Psychometric Assessment of the Mental Health Continuum-Short Form in Athletes: A Bifactor Modeling Approach

in Journal of Clinical Sport Psychology
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  • 1 Sport and Exercise Sciences Research Institute, Ulster University, Newtownabbey, Northern Ireland
  • | 2 Bamford Centre for Mental Health and Well-Being, Ulster University, Derry, Northern Ireland
  • | 3 School of Psychology, Ulster University, Coleraine, Northern Ireland
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Aim: A recent mental health in sport consensus statement advocates Keyes’ two continua model with an associated Mental Health Continuum (MHC) instrument to assess mental health in athletes. However, there remains statistically inconsistent usage of the MHC in athletes, so further exploration of the MHC’s psychometric factors is required. Methods: Athletes (N = 1,097) aged 32.63 (SD = 11.16) comprising 603 females (55.7%) and 478 males (44.3%), completed the 14-item MHC-Short Form, alongside validated measures of anxiety and depression. Five confirmatory factor analytic and bifactor models were developed based on extant research and theory. Results: Overall, a bifactor structure with a “general” positive mental health factor, and three specific factors (“hedonic well-being,” “social well-being,” and “psychological well-being”) fitted the data well and was deemed the superior model. Conclusion: A bifactor model of the MHC-Short Form is recommended comprising a composite score alongside specific factors of hedonic, social, and psychological well-being.

  • Bentler, P.M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107(2), 238. https://doi.org/10.1037/0033-2909.107.2.238

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Breslin, G., & Leavey, G. (Eds.). (2019). Mental health and well-being interventions in sport: Research, theory and practice. Routledge.

  • Breslin, G., Shannon, S., Ferguson, K., Devlin, S., Haughey, T., & Prentice, G. (2019). Predicting athlete mental health stigma using the theory of reasoned action framework. Journal of Clinical Sport Psychology, 13(1), 103115. https://doi.org/10.1123/jcsp.2017-0055

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Breslin, G., Shannon, S., Haughey, T., Donnelly, P., & Leavey, G. (2017). A systematic review of interventions to increase awareness of mental health and well-being in athletes, coaches and officials. Systematic Reviews, 6(1), 115. https://doi.org/10.1186/s13643-017-0568-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Byrne, B.M. (2001). Structural equation modeling with AMOS, EQS, and LISREL: Comparative approaches to testing for the factorial validity of a measuring instrument. International Journal of Testing, 1(1), 5586. https://doi.org/10.1207/S15327574IJT0101_4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Carpenter, N.C., Son, J., Harris, T.B., Alexander, A.L., & Horner, M.T. (2016). Don’t forget the items: Item-level meta-analytic and substantive validity techniques for reexamining scale validation. Organizational Research Methods, 19(4), 616650. https://doi.org/10.1177/1094428116639132

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Comrey, A.L., & Lee, H.B. (1992). Interpretation and application of factor analytic results. In A.L. Comrey & H.B. Lee (Eds.), A first course in factor analysis (p. 2). Lawrence Eribaum Associates.

    • Search Google Scholar
    • Export Citation
  • De Bruin, G.P., & Du Plessis, G.A. (2015). Bifactor analysis of the Mental Health Continuum-Short Form (MHC-SF). Psychological Reports, 116(2), 438446. https://doi.org/10.2466/03.02.PR0.116k20w6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Deci, E.L., & Ryan, R.M. (2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11(4), 227268. https://doi.org/10.1207/S15327965PLI1104_01

    • Crossref
    • Search Google Scholar
    • Export Citation
  • de Holanda Coelho, G.L., Hanel, P.H., Medeiros Cavalcanti, T., Teixeira Rezende, A., & Veloso Gouveia, V. (2016). Brief resilience scale: Testing its factorial structure and invariance in Brazil. Universitas Psychologica, 15(2), 397408. https://doi.org/10.11144/Javeriana.upsy15-2.brst

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Diener, E., & Emmons, R.A. (1984). The independence of positive and negative affect. Journal of Personality and Social Psychology, 47(5), 1105. https://doi.org/10.1037/0022-3514.47.5.1105

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Donker, T., van Straten, A., Marks, I., & Cuijpers, P. (2011). Quick and easy self-rating of generalized anxiety disorder: Validity of the Dutch web-based GAD-7, GAD-2 and GAD-SI. Psychiatry Research, 188(1), 5864. https://doi.org/10.1016/j.psychres.2011.01.016

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Dueber, D.M. (2017). Bifactor indices calculator: A Microsoft Excel-based tool to calculate various indices relevant to bifactor CFA models. https://uknowledge.uky.edu/edp_tools/1/

    • Search Google Scholar
    • Export Citation
  • Ferentinos, P., Yotsidi, V., Porichi, E., Douzenis, A., Papageorgiou, C., & Stalikas, A. (2019). Well-being in patients with affective disorders compared to nonclinical participants: A multi-model evaluation of the Mental Health Continuum-Short Form. Journal of Clinical Psychology, 75(9), 15851612. https://doi.org/10.1002/jclp.22780

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Field, A. (2013). Discovering statistics using IBM SPSS statistics. Sage.

  • Foster, B.J., & Chow, G.M. (2019). Development of the Sport Mental Health Continuum—Short Form (Sport MHC-SF). Journal of Clinical Sport Psychology, 13(4), 593608. https://doi.org/10.1123/jcsp.2017-0057

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Fried, E.I. (2017). What are psychological constructs? On the nature and statistical modelling of emotions, intelligence, personality traits and mental disorders. Health Psychology Review, 11(2), 130134. https://doi.org/10.1080/17437199.2017.1306718

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gerbing, D.W., & Anderson, J.C. (1984). On the meaning of within-factor correlated measurement errors. Journal of Consumer Research, 11(1), 572580. https://doi.org/10.1086/208993

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Giles, S., Fletcher, D., Arnold, R., Ashfield, A., & Harrison, J. (2020). Measuring well-being in sport performers: Where are we now and how do we progress? Sports Medicine, 50(7), 12551270. https://doi.org/10.1007/s40279-020-01274-z

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gouttebarge, V., Bindra, A., Blauwet, C., Campriani, N., Currie, A., Engebretsen, L., & Budgett, R. (2021). International Olympic Committee (IOC) Sport Mental Health Assessment Tool 1 (SMHAT-1) and Sport Mental Health Recognition Tool 1 (SMHRT-1): Towards better support of athletes’ mental health. British Journal of Sports Medicine, 55(1), 3037. https://doi.org/10.1136/bjsports-2020-102411

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hagger, M.S., & Chatzisarantis, N.L. (2009). Assumptions in research in sport and exercise psychology. Psychology of Sport and Exercise, 10(5), 511519. https://doi.org/10.1016/j.psychsport.2009.01.004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Henriksen, K., Schinke, R., Moesch, K., McCann, S., Parham, W.D., Larsen, C.H., & Terry, P. (2020). Consensus statement on improving the mental health of high performance athletes. International Journal of Sport and Exercise Psychology, 18(5), 553560. https://doi.org/10.1080/1612197X.2019.1570473

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hermida, R. (2015). The problem of allowing correlated errors in structural equation modeling: Concerns and considerations. Computational Methods in Social Sciences, 3(1), 517.

    • Search Google Scholar
    • Export Citation
  • Hides, L., Quinn, C., Stoyanov, S., Cockshaw, W., Mitchell, T., & Kavanagh, D.J. (2016). Is the mental wellbeing of young Australians best represented by a single, multidimensional or bifactor model? Psychiatry Research, 241, 17. https://doi.org/10.1016/j.psychres.2016.04.077

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hu, L.T., & Bentler, P.M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 155. https://doi.org/10.1080/10705519909540118

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hughes, L., & Leavey, G. (2012). Setting the bar: Athletes and vulnerability to mental illness. British Journal of Psychiatry, 200(2), 9596. https://doi.org/10.1192/bjp.bp.111.095976

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Huppert, F.A. (2009). Psychological well-being: Evidence regarding its causes and consequences. Applied Psychology: Health and Well-Being, 1(2), 137164.

    • Search Google Scholar
    • Export Citation
  • Jackson, D.L. (2003). Revisiting sample size and number of parameter estimates: Some support for the N:q hypothesis. Structural Equation Modeling, 10(1), 128141. https://doi.org/10.1207/S15328007SEM1001_6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Jackson, D.L., Gillaspy, J.A., Jr., & Purc-Stephenson, R. (2009). Reporting practices in confirmatory factor analysis: An overview and some recommendations. Psychological Methods, 14(1), 6. https://doi.org/10.1037/a0014694

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Jones, P.B. (2013). Adult mental health disorders and their age at onset. The British Journal of Psychiatry, 202(Suppl. 54), S5S10. https://doi.org/10.1192/bjp.bp.112.119164

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Joshanloo, M., & Jovanović, V. (2017). The factor structure of the Mental Health Continuum-Short Form (MHC-SF) in Serbia: An evaluation using exploratory structural equation modeling. Journal of Mental Health, 26(6), 510515. https://doi.org/10.1080/09638237.2016.1222058

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Jovanović, V. (2015). Structural validity of the Mental Health Continuum-Short Form: The bifactor model of emotional, social and psychological well-being. Personality and Individual Differences, 75, 154159. https://doi.org/10.1016/j.paid.2014.11.026

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Keyes, C.L. (2002). The mental health continuum: From languishing to flourishing in life. Journal of Health and Social Behavior, 43(2), 207222. https://doi.org/10.2307/3090197

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Keyes, C.L. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73(3), 539. https://doi.org/10.1037/0022-006X.73.3.539

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • Keyes, C.L., Wissing, M., Potgieter, J.P., Temane, M., Kruger, A., & Van Rooy, S. (2008). Evaluation of the mental health continuum–short form (MHC–SF) in Setswana-speaking South Africans. Clinical Psychology & Psychotherapy, 15(3), 181192. https://doi.org/10.1002/cpp.572

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kroenke, K., Strine, T.W., Spitzer, R.L., Williams, J.B., Berry, J.T., & Mokdad, A.H. (2009). The PHQ-8 as a measure of current depression in the general population. Journal of Affective Disorders, 114(1–3), 163173. https://doi.org/10.1016/j.jad.2008.06.026

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lamers, S.M., Westerhof, G.J., Bohlmeijer, E.T., ten Klooster, P.M., & Keyes, C.L. (2011). Evaluating the psychometric properties of the Mental Health Continuum-Short Form (MHC-SF). Journal of Clinical Psychology, 67(1), 99110. https://doi.org/10.1002/jclp.20741

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Longo, Y., Jovanović, V., Sampaio de Carvalho, J., & Karaś, D. (2020). The general factor of well-being: Multinational evidence using bifactor ESEM on the Mental Health Continuum–Short Form. Assessment, 27(3), 596606. https://doi.org/10.1177/1073191117748394

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lonsdale, C., Hodge, K., & Rose, E.A. (2006). Pixels vs. paper: Comparing online and traditional survey methods in sport psychology. Journal of Sport and Exercise Psychology, 28(1), 100108. https://doi.org/10.1123/jsep.28.1.100

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Löwe, B., Decker, O., Müller, S., Brähler, E., Schellberg, D., Herzog, W., & Herzberg, P.Y. (2008). Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical Care, 46(3), 266274. https://doi.org/10.1097/MLR.0b013e318160d093

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lundqvist, C., & Sandin, F. (2014). Well-being in elite sport: Dimensions of hedonic and eudaimonic well-being among elite orienteers. The Sport Psychologist, 28(3), 245254. https://doi.org/10.1123/tsp.2013-0024

    • Crossref
    • Search Google Scholar
    • Export Citation
  • McGivern, A., Shannon, S., & Breslin, G. (2021). Resilience, well-being, depression symptoms and concussion levels in equestrian athletes. Journal of Public Mental Health, 20(3), 172181. https://doi.org/10.1108/JPMH-08-2020-0110

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mistry, A.D., McCabe, T., & Currie, A. (Eds.). (2020). Case studies in sports psychiatry. Cambridge University Press.

  • National Collegiate Athletic Association. (2019). National Collegiate Athletic Association’s estimated probability of competing in college athletics.https://collegiatewaterpolo.org/national-collegiate-athletic-associations-estimated-probability-of-competing-in-college-athletics/

  • Park, J.M., Han, A.K., & Cho, Y.H. (2011). Construct equivalence and latent means analysis of health behaviors between male and female middle school students. Asian Nursing Research, 5(4), 216221. https://doi.org/10.1016/j.anr.2011.12.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Razykov, I., Ziegelstein, R.C., Whooley, M.A., & Thombs, B.D. (2012). The PHQ-9 versus the PHQ-8—Is item 9 useful for assessing suicide risk in coronary artery disease patients? Data from the heart and soul study. Journal of Psychosomatic Research, 73(3), 163168. https://doi.org/10.1016/j.jpsychores.2012.06.001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reardon, C.L., Hainline, B., Aron, C.M., Baron, D., Baum, A.L., Bindra, A., & Engebretsen, L. (2019). Mental health in elite athletes: International Olympic Committee consensus statement (2019). British Journal of Sports Medicine, 53(11), 667699. https://doi.org/10.1136/bjsports-2019-100715

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reise, S.P. (2012). The rediscovery of bifactor measurement models. Multivariate Behavioral Research, 47(5), 667696. https://doi.org/10.1080/00273171.2012.715555

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reise, S.P., & Rodriguez, A. (2016). Item response theory and the measurement of psychiatric constructs: Some empirical and conceptual issues and challenges. Psychological Medicine, 46(10), 20252039. https://doi.org/10.1017/S0033291716000520

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rejeski, W.J., Brawley, L.R., & Shumaker, S.A. (1996). Physical activity and health-related quality of life. Exercise and Sport Sciences Reviews, 24(1), 71108.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rodriguez, A, Reise, S.P., & Haviland, M.G. (2016). Applying bifactor statistical indices in the evaluation of psychological measures. Journal of Personality Assessment, 98(3), 223237. https://doi.org/10.1080/00223891.2015.1089249

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Salama-Younes, M. (2011). Validation of the mental health continuum short form and subjective vitality scale with Egyptian adolescent athletes. In The human pursuit of well-being (pp. 221234). Springer.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Schreiber, J.B., Nora, A., Stage, F.K., Barlow, E.A., & King, J. (2006). Reporting structural equation modeling and confirmatory factor analysis results: A review. The Journal of Educational Research, 99(6), 323338. https://doi.org/10.3200/JOER.99.6.323-338

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Shannon, S., Breslin, G., Haughey, T., Sarju, N., Neill, D., Lawlor, M., & Leavey, G. (2019). Predicting student-athlete and non-athletes’ intentions to self-manage mental health: Testing an integrated behaviour change model. Mental Health & Prevention, 13, 9299. https://doi.org/10.1016/j.mhp.2019.01.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Smith, B.W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008). The brief resilience scale: Assessing the ability to bounce back. International Journal of Behavioral Medicine, 15(3), 194200. https://doi.org/10.1080/10705500802222972

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Spitzer, R.L., Kroenke, K., Williams, J.B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 10921097. https://doi.org/10.1001/archinte.166.10.1092

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stucky, B.D., & Edelen, M.O. (2015). Using hierarchical IRT models to create unidimensional measures from multidimensional data. In S.P. Reise & D.A. Revicki (Eds.), Handbook of item response theory modeling: Applications to typical performance assessment (pp. 183206). Routledge.

    • Search Google Scholar
    • Export Citation
  • Swann, C., Moran, A., & Piggott, D. (2015). Defining elite athletes: Issues in the study of expert performance in sport psychology. Psychology of Sport and Exercise, 16, 314. https://doi.org/10.1016/j.psychsport.2014.07.004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tanaka, J.S. (1987). “How big is big enough?” Sample size and goodness of fit in structural equation models with latent variables. Child Development, 58(1), 134146. https://doi.org/10.2307/1130296

    • Crossref
    • Search Google Scholar
    • Export Citation
  • United Nations Department of Economic and Social Affairs Population Division. (2015). World population ageing. United Nations. https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2015_Report.pdf

    • Search Google Scholar
    • Export Citation
  • Uphill, M., Sly, D., & Swain, J. (2016). From mental health to mental wealth in athletes: Looking back and moving forward. Frontiers in Psychology, 7, 935. https://doi.org/10.3389/fpsyg.2016.00935

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Vella, S.A., Benson, A., Sutcliffe, J., McLaren, C., Swann, C., Schweickle, M.J.,& Bruner, M. (2020). Self-determined motivation, social identification and the mental health of adolescent male team sport participants. Journal of Applied Sport Psychology, 33(4), 115.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Vella, S.A., & Swann, C. (2021). Time for mental healthcare guidelines for recreational sports: A call to action. British Journal of Sports Medicine, 55(4), 184185. https://doi.org/10.1136/bjsports-2019-101591

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wieland, A., Durach, C.F., Kembro, J., & Treiblmaier, H. (2017). Statistical and judgmental criteria for scale purification. Supply Chain Management, 22(4), 321328. https://doi.org/10.1108/SCM-07-2016-0230

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wu, Y., Levis, B., Riehm, K.E., Saadat, N., Levis, A.W., Azar, M., & Ioannidis, J.P. (2020). Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: A systematic review and individual participant data meta-analysis. Psychological Medicine, 50(8), 13681380. https://doi.org/10.1017/S0033291719001314

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wynters, R., Liddle, S.K., Swann, C., Schweickle, M.J., & Vella, S.A. (2021). Qualitative evaluation of a sports-based mental health literacy program for adolescent males. Psychology of Sport and Exercise, 56, Article 101989. https://doi.org/10.1016/j.psychsport.2021.101989

    • Crossref
    • Search Google Scholar
    • Export Citation
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