Development of Positive Mental Health Measurement for Gender-Diverse Students in Thailand
Main Article Content
Abstract
Gender-diverse students experience elevated rates of anxiety, depression, suicidal thoughts, and self-harm compared to their heterosexual peers. This study aims to develop a Positive Mental Health Measurement for gender-diverse students in Thailand. Employing a mixed methods research approach, specifically utilizing an exploratory sequential research design, the study began with a qualitative phase to explore the dimensions and meaning of positive mental health through in-depth interviews with 10 participants. Subsequently, a quantitative phase involved a second-order confirmatory factor analysis. The sample comprised 800 participants, divided equally between the exploratory factor analysis (EFA = 400) and second-order confirmatory factor analysis (CFA = 400). The Cronbach’s alpha coefficient for the scale was calculated as 0.927, indicating high internal consistency reliability. Results identified seven key components of positive mental health: 1) self-acceptance, 2) prosocial behavior, 3) interpersonal relationships, 4) autonomy, 5) coping ability, 6) self-esteem, and 7) problem-solving. The second-order confirmatory factor analysis confirmed the structure of the positive mental health model, with fit indices meeting standard thresholds (χ2 = 278.40, p = 0.076, GFI = 0.95, AGFI = 0.92, CFI = 1.00, SRMR = 0.04, RMR = 0.04, RMSEA = 0.01, NFI = 0.99). Standardized loadings of the seven factors onto the higher-order factor were robust, ranging from 0.70 to 0.96. The implication of this study underscores the importance of employing positive mental health measurement to proactively address mental health challenges among undergraduate students with diverse sexual orientations.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
• Aldridge, Z., Thorne, N., Bouman, W. P., Witcomb, G. L., & Arcelus, J. (2023). A longitudinal study exploring the role of mental health symptoms and social support regarding life satisfaction 18 months after initiation of gender-affirming hormone treatment. Healthcare (Basel, Switzerland), 11(3), Article 379. https://doi.org/10.3390/healthcare11030379
• Boateng, G. O., Neilands, T. B., Frongillo, E. A., Melgar-Quiñonez, H. R., & Young, S. L. (2018). Best practices for developing and validating scales for health, social, and behavioral research: A primer. Frontiers in Public Health, 6, Article 149. https://doi.org/10.3389/fpubh.2018.00149
• Bridge, L., Smith, P., & Rimes, K. A. (2022). Self-esteem in sexual minority young adults: A qualitative interview study exploring protective factors and helpful coping responses. International Review of Psychiatry, 34(3-4), 257–265. https://doi.org/10.1080/09540261.2022.2051446
• Brunt, A. (2008). Factor analysis. In L. M. Given (Ed.), The SAGE Encyclopedia of Qualitative Research Methods (Vol. 1, pp. 304–307). Sage Publications.
• Byrne, B. M. (2006). Structural equation modeling with EQS: Basic concepts, applications, and programming (2nd ed.). Lawrence Erlbaum Associates.
• Camp, J., Vitoratou, S., & Rimes, K. A. (2020). LGBQ+ self-acceptance and its relationship with minority stressors and mental health: A systematic literature review. Archives of Sexual Behavior, 49(7), 2353–2373. https://doi.org/10.1007/s10508-020-01755-2
• Coronel-Santos, M. A., & Rodríguez-Macías, J. C. (2022). Integral definition and conceptual model of mental health: Proposal from a systematic review of different paradigms. Frontiers in Sociology, 7, Article 978804. https://doi.org/10.3389/fsoc.2022.978804
• Cortina, J. M. (1993). What is coefficient alpha? An examination of theory and applications. Journal of Applied Psychology, 78(1), 98–104. https://doi.org/10.1037/0021-9010.78.1.98
• Coulter, R. W., Birkett, M., Corliss, H. L., Hatzenbuehler, M. L., Mustanski, B., & Stall, R. D. (2016). Associations between LGBTQ-affirmative school climate and adolescent drinking behaviors. Drug and Alcohol Dependence, 161, 340–347. https://doi.org/10.1016/j.drugalcdep.2016.02.022
• Creswell, J. W., & Clark, V. L. P. (2018). Designing and conducting mixed methods research (3rd ed.). Sage Publications.
• Curry, O. S., Rowland, L. A., Van Lissa, C. J., Zlotowitz, S., McAlaney, J., & Whitehouse, H. (2018). Happy to help? A systematic review and meta-analysis of the effects of performing acts of kindness on the well-being of the actor. Journal of Experimental Social Psychology, 76, 320–329. https://doi.org/10.1016/j.jesp.2018.02.014
• Fetters, M. D., Curry, L. A., & Creswell, J. W. (2013). Achieving integration in mixed methods designs–principles and practices. Health Services Research, 48(2), 2134–2156. https://doi.org/10.1111/1475-6773.12117
• Field, A. (2009). Discovering statistics using SPSS (3rd ed.). Sage Publications.
• Fowler, K., & Dooley, K. E. (2023). Positive mental health in adults with bipolar disorder: Exploring social support subtypes, negative social interactions and potential to flourish. BMC Psychiatry, 23(1), Article 759. https://doi.org/10.1186/s12888-023-05244-3
• Gates, G. J., & Dentato, M. P. (2020). LGBTQ issues and volunteerism: Enhancing mental health and promoting acceptance. Journal of Community Psychology, 48(3), 456–470. https://doi.org/10.1002/jcop.22395
• Gautam, S., Jain, A., Chaudhary, J., Gautam, M., Gaur, M., & Grover, S. (2024). Concept of mental health and mental well-being, its determinants and coping strategies. Indian Journal of Psychiatry, 66(Suppl 2), S231–S244. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_707_23
• Gonzales, J., Lanchipa-Ale, A., Puma, E., Mansilla, E., & Laura, P. (2022). Positive dimensions of mental health and personality in a sample of university students. Journal of Medicinal and Chemical Sciences, 5(7), 1215–1223. https://doi.org/10.26655/JMCHEMSCI.2022.7.10
• Hair, J. F., Jr., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate data analysis (7th ed.). Pearson.
• Hair, J. F., Jr., Hult, G. T. M., Ringle, C. M., & Sarstedt, M. (2018). Advanced issues in partial least squares structural equation modeling. Sage Publications.
• Hatch, S. L., Harvey, S. B., & Maughan, B. (2010). A developmental-contextual approach to understanding mental health and well-being in early adulthood. Social Science & Medicine, 70(2), 261–268. https://doi.org/10.1016/j.socscimed.2009.10.005
• Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135(5), 707–730. https://doi.org/10.1037/a0016441
• 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), 1–55. https://doi.org/10.1080/10705519909540118
• Jahoda, M. (1958). Current concepts of positive mental health. Joint Commission on Mental Illness and Health. https://doi.org/10.1037/11258-000
• Juhari, J. A., Gill, J. S., & Francis, B. (2022). Coping strategies and mental disorders among the LGBT+ community in Malaysia. Healthcare (Basel, Switzerland), 10(10), Article 1885. https://doi.org/10.3390/healthcare10101885
• Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Hawkins, J., Queen, B., Lowry, R., Olsen, E. O., Chyen, D., Whittle, L., Thornton, J., Lim, C., Yamakawa, Y., Brener, N., & Zaza, S. (2016). Youth risk behavior surveillance—United States, 2015. Morbidity and Mortality Weekly Report: Surveillance Summaries, 65(6), 1–174. https://doi.org/10.15585/mmwr.ss6506a1
• Keyes, C. L. (2002). The mental health continuum: From languishing to flourishing in life. Journal of Health and Social Behavior, 43(2), 207–222. ehttps://doi.org/10.2307/3090197
• Khantharot, K., Jaroenpon, P., Laimee, T., & Saenthum, P. (2022). Phawa sukkhaphap chit lae khwam thuk chak prasopkan nai edok khong klum phu mi khwam laklai thang phet [Mental health status and past experiences of distress among gender-diverse groups]. Journal of Health Sciences Scholarship, 9(2), 104–118. https://he01.tci-thaijo.org/index.php/johss/article/view/256511
• Kittiteerasack, P., Matthews, A., & Steffen, A. (2019). The validity and linguistic testing of translated measures of sexual orientation and gender identity for research in lesbian, gay, bisexual, and transgender (LGBT) populations in Thailand. Nursing Journal, 49(4), 122–137. https://he02.tci-thaijo.org/index.php/cmunursing/article/view/230314/156776
• Kline, R. B. (2005). Principles and practice of structural equation modeling (2nd ed.). Guilford Press.
• Layland, E. K., Carter, A., Perry, N. S., Cuddy, M. M., & Tate, C. C. (2021). Assessing the mental health and well-being benefits of gender-diverse student environments: A review of current literature. Journal of LGBTQ Health, 8(3), 255–267. https://doi.org/10.1080/23290328.2021.1896619
• Layous, K., Nelson, S. K., Kurtz, J. L., & Lyubomirsky, S. (2017). What triggers prosocial effort? A positive feedback loop between positive activities, kindness, and well-being. The Journal of Positive Psychology, 12(4), 385–398. https://doi.org/10.1080/17439760.2016.1198924
• Legate, N., & Ryan, W. S. (2014). Autonomy support as acceptance for disclosing and developing a healthy lesbian, gay, bisexual or transgendered identity. In N. Weinstein (Ed.), Human motivation and interpersonal relationships: Theory, research, and applications (pp. 191–212). Springer Netherlands. https://doi.org/10.1007/978-94-017-8542-6_9
• Linley, P. A., Joseph, S., Harrington, S., & Wood, A. M. (2006). Positive psychology: Past, present, and (possible) future. The Journal of Positive Psychology, 1(1), 3–16. https://doi.org/10.1080/17439760500372796
• Lluch, C. (2002). Jahoda's framework and its impact on the development of positive mental health research. Journal of Health Psychology, 7(6), 541–555. https://doi.org/10.1177/1359105302007005695
• Lothwell, J. E., McMahon, S. D., & Scott, J. L. (2020). Mental health disparities among LGBTQ youth: Addressing the challenges and building resilience. Journal of Adolescent Health, 66(2), 123–130. https://doi.org/10.1016/j.jadohealth.2019.09.006
• Luijten, C. C., Kuppens, S., Bongardt, D. v. d., & Nieboer, A. P. (2019). Evaluating the psychometric properties of the mental health continuum-short form (MHC-SF) in Dutch adolescents. Health and Quality of Life Outcomes, 17(1), Article 157. https://doi.org/10.1186/s12955-019-1221-y
• Lukat, J., Margraf, J., Lutz, R., van der Veld, W. M., & Becker, E. S. (2016). Psychometric properties of the Positive Mental Health Scale (PMH-scale). BMC Psychology, 4, Article 8. https://doi.org/10.1186/s40359-016-0111-x
• Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674
• Mongkol, A., Wongpiramkulsanit, Y., Tangseree, T., Hathatphanom, W., Romsai, P., & Jutta, W. (2009). Development and testing of the Thai Mental Health Index (Version 2007). Cooperative Printing House of the Thai Farmers Bank Public Company Limited.
• Nastasi, B. K., & Schensul, S. L. (2005). Contributions of qualitative research to the validity of intervention research. Journal of School Psychology, 43(3), 177–195. https://doi.org/10.1016/j.jsp.2005.04.003
• Ojanen, T. T., Phukao, D., Boonmongkon, P., Rungreangkulkij, S., & Gender, T. O. (2020). Defining mental health practitioners’ LGBTIQ cultural competence in Thailand. Journal of Population and Social Studies, 29(2), 158–176. https://doi.org/10.25133/jpssv292021.010
• Okanlawon, K. (2021). Homophobia in Nigerian schools and universities: Victimization, mental health issues, resilience of the LGBT students and support from straight allies: A literature review. Journal of LGBT Youth, 18(4), 327-359. https://doi.org/10.1080/19361653.2020.1749211
• Orpana, H., Vachon, J., Dykxhoorn, J., McRae, L., & Jayaraman, G. (2016). Monitoring positive mental health and its determinants in Canada: The development of the Positive Mental Health Surveillance Indicator Framework. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 36(1), 1–10. https://doi.org/10.24095/hpcdp.36.1.01
• Özpulat, F., Öztaş, D., & Günaydin, N. (2022). Reliability and validity of the Positive Mental Health Literacy Scale in Turkish adolescents. Alpha Psychiatry, 23(2), 76–81. https://doi.org/10.5152/alphapsychiatry.2022.21165
• Redfield, R. R., Schuchat, A., Richards, C. L., Bunnell, R., Greenspan, A., & Iademarco, M. F. (2020). Youth risk behavior surveillance—United States, 2019. MMWR Surveillance Summaries, 69(1), 1–14. https://doi.org/10.15585/mmwr.ss6901a1
• Rovinelli, R. J., & Hambleton, R. K. (1977). On the use of content specialists in the assessment of criterion-referenced test item validity. Dutch Journal of Educational Research, 2(2), 49–60.
• Ryan, R. M., & Deci, E. L. (2001). On happiness and human potentials: A review of research on hedonic and eudaimonic well-being. Annual Review of Psychology, 52(1), 141–166. https://doi.org/10.1146/annurev.psych.52.1.141
• Seligman, M. E. P., & Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American Psychologist, 55(1), 5–14. https://doi.org/10.1037/0003-066X.55.1.5
• Sequeira, C., Carvalho, J. C., Gonçalves, A., Nogueira, M. J., Lluch-Canut, T., & Roldán-Merino, J. (2020). Levels of positive mental health in Portuguese and Spanish nursing students. Journal of the American Psychiatric Nurses Association, 26(5), 483–492. https://doi.org/10.1177/1078390319851569
• Singsatid, T., & Nimnuan, C. (2023). Relationship between gender and mental health among undergraduate students. Journal of Medical Bioscience, 5(2), 109–121. https://doi.org/10.14456/jmbs.2023.12
• Starks, T. J., Newcomb, M. E., & Mustanski, B. (2015). A longitudinal study of interpersonal relationships among lesbian, gay, and bisexual adolescents and young adults: Mediational pathways from attachment to romantic relationship quality. Archives of Sexual Behavior, 44(7), 1821–1831. https://doi.org/10.1007/s10508-015-0492-6
• Stevens, S., Haverly, K., & Powell, C. (2020). Improvements in self-acceptance for LGBTQ+ and straight allied youth and young adults enrolled in an affirming system of care program. Children and Youth Services Review, 118, Article 105382. https://doi.org/10.1016/j.childyouth.2020.105382
• Szymanski, D. M., & Gupta, A. (2009). Examining the relationship between multiple internalized oppressions and African American lesbian, gay, bisexual, and questioning persons' self-esteem and psychological distress. Journal of Counseling Psychology, 56(1), 110–118. https://doi.org/10.1037/a0013317
• Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Pearson Education.
• Taherdoost, H., Sahibuddin, S., & Jalaliyoon, N. (2022). Exploratory factor analysis: Concepts and theory. Advances in Applied and Pure Mathematics, 27, 375–382. Retrieved from https://hal.archives-ouvertes.fr/hal-02557344/document
• Toomey, R. B., Ryan, C., Diaz, R. M., & Russell, S. T. (2018). Coping with sexual orientation-related minority stress. Journal of Homosexuality, 65(4), 484–500. https://doi.org/10.1080/00918369.2017.1321888
• Trzesniewski, K. H., Donnellan, M. B., & Robins, R. W. (2013). Development of self-esteem. In V. Zeigler-Hill (Ed.), Self-esteem (pp. 60–79). Psychology Press.
• Vaillant, G. E. (2012). Positive mental health: Is there a cross-cultural definition? World Psychiatry, 11(2), 93–99. https://doi.org/10.1016/j.wpsyc.2012.05.006
• Vaingankar, J. A., Abdin, E., Chong, S. A., Sambasivam, R., Jeyagurunathan, A., Seow, E., Picco, L., Pang, S., Lim, S., & Subramaniam, M. (2016). Psychometric properties of the positive mental health instrument among people with mental disorders: A cross-sectional study. Health and Quality of Life Outcomes, 14, Article 19. https://doi.org/10.1186/s12955-016-0424-8
• Vaingankar, J. A., Subramaniam, M., Chong, S. A., Abdin, E., Orlando Edelen, M., Picco, L., Lim, Y. W., Phua, M. Y., Chua, B. Y., Tee, J. Y., & Sherbourne, C. (2011). The positive mental health instrument: Development and validation of a culturally relevant scale in a multi-ethnic Asian population. Health and Quality of Life Outcomes, 9, Article 92. https://doi.org/10.1186/1477-7525-9-92
• Velten, J., Brailovskaia, J., & Margraf, J. (2022). Positive mental health scale: Validation and measurement invariance across eight countries, genders, and age groups. Psychological Assessment, 34(4), 115-130. https://doi.org/10.1037/pas0001094
• Wiwattarangkul, T., & Wainipitapong, S. (2023). Attitudes towards LGBTQ+ individuals among Thai medical students. PlOS ONE, 18(12), Article e0296039. https://doi.org/10.1371/journal.pone.0296039
• World Health Organization. (2004). Promoting mental health: Concepts, emerging evidence, practice: Summary report. https://apps.who.int/iris/handle/10665/42940