Positive Mental Wellbeing in Adolescents 1 Positive mental wellbeing in Australian adolescents: Evaluating the Warwick-Edinburgh Mental Wellbeing Scale

While there is increasing recognition of the need to go beyond measures of mental ill health, there is a relative dearth of validated tools for assessing mental wellbeing among adolescents. The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) is a promising tool for use in this context, and this study evaluated its use in an Australian context. The WEBWBS was completed by 829 Western Australian adolescents, aged 13 to 16 years old, drawn from grades 8, 9 and 10 in seven separate high schools. Using confirmatory factor analytic techniques, the utility of the full 14item scale was not supported but good fit for a previously validated seven-item short version (SWEMWBS) was supported. Strong measurement invariance was demonstrated across age and weak measurement invariance was demonstrated across gender. The scale has good internal reliability. There were no differences in SWEMWBS scores across Grades 8 to 10. Overall, the SWEMWBS represents a useful tool for educational, developmental, and school psychologists investigating positive mental wellbeing in younger adolescents. Positive Mental Wellbeing in Adolescents 3 Adolescence is a critical developmental period for mental health, with symptoms of lifelong mental illness typically developing prior to age 25 years (Call, Riedel, Hein, McLoyd, Peterson, & Kipke, 2002). Current reported rates of mental health problems among adolescents are high, with prevalence estimates reported to be 40.3% over 12 months and 23.4% over the past 30 days (Kesslet, Avenevoli, Costello, Georgiades, Green, Gruber et al., 2012). Almost 20% of young people reporting mental health problems report three or more problems (Heneghan, Stein, Hurlburt, Zhang, Rolls-Reutz, Fisher, Landsverk, & Horowitz, 2013). Such problems are more prevalent in rural areas as a result of psychosocial, behavioural and demographic variables which differ from those in urban areas (see Australian Bureau of Statistics, 2012). The Australian landscape makes such issues especially salient for professionals working in the country. The imposing burden on society in terms of the individual, families and the health, justice and welfare systems as a consequence of mental health problems that arise in childhood and adolescence are well documented (Heckman, 2012), making adolescence a critical time for developing positive mental wellbeing. Undeniably, positive mental wellbeing has emerged as an important protective factor against mental health issues (Gargiulo & Stokes, 2009) and a range of other health outcomes (Australian Bureau of Statistics, 2008). Consequently, because of its major implications for health and social outcomes and psychological functioning (Linley & Joseph, 2004; Stewart-Brown, Tennant, Tennant, Platt, Parkinson, & Weich, 2009), and for its contribution to public health and policy issues (Dolan, Laylard, & Metcalf, 2011), positive mental wellbeing has received attention worldwide. In many countries, promoting positive mental wellbeing among teenagers has become a national priority (Clarke, Friede, Putz, Ashdown, Martin, Blake et al., 2011), particularly as a preventive and population based complement to the treatment of psychopathology (Jacka, Reavley, Jorm, Toumboiurou, Lewis, Berk et al., 2013; Perry, Presley-Cantrell, & Dhingra, 2010). Considered by many to be a complex construct, positive mental wellbeing covers both hedonic (i.e., happiness, subjective wellbeing) and eudemonic (i.e., positive functioning) aspects of Positive Mental Wellbeing in Adolescents 4 wellbeing (Clarke et al., 2011; Ryan & Deci, 2001; Tennant, Hiller, Fishwick, Platt, Joseph, Weich et al., 2007), both of which together comprise the broad concept of mental wellbeing (Clarke et al., 2011). It has also been argued that it takes a combination of these for one to be considered mentally healthy (Keyes, 2007). However, regardless of the increased interest in positive mental wellbeing, there is a dearth of appropriate measures (Hu, Stewart-Brown, Twigg, & Weich, 2007), particularly for adolescents. Consequently, surveys and intervention evaluations have relied on measures of mental illness (e.g., prevalence of depression or anxiety) as their ‘marker’ of mental wellbeing (Hu et al., 2007), even though mental wellbeing is conceptualised as more than the absence of mental illness (Clarke et al., 2011). One instrument that has shown promise and may be particularly useful for school, educational, and developmental psychologists is the 14-item Warwick-Edinburgh Mental Well Being Scale (WEMWBS: Stewart-Brown et al., 2011; Tennant et al., 2007). This covers both hedonic elements of positive mental wellbeing (9 items covering happiness, joy, contentment: e.g., “I’ve been feeling cheerful”, “I’ve been feeling optimistic about the future”, “I’ve been feeling relaxed”) and eudemonic elements of positive mental wellbeing (5 items covering psychological functioning, autonomy, positive relationships with others, sense of purpose in life: e.g., “I’ve had energy to spare”, “I’ve been thinking clearly”, “I’ve been able to make up my own mind about things”). For a description of its development see Tennant et al. (2007a; 2007b). However, the data supporting its use come almost exclusively from adults: Cronbach alphas of α = 0.87 0.93 and significant correlations with other scales measuring components of affect or wellbeing (Clarke et al., 2011; Lloyd & Devine, 2012; Tennant et al., 2007a) including using the shorted 7 item version (Vaingankar, Subramaniam, Chong, Abdin, Edelen, Picco et al., 2011); significant age and gender effects (Tennant et al., 2007a); and test-retest reliability 0.66 0.83 (Clarke et al., 2011; Tennant et al., 2007a). Two studies employing the Rasch model (Rasch, 1960, 1980) have also found support for the unidimensionality of the WEMWBS, but in the form of a shortened 7-item version (Bartram, Sinclair, & Baldwin, 2012; Stewart-Brown et al., 2009). Finally, Maheswaran, Weich, Powell, and Positive Mental Wellbeing in Adolescents 5 Stewart-Brown (2012) report that the WEMWBS is sensitive to a range of interventions across a number of different populations. Thus, items in the WEMWBS appear suitable for measuring the latent trait of positive mental wellbeing in adults. To date, however, the administration of the WEMWBS with adolescents has been scarce, with it seems only one study conducted. Employing Confirmatory Factor Analysis (CFA) with data from 1650, 13 to 16 year olds, Clarke et al. (2011) reported excellent fit statistics (GFI = 1.000, RMSEA = 0.003). Although there was strong support for a single underlying construct for the 14-item WEMWBS, follow up single sex focus group interviews with 80 of the adolescent participants identified issues pertaining to: definition and understanding of items, potential for misinterpretation of items, items possibly causing embarrassment, and variable interpretation where items referred to a more holistic reflective approach to oneself. Although some of the participants thought there “might be some redundancy which could be removed through amalgamation of items” (Clarke et al., 2011, p. 7), the authors provided no indication of which items the participants were referring to. The promotion of mental wellbeing in adolescents is a high priority globally, but is hindered by the dominance of measures of mental illness and poor psychological wellbeing. While the WEMWBS with its orientation towards protective factors for mental wellbeing (Stewart-Browne 2011) is a promising exception, there is a need to trial it in different populations (Vainganker et al., 2011) and to test its validity in other countries where concepts of mental wellbeing may be unique and culturally specific (Tennant et al., 2007a).