Over the last 20 years, poor mental health in children has increased across most of the developed world (Ford et al., 2021; Hammond et al., 2020).
Understanding how mental health and well-being are connected in children is essential for developing policies that help prevent mental health problems, promote good mental health, and support those in need across the health, social care, and education sectors. 'Mental health' and 'well-being' are often used interchangeably, but they have distinct meanings (Westerhof & Keyes, 2010; Stewart-Brown et al., 2009).
Well-being can influence mental health, and by focusing on improving well-being, we may find new approaches to improve mental health outcomes (Weare, 2017; Lereya et al., 2022).
Despite their importance, we still have a limited understanding of clearly defining and separating these two ideas. Mental health includes thoughts, feelings, and actions, while well-being is about feeling good and managing daily life well. Some people think mental health and well-being are on the same scale, where better well-being means fewer mental health issues. Others believe they are separate but related ideas, meaning you can feel good even if you have mental health problems, and vice versa.
This study uses data from the 2019 and 2021 Student Health and Research Network (SHRN) surveys.
SHRN was set up in 2013 by Public Health Wales, Cardiff University, the Welsh Government, and other partners to improve children's health in Wales. The report examines how mental health and well-being are linked and supports the Welsh Government's goal of promoting well-being. Since 2017, SHRN has collected data from students aged 11-16 every two years through online surveys covering many health and behaviour topics. These responses help track changes and trends in mental health and well-being over time.
We examined several factors using the Strengths and Difficulties Questionnaire (SDQ) to assess mental health and the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) to measure well-being. We also included demographic variables (e.g., age, gender) and behavioural factors (e.g., sleep quality, physical activity) to account for differences.
The first analysis was to examine the relationship between mental health and well-being. We used a method that looked at both school-level and individual-level effects to account for differences between schools. This helped us understand how much of the variation in mental health and well-being is due to differences between schools and how much is due to differences between individual students.
The second analysis used Structural Equation Modelling (SEM) to explore various mental health and well-being factors. This analysis included both mental health and well-being as outcomes, with all the covariates impacting both outcomes at the same time. We then examined how each factor influenced mental health and well-being independently.
This study shows that mental health and well-being are closely linked—when one worsens, so does the other.
The study also found that factors from all areas of life, like age, behaviour, and social conditions, are connected to poorer mental health and well-being.
Certain variables were found to help disentangle the complex relationship between the two constructs. Improving how we define mental health and well-being can help clarify public health strategies, leading to better support and collaboration.
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