The purpose of the present study was to analyze the structure and the psychometric properties of data gathered with the Mental Health Continuum-Short Form version for adolescents (30) in Iranian adolescences, its internal consistency and reliability, its invariance across gender, and plausibility of the two continua model proposing that mental health and illness are distinct yet related constructs. The Mental Health Continuum, or MHC, represents a clinical approach to the continuous assessment and categorical diagnosis of states of positive mental health (30,17). The short form of the MHC scale, consisting of 14 items, is one of the instruments to assess well-being most widely used internationally (21). For this reason, the main objective of this study was to validate the MHC–SF within an Iranian adolescences population. The current findings confirm that the MHC–SF is a valid and reliable instrument that can be used for assessing well-being within the Iranian adolescences.
The findings of our study confirm that the multidimensional structure of well-being (emotional, social and psychological). The three-factor model displayed acceptable goodness-of-fit indexes, and comparatively better than those of single-factor and two-factor models. These results are consistent with a growing number of studies that suggest that MHC-SF measures a predominant general well-being factor and three specific factors that correspond to the emotional, social, and psychological well-being subscales (27, 29, 33, 43-45).
The emotional and psychological subscales of MHC-SF in this population showed high internal consistency and reliability, as assessed with Cronbach’s alpha. Internal consistency and reliability coefficients of the social well-being subscale, although satisfactory, were low relative to the other subscales. Similar findings have been observed in previous studies (27,29,30,46). All Cronbach’s alphas were above those observed in South African and Dutch and Italian studies (29,30,46).
Confirmatory Factor Analysis (CFA) were computed to ascertain the factor structure of the MHC-SF. To examine whether these three factors tapped the same dimension, a second-order CFA was conducted. CFA has provided a fairly good level of support for the tripartite structure of the MHC-SF (29,47) 12. The only cross-cultural study on the factor structure of the MHC-SF is Joshanloo et al.’s (47) study using CFA, showing that the three-dimensional model of the MHC-SF fitted the data well in Iran, South Africa, and the Netherlands. The overall Iranian MHC-SF and the three sub-dimensions had a better internal consistency than did other studies. Additionally, our findings supported strong invariance of the three subscales of the MHC-SF by gender. These findings suggest that MHC-SF is measured similarly across males and females using the 3-factor model, allowing comparison across gender.
The convergent validity of the MHC-SF is good in the current study, suggesting that the MHC-SF is a valid instrument. The results of Pearson correlation coefficient for convergent and divergent validity indicated the relationship between MHC-SF-A subscales to evaluate the internal homogeneity of the test. Between anxiety and depression, depression covered a broader conceptualization of well-being. It means the well-being validation measure depression, for example, correlated strongest with total MHC-SF score, an assessment of overall well-being. According to Keyes’ conceptualization (16), MHC-SF-A is expected to be negatively related to anxiety and depression. Prior studies also have provided evidence of convergent validity of emotional, social, and psychological dimensions of mental well-being (18,46).
In addition to convergent validity, the present study also confirmed divergent and discriminant validity of the MHC–SF. The two-continua model holds that mental illness and mental health are related, but distinct, dimensions. The present study makes clear that measures of mental health are correlated with, but distinct from, measures of mental illness. This means that the absence of mental illness does not necessarily imply the presence of mental health, justifying the need for a measure to assess mental health.
In general, the MHC-SF is a useful, brief self-report questionnaire for assessment of positive mental health. As a result, the study contributes in filling the knowledge gap on the validation and usefulness of MHC-SF in national cultures world-wide to measure positive mental health.
There are a number of limitations to this study that need to be considered. Due to the large sample size, even weak correlations are statistically significant. To account for this, we applied an alpha of .001 instead of the common .05 as a margin of significance in the validation analyses. Because of the overly restrictive assumptions of the CFA approach and the resulting inflation of factor intercorrelations, the future studies are will be able to use Exploratory Structural Equation Modeling (ESEM) to represent the factor structure of multidimensional constructs such as mental well-being. In addition, future research should explore the validity of the Iranian MHC–SF, and the three classifications for positive mental health, for people in different categories.
The findings have important implications for mental health policy and care. Currently, mental health care focuses mainly on psychopathology in diagnostics as well as in treatment. However, with mental health and mental illness being two distinct indicators of mental health, it may be beneficial to focus also on promotion of positive mental health. It is hoped that this study will pave the way for more informed and comprehensive conceptualization and assessment of mental well-being in a variety of age groups.