Introduction: Research increasingly recommends school-based universal mental health screening as a first step in prevention and early intervention efforts that identify the broader mental health needs of youth. Concurrently, definitions of mental health have expanded to include dual-factor models which promote a focus on emotional/behavioral risk and social-emotional well-being as separate, yet related dimensions. Although the cross-sectional dual-factor mental health literature is growing, research examining longitudinal trends is limited despite its importance for informing recommendations for frequency of screening and prevention and intervention programming. Thus, this study explored stability patterns of dual-factor mental health across four high school years.
Method: All adolescents attending one high school in California during the 2013-2015 academic years were invited to complete a universal screening survey within the first month of each academic year. An accelerated longitudinal design resulting in a final sample of 875 adolescents (50.4% female, 53.5% Latinx) from two cohorts (Cohort A = Grades 9 to 11, Cohort B = Grades 10 to 12). First, latent profile analysis (LPA) models including four indicators of social emotional health and two indicators of emotional and behavioral risk were specified for each grade level. Then, latent transition analysis (LTA) was performed to examine patterns in the stability of dual-factor mental health from grades 9 to 12.
Results: Cross-sectional LPAs resulted in four profiles labeled: complete mental health (CMH), moderately mentally healthy (MMH), symptomatic but content (SBC), and troubled (TRB). The LTA model-building process supported a final model that controlled for a cohort covariate and included full measurement invariance, nonstationary transitions, and second-order effects. Transition probabilities supported greatest stability across one and two-year transitions for the CMH (.61 to .93) profile, with weaker estimates for the MMH (.34 to.70), SBC (.26 to .69), and TRB (.25 to .60) profiles. Four-year stability patterns indicated that most youth transitioned profiles at least once; 42.3% were in either the CMH or MMH profile and 10.6% were in either the SBC or TRB profile across all years.
Conclusions: These findings support regular monitoring of youths’ dual-factor mental health, for example through universal dual-factor mental health screening. Yearly, school-based screening for well-being and distress is critical for accurately informing prevention and intervention programming that addresses risk and fosters well-being.