlie both mental health difficulties and wellbeing. However, the classical bifactor model commonly used to demonstrate this general trait has recently been criticised when a unidimensional structure is not supported. Furthermore, research is lacking in this area with children and early adolescents. We present confirmatory factor analysis models to explore the structure of psychopathology and wellbeing in early adolescents, using secondary data from a large U.K. sample (N = 1982). A simple correlated factors structure fitted the data well and revealed that wellbeing was just as related to internalising as this was to externalising symptoms. The classical bifactor solution also fitted the data well but was rejected as the general factor explained only 55% of the total common variance. S-1 models were therefore used to explore general covariance in a more robust way, and revealed that a general internalising distress factor could play an important role in all item responses. Gender and income differences in mental health were also explored through invariance testing and correlations. Our findings demonstrate the importance of considering mental health difficulties and wellbeing items together, and suggestions are made for how their correspondence could be controlled for.
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Youths tend to underutilize mental health services, fearing stigmatization and preferring autonomy, and only a fraction receives adequate treatment.
“Youths tend to underutilize services, fearing stigmatization and preferring autonomy,18,19,20,21 and only a fraction receives adequate treatment.22,23,24,25”
From Efficacy of Motivational Interviewing to Improve Utilization of Mental Health Services Among Youths With Chronic Medical Conditions: A Cluster Randomized Clinical Trial (2021) · cites this paper as [19]
The Introduction discusses adolescent mental health and criticism of diagnoses for their potential to stigmatize, but not stigma as a reason youths avoid services. Searches of our copy for service use, autonomy, and adequate treatment found no passage addressing those claims. (LLM, conf=0.77)
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“In light of the rising decline in psychological well-being and increasing levels of mental illness in young people [9,10], the efficacy and suitability of well-being interventions that are already available for those with mental health conditions should also be considered in young people who experience low psychologic…”
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“This is needed since some work has started to explore empirically the relationships between different domains (e.g., Black et al., 2019; Patalay & Fitzsimons, 2016), but findings in this area seem to be sensitive to measurement issues such as informant (Patalay & Fitzsimons, 2018) and…”
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“Nevertheless, despite this theoretical broad range, there is some evidence different aspects of mental health and well-being can be highly related statistically (Black et al., 2019; Disabato et al., 2016).”
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“Bifactor-(S − 1), on the other hand, has proved promising, and been applied to many psychological constructs, without the problems inherent to classical bifactor models (e.g., Black et al., 2019; Burns et al., 2020; Eid, 2020; Heinrich et al., 2018).”
BackgroundAhmad, J., Mamun, A. A., Reza, M. N. H., Makhbul, Z. K. M., & Ali, K. A. M. (2023) · Environmental Science and Pollution Research · doi:10.1007/s11356-023-28624-4 · Cited by 11
“Covariance-based (CB) SEM and PLS-SEM are the most popular methods used for data analysis (Black et al. 2019).”
MethodKhanna, D., Black, L., Panayiotou, M., Humphrey, N., & Demkowicz, O. (2024) · Child Indicators Research · doi:10.1007/s12187-024-10106-9 · Cited by 12
“For instance, Black et al. (2019) suggest the use of a bifactor S-1 model to test general covariances more robustly; an S-1 model is even more useful in the presence of vanishing factors (Panayiotou et al., 2020).”
A Community Mental Health and Wellbeing Literacy Study Among Australian Adults
Chng, J., Burns, R., Murray, K., & Crisp, D. (2022) · Journal of Happiness and Health · doi:10.47602/johah.v2i1.13 · Cited by 9
“, 2020; Ryff & Keyes, 1995) and its relationship with mental health (Black et al., 2019; Keyes, 2005; Massé et al., 1998; Winefield et al., 2012), the results from our second discrimination task clearly show that community members do not necessarily discriminate different components of wellbeing and mental health as s…”
BackgroundResultBischops, A., Sieper, L., Dukart, J., Schaal, N. K., Reinauer, C., Oommen, P. T., Tomoiagă, C. T., David, D., Mayatepek, E., & Meißner, T. (2024) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02395-w · Cited by 10
Mordeno, I. G., Gallemit, I. M. J. S., Bangcola, B. F. B., Busaco, J. J. J. L., Tuto, R. T., & Hall, B. J. (2022) · PsyCh Journal · doi:10.1002/pchj.578 · Cited by 9
Munialo, S., Onyango, C. M., Lukachi, J. A., Wasonga, O. V., Maina, J. G., Nzuma, J. M., Dawood, A., & Sibanda, L. M. (2023) · Frontiers in Sustainable Food Systems · doi:10.3389/fsufs.2023.1125094 · Cited by 9
The KIDSCREEN-27 scale: translation and validation study of the Slovenian version
Cilar, L., Pajnkihar, M., Ravens‐Sieberer, U., Barr, O. G., & Štiglic, G. (2022) · Health and Quality of Life Outcomes · doi:10.1186/s12955-022-01973-3 · Cited by 7
“Mental well-being compromises positive effects, evaluations of life, and absence of negative effects [6].”
BackgroundMendelian randomization analysis using multiple biomarkers of an underlying common exposure
Jin, J., Qi, G., Yu, Z., & Chatterjee, N. (2024) · Biostatistics · doi:10.1093/biostatistics/kxae006 · Cited by 6
Harris, J. L., Swanson, B., & Petersen, I. T. (2023) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-023-00464-1 · Cited by 11
“Studies that included additional factors (e.g. stress, personality, well-being, prosocial behavior) were excluded (e.g. Black et al., 2019), because the conceptual interpretation of general psychopathology would differ greatly as a function of the specific factors from which it was composed.”
Black, L., Farzinnia, R., Humphrey, N., & Marquez, J. (2023) · Psychological Medicine · doi:10.1017/s0033291723002362 · Cited by 4
“Louise Black et al. dependence (Black, Panayiotou, & Humphrey, 2019), further suggesting the inappropriateness of including both of each pair in a network analysis (Christensen, Garrido, & Golino, 2023).”
Gallemit, I. M. J. S., Mordeno, I. G., Simon, P. D., & Ferolino, M. A. L. (2024) · BMC Psychology · doi:10.1186/s40359-024-01941-0 · Cited by 5
“Thus, following the orthodox portrayal of mental health may not fully explain the psychological experiences of individuals [1].”
BackgroundBoyes, A., & Hermens, D. F. (2025) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2025.09.002 · Cited by 2
Núñez, D. E., Villacura-Herrera, C., Gaete, J., Meza, D., Andaur, J., Wigman, J. T. W., & Robinson, J. (2023) · Health and Quality of Life Outcomes · doi:10.1186/s12955-023-02163-5 · Cited by 1
“These characteristics could increase the capability to accurately capture slight variations in functioning levels in non-clinical settings [20], following recent literature encouraging both conceptualizing and measuring mental health beyond psychiatric symptoms [19, 23].”
InfluentialScalco, M. D., Kotelnikova, Y., Evans, M., Harshaw, C., Webre, N. M., Lengua, L. J., & Colder, C. R. (2025) · Development and Psychopathology · doi:10.1017/s095457942400107x · Cited by 1
Sliwka, A., Klopsch, B., & Batarilo-Henschen, K. (2022) · Springer eBooks · doi:10.1007/978-3-658-37473-0_12 · Cited by 1
Harris, J. L., Swanson, B., & Petersen, I. T. (2023) · doi:10.31234/osf.io/nbqx7 · Cited by 1
The KIDSCREEN-27 scale: translation and validation study of the Slovenian versionPreprint
Cilar, L., Pajnkihar, M., Ravens‐Sieberer, U., Barr, O. G., & Štiglic, G. (2022) · Research Square · doi:10.21203/rs.3.rs-1290683/v1
New Challenges and Future Perspectives in Nutrition and Sustainable Diets in Africa
(2024) · Frontiers research topics · doi:10.3389/978-2-8325-4883-7
Carvalho, M., Branquinho, C., Noronha, C., Rodrigues, N. N., Gaspar, T., & de Matos, M. G. (2025) · Children · doi:10.3390/children12091188
“The obtained profiles for each group were also in agreement with previous literature (e.g., [1,12,16,17,20,21,32]).”
Incorporating wellbeing into general factor models: A more complete mental state?
Chokhani, R., Lereya, S. T., & Deighton, J. (2025) · PLoS ONE · doi:10.1371/journal.pone.0335657
Daniel Núñez, G., Villacura-Herrera, C., Gaete, J., Meza, D., Andaur, J., Wigman, J. T. W., & Robinson, J. (2024) · Figshare · doi:10.6084/m9.figshare.26606293
Bravo, P., García, K., & Núñez, D. (2026) · BMC Psychology · doi:10.1186/s40359-026-04073-9
“Psycho-pathology has been identified as one of the common risk factors for suicide [2–5], mainly in adolescence, when the onset of psychiatric disorders usually occurs [6–8].”
Sun, C., Kwok, S. Y. C. L., & Huang, Y. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1752388
“Prior research on the bifactor or bifactor (S–1) model has primarily focused on samples from developed, Western countries, such as the United Kingdom (Black et al., 2019) and Australia (Hides et al., 2020).”
InfluentialAdolescent brain-age differences between profiles based on suicidal ideation, distress and wellbeingPreprint
Crethar, M., Han, L. K. M., Prince, T., Mills, L., Silk, T. J., Vijayakumar, N., Hermens, D. F., & Boyes, A. (2026) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.64898/2026.07.31.741956
Metadata
- Authors
- Black, L., Panayiotou, M., & Humphrey, N.
- Affiliations
- University of Manchester (GB)
- Corresponding author
- Black, Louise
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2019-02-26
- Volume
- 14
- Issue
- 2
- Pages
- e0213018
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6391027
- OpenAlex
- W2915358366
- Cited by
- 38
- References
- 93
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 7 · 2023: 11 · 2022: 7 · 2021: 4 · 2020: 2
- FWCI
- 3.83
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Big Lottery Fund (R118420)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- mental illness, well-being, early adolescence, bifactor model, general factor, internalizing problems, externalising symptoms, factor structure, gender differences, income gap, measurement invariance
- MeSH terms
- Child, Factor Analysis, Statistical, Female, Humans, Income, Male, Mental Health, Psychometrics, Surveys and Questionnaires, Chi-Square Distribution, Sex Distribution
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