Measuring positive mental health and flourishing in Denmark: validation of the mental health continuum-short form (MHC-SF) and cross-cultural comparison across three countries

Abstract

Background The Mental Health Continuum–Short Form (MHC-SF) is a measure of positive mental health and flourishing, which is widely used in several countries but has not yet been validated in Denmark. This study aimed to examine its qualitative and quantitative properties in a Danish population sample and compare scores with Canada and the Netherlands. Methods Three thousand five hundred eight participants aged 16–95 filled out an electronic survey. Both the unidimensional and multidimensional aspects of the Danish MHC-SF were studied through bifactor modelling. Cognitive interviews examined face validity and usability. Results The general score of the Danish MHC-SF was reliable for computing unit-weighted composite scores, as well as using a bifactor model to compute general factor scores or measurement models in an SEM context. Nonetheless, subscale scores were unreliable, explaining very low variance beyond that explained by the general factor. The participants of the qualitative interviews observed problems with wording and content of the items, especially from the social subscale. The general score correlated with other scales as expected. We found substantial variation in flourishing prevalence rates between the three cultural settings. Conclusions The Danish MHC-SF produced reliable general scores of well-being. Most of the issues observed regarding the subscale scores have been shown in previous research in other contexts. The further analysis of indices of the bifactor model and the inclusion of qualitative interviews allowed for a better understanding of the possible sources of problems with the questionnaire’s subscales. The use of subscales, the substantive understanding of the general score, as well as the operationalization of the state of flourishing, require further study.

Psychometric evaluation of the mental health continuum – short form in Swedish adolescents

“…Taken together, our results on factor structure are well in line with the only other study, to our knowledge, that has been published thus far and included testing of the bifactor model in adolescents (Reinhardt et al, 2020). The results are also in line with recent psychometric evaluations in adults that compared other factor solutions to the bifactor model (de Bruin & du Plessis, 2015;Ferentinos et al, 2019;Hides et al, 2016;Longo et al, 2020;Luijten et al, 2019;Monteiro et al, 2020;Reinhardt et al, 2020;Rogoza et al, 2018;Santini et al, 2020). These studies and our study show that the bifactor has superior fit compared with previously tested models, including the correlated three-factor model first proposed by Keyes (C. L. Keyes, 2002, 2005Lamers et al, 2011).…”

“…More recently, some of these limitations were addressed by studies that tested additional methods and models (de Bruin & du Plessis, 2015;Echeverria et al, 2017;Ferentinos et al, 2019;Hides et al, 2016;Jovanovic, 2015;Longo et al, 2020;Luijten et al, 2019;Reinhardt et al, 2020;Santini et al, 2020;Żemojtel-Piotrowska et al, 2017). The bifactor model, for example, allows for evaluation of the relevance and reliability of subscale scores after controlling for the variance of the general factor (Reise, 2012).…”

“…Thus, if the contribution of a subscale, assumed to measure a specific latent construct, is small in relation to that of the general factor for the corresponding subscale items, then using the subscale as a measure of that specific latent factor can be questioned (Gignac & Watkins, 2013). Santini et al studied the Danish MHC-SF through the use of bifactor modelling and found that subscale scores were unreliable, explaining very low variance beyond that explained by the general factor (Santini et al, 2020). This finding is well in line with the study of Żemojtel-Piotrowska et al who also obtained similar results when they tested four different CFA models of MHC-SF, derived from theory and previous research.…”

“…Psychometric studies that compared the fit of the bifactor model with that of other proposed models have, in most cases, favoured the bifactor solution (de Bruin & du Plessis, 2015;Ferentinos et al, 2019;Hides et al, 2016;Longo et al, 2020;Luijten et al, 2019;Monteiro et al, 2020;Reinhardt et al, 2020;Rogoza et al, 2018;Santini et al, 2020), including studies using exploratory structural equation modelling techniques (Ferentinos et al, 2019;Longo et al, 2020;Reinhardt et al, 2020;Rogoza et al, 2018). However, only one study (Reinhardt et al, 2020) (to our knowledge) has tested the bifactor model on adolescents exclusively.…”

Assessing mental wellbeing using the Mental Health Continuum—Short Form: A systematic review and meta-analytic structural equation modelling.

“…or languishing (i.e., low wellbeing; Keyes, 2007). Several representative population studies have shown that only a minority of the population report flourishing despite high levels of population happiness (Hone et al,2014; Huppert & So, 2013; Santini et al, 2020; Schotanus-Dijkstra et al, 2016). Combining continuous scoring of the scale and subscales with a categorical classification approach is advantageous and often used in clinical practice (Morey & Hopwood, 2019), In combination with strong psychometric properties, the MHC-SF is an attractive tool for researchers and practitioners to assess wellbeing either in isolation or conjointly with the assessment of psychological distress.…”