Mental health in children with and without disabilities in a register-based Swedish sample supports the two-continua model: a latent class analysis

Mental health is a term frequently used to describe mental health problems. However, mental health includes both mental health problems and well-being. Therefore, mental health can be seen as having two distinct yet related dimensions, as described in the two-continua model of mental health (Westerhof & Keyes, 2010) where an individual can simultaneously experience any combination of well-being and problems, suggesting four classes: (i) high well-being, low problems; (ii) high well-being, high problems; (iii) low well-being, low problems; and (iv) low well-being, high problems. Through this framework an understanding of differences in putative risk and protective factors can be gained when compared across classes. While the model has received support, it is unclear how it applies to children. In particular, children with disabilities, as disabilities pose a risk factor to poor mental health. A greater understanding of similarities and differences between children with and without disabilities, and of risk and protective factors, could help tailor support focused on enhancing well-being, both as a goal and as a means to better self-management of mental health.

The present project utilizes Sweden Statistics (SCB) study (barnULF) to measure life conditions. Nearly 4000 children aged 10-18, with and without disabilities, and their caregivers (ULF/SILC) were studied through yearly interview-based sample surveys conducted between 2013 and 2019. Latent class analysis was performed to assess whether the data fit a 4-class model in line with the two-continua model. Possible factors influencing mental health, including participation, were compared across the identified classes and between children with and without disabilities.

The analysis confirmed the predicted model. Each class showed distinct features regarding putative risk and protective factors of mental health and demographics in both the child and caregiver. These features differed significantly between children with and without disabilities, especially relating to participation, social bonds, family functioning, digital media use, and perceived safety. Age, disability, and gender predicted class adversity.

The results suggest that mental health problems and well-being are two related but separate constructs, highlighting the importance of promoting participation and recognizing well-being and not just mental health problems when planning interventions. The results also highlight the importance of providing support for not only the child but also their caregiver.