Health, well-being, and psychopathology in a clinical population: Structure and discriminant validity of Mental Health Continuum Short Form (MHC-SF).

Objective: The literature suggests a distinction between illness (negative health) and the ability to cope with challenges such as illness (positive health). The two continua model of mental health distinguishes psychiatric symptoms (illness) from well-being (positive health). Well-being consists of hedonic, eudaimonic, and social well-being, constituting one factor that is moderately correlated with psychopathology in the general population. In a mental health care population, we examined whether the three dimensions of well-being are distinguishable and whether well-being is also moderately correlated with symptoms.

Method: A representative sample of 1,069 patients (63% female, 47% male; mean age: 42 years) voluntarily completed the Mental Health Continuum-Short Form (MHC-SF), a 14-item test that assesses three components of well-being.

Results: Confirmatory factor analysis revealed a model with strong correlations between the three subscales of the MHC-SF, indicating poor discriminant validity. Furthermore, the MHC-SF was strongly correlated (r = -.71) with the symptomatic distress scale of the OQ-45. Exploratory factor analysis permitted a two-factor solution, providing support for the two continua model of mental health. However, the explained variance of the second factor (well-being) was meager in comparison with the first factor (psychopathology). The results of a canonic correlation did not confirm the two continua model, and only a model with one common canonical factor was significant.

Conclusions: For patients with clinical levels of psychopathology, the level of well-being and psychopathology correlate much higher than in the general population. Well-being and psychopathology are so entwined that the supposed distinction should be seriously questioned.