The Influence of Social Determinants and 5Cs of Positive Youth Development on the Mental Health of Chilean Adolescents

doi:10.21203/rs.3.rs-5234516/v1

This study analyzes the influence of social determinants (SD) and positive youth development (PYD) on the mental health (MH) of Chilean adolescents. A nonexperimental, cross-sectional, correlational-explanatory design was adopted to analyze data from 612 adolescents (43.46% males and 56.54% females) aged between 11 and 19 years (M = 14.92, SD = 1.50). The SD evaluated included parental educational level, family affluence, gender, migratory status, and ethnicity. PYD was assessed via the 5Cs model (Competence, Confidence, Connection, Character, and Caring). MH was conceptualized through the dual-factor model, which encompasses positive mental health (PMH) and negative mental health (NMH). The analyses included confirmatory factor analysis to assess the measurement models and structural equation modeling to examine the direct and indirect effects of the hypothesized relationships. The findings indicate that family affluence and gender are the factors most consistently associated with the dimensions of PYD and MH. Confidence and connection positively influence MH, improving PMH and reducing NMH, and mediate the relationship between SD and MH. The importance of considering the socioeconomic context and individual capabilities in mental health promotion strategies is highlighted, proposing an integral approach that addresses both the positive and negative aspects of adolescent well-being.

Social determinants

Positive youth development

Mental health

Adolescents

Chile.

Adolescence is a developmental stage that spans the second decade of life and is marked by significant physical, emotional, and social changes (1, 2). Several studies have linked mental health problems during this stage to immediate adverse outcomes, including but not limited to psychosocial issues such as isolation and peer victimization (3), low academic performance (3), school absenteeism (4) and an increased risk of suicide (5). Similarly, mental health problems during adolescence are associated with an increased risk of major depression, anxiety disorders, and substance abuse in adulthood (6, 7).

Understanding the factors that influence mental health is essential for designing effective interventions that facilitate health processes and ensure a positive transition to adulthood (8–10). This requires adopting a holistic and multivariable approach that integrates social contexts while identifying and promoting adolescents’ strengths and capacities (9, 11). This approach leads to the examination of social determinants as key axes shaping the living conditions of young people.

The World Health Organization (WHO) defines social determinants as “the conditions in which people are born, grow, work, live, and age, including the wider set of forces and systems shaping the conditions of daily life” (12). These factors are shaped by the distribution of money, power and resources at global, national, and local levels, and are key to understanding the health inequalities observed among population groups (13, 14).

The Social Determinants of Health (SDH) framework highlights the importance of social determinants (SD), also known as structural determinants, as they generate and reinforce social stratification. These mechanisms shape the health opportunities of social groups depending on their socioeconomic position (SEP) within hierarchies of power, prestige and access to resources, ultimately affecting their health outcomes (12, 15). The SDH model defines a set of proxy variables to assess socioeconomic position, each of which affects health in a distinctive and significant way (16):

Income: Has a lasting impact on health by influencing material conditions through spending on goods and services that improve health.
Education: Leads to better employment opportunities, allowing greater access to health resources, as well as increasing engagement in healthy behaviors.
Occupation: Reflects social status and influences health through material resources and working conditions.
Social Class: Defined by control over productive resources, it establishes power dynamics that shape economic and health inequalities.
Gender: Gender stereotypes and power structures result in significant health disparities, primarily affecting women and girls through discrimination and social pressures.
Race/Ethnicity: Critical factors underpinning social divisions, that influence health and life expectancy among marginalized groups.

Research on how these factors affect adolescent mental health presents significant methodological challenges. First, many SD are not directly applicable to adolescents, as their social conditions are largely determined by their parents’ SEP. When it is impossible to gather information about the parents, researchers rely on adolescent self-reporting, which often lead to inaccuracies due their limited knowledge of specific details about their family situation, increasing measurement error and the volume of missing data (17). In response, indirect measures such as family wealth assessment (18, 19) or composite indicators are employed to obtain more accurate estimates (17).

While these SD can have profound limiting effects on mental health by shaping living conditions that restrict or facilitate access to resources and opportunities, recent theoretical approaches suggest the need to examine the dynamic interactions between individuals and their ecological environment to explain variations in levels of well-being and mental health (16, 20). Recognizing the importance of SD, the Positive Youth Development (PYD) approach positions itself as a strategic response to mediate these effects and improve adolescents’ mental health.

PYD is a theoretical and practical approach focused on identifying and promoting the resources, competencies, and capacities of both young people and their ecological niches, with the objective of fostering their healthy development into adulthood (1, 20–23). This approach offers valuable insights for deepening the understanding of social determinants of adolescent mental health.

Based on both professional experience and an extensive literature review on adolescent development, Lerner (1, 24) proposed that PYD is composed of five Cs (“5Cs”), which describe psychological, social, and behavioral characteristics of youth who develop adaptively:

Competence: A positive view of one’s actions in specific areas of development, including social, cognitive, and academic competencies.
Confidence: An internal sense of positive self-esteem and general self-efficacy; a global self-concept rather than beliefs limited to specific areas.
Connection: Positive bonds with people and institutions, reflected in bidirectional exchanges between the individual and their peers, family, school, and community.
Character: Respect for social and cultural rules, adoption of correct behaviors, a clear sense of right and wrong (morality), and integrity.
Caring: A sense of sympathy and empathy for others.

In the context of this model, thriving is defined as the holistic and healthy development of a young person, characterized by the 5Cs (20). According to Lerner et al. (24), the sustained manifestation of these characteristics also drives the emergence of a sixth C: Contribution. Thus, when a young person develops positively during adolescence, they are on a trajectory toward “idealized adulthood” (25), which is characterized by reciprocal and mutually beneficial contributions both to themselves (such as personal health care) and to their family, community and various structures of civil society (such as neighbors, neighborhoods, school, religious groups, etc.).

The 5Cs model of PYD also suggests that when young people are thriving, they are less likely to engage in risky behaviors and conduct problems. In the context of 4-H longitudinal study conducted in the United States, Lerner and his colleagues found initial support for this proposition by confirming the negative relationships between 5Cs and delinquency, substance abuse, depression, and aggression (24, 26). Subsequent studies have extended these findings by exploring the associations between PYD, both as a global measure and in its five individual dimensions, and other desirable outcomes in various international contexts.

In terms of mental health, evidence has confirmed significant associations that align with previously noted theoretical expectations. Specifically, PYD has been shown to be related to lower levels of internalizing problems (27–29) and externalizing problems (30), as well as higher levels of well-being (31, 32), life satisfaction (33), and healthy lifestyles (34), among others. However, this relationship is less consistent when the independent effect of each C is analyzed, suggesting a possible cultural influence on the manifestation of these factors. Despite this, Competence and Connection show stronger evidence of their protective role against mental health problems (35–38) and their ability to promote well-being (38). By contrast, high levels of Caring have been associated with mixed and even maladaptive outcomes (39).

The present study

Despite advances in research on adolescent mental health, the effects of social determinants have been evaluated in isolation, without an integrated theoretical framework. Recent studies with Latin American adolescents have begun to address this gap, showing that exposure to intersectional inequalities based on race/ethnicity, migration, gender, and social class leads to lower levels of well-being and increased mental health problems, as well as significant barriers to accessing care (40). In the case of Chile, research indicates that factors such as gender, age, family structure, migration status, and parental education limit access to mental health services (41), and that educational and socioeconomic vulnerability significantly impact mental health (42). More recently, Marín-Gutiérrez et al. (43) reported that family affluence, gender, and migration status directly impact levels of well-being and psychopathology.

PYD has emerged as a valuable approach for improving mental health in Chile, although local research is still scarce. In this context, Marín-Gutiérrez et al. (44) found that four of the 5Cs (Competence, Confidence, Connection, and Character) were significantly correlated with self-esteem, anxiety and depression. In a subsequent study, it was confirmed that only Confidence and Connection had a significant negative effect on symptoms of depression, anxiety, stress, and emotional distress in adolescents (36). Similarly, Pérez-Díaz et al. (45) demonstrated that Confidence and Character mediate the relationship between positive identity and psychological well-being among university students. These findings highlight the effectiveness of certain components of PYD in promoting mental health and suggest the need for further research that considers social and economic influences to design effective, contextually situated interventions.

Given the previously described evidence, it is essential to enhance our understanding of the effects of social determinants (SD) on adolescent mental health (MH), as well as to explore the mediating role of positive youth development (PYD) in this relationship, in order to propose comprehensive models that accurately explain mental health in this age group. In this context, the present study aims to analyze an explanatory model of adolescent mental health based on the SDH framework (12, 15, 16) and the 5Cs of PYD (1, 24). For the purposes of this proposal, mental health will be operationalized into two latent correlated factors: positive mental health (PMH, e.g., well-being) and negative mental health (NMH, e.g., psychopathology), following the theoretical proposals of the dual-factor model (46–48), in order to capture both the adaptive and maladaptive aspects of mental health.

As research hypotheses, the following are proposed:

H1: Social Determinants have a direct effect on the 5Cs of Positive Youth Development.

H2: Social Determinants have a direct effect on Mental Health.

H3: The 5Cs of Positive Youth Development have a direct effect on Mental Health.

H4: The 5Cs of Positive Youth Development mediate the relationship between Social Determinants and Mental Health.

Design

A quantitative, cross-sectional study with a correlational-explanatory scope was conducted. The population under study consisted of adolescents attending school in three cities in northern Chile. The sampling method was nonprobabilistic and was based on convenience.

Participants

The sample consisted of 647 adolescents, aged between 11 and 19 years (M = 14.9, SD = 1.55). Of these, 279 were male (43.1%), 348 were female (53.8%), and 20 were non-binary (3.1%). The majority were Chilean (92.2%), whereas 7.6% were foreign, mostly from countries such as Bolivia (2.6%), Perú (2.2%), and Venezuela (1.1%). In terms of ethnicity, 19.6% identified as belonging to an ethnic group, with Aymara (10.5%), Mapuche (3.9%), and Diaguita (2.3%) being the most common. Regarding family structure, 57.7% of the adolescents lived in two-parent households, 38.4% in single-parent households, and 3.9% did not live with either parent. In terms of parental education, 59.3% had higher education, 38.6% had secondary education, 2.0% had basic education, and 0.2% had no formal education.

Variables and Instruments

Social Determinants. To measure social determinants according to the model proposed by the WHO (12–16), a sociodemographic questionnaire was designed to collect information on gender, ethnicity, nationality, and parental educational level. Following Moreno-Maldonado et al. (17), parental educational level was determined by asking the following question: “What is the highest educational level achieved by your [mother/father]?”, with response options coded from 0 to 3 (“No formal education”, “Basic/Primary Education”, “Secondary/High School Education”, and “Higher/University Education”). As a proxy measure of income level, the Family Affluence Scale II (FAS-II; 18) was applied. The FAS-II consists of four items: number of vehicles (0 = no; 1 = yes, one; 2 = yes, two or more), number of computers (0 = none; 1 = one; 2 = two; 3 = more than two), own bedroom (0 = no; 1 = yes), and number of family vacations in the last 12 months (0 = none; 1 = once; 2 = twice; 3 = more than twice). These items are summed to form an index ranging from 0 to 9 points, with 0 indicating the lowest material wealth and 9 the highest. The FAS-II does not require internal consistency measures as it uses a formative logic that combines individual indicators into a single score.

5Cs of Positive Youth Development. The Positive Youth Development-Short Form (PYD-SF; (49), adapted for Chilean adolescents (36, 44) was used. The PYD-SF assesses the 5Cs of the PYD model: Competence, Confidence, Connection, Character, and Caring/Compassion, and uses a five-point Likert response format, ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). The total score for each dimension is obtained by summing the direct scores of its respective items. The internal consistency coefficients were satisfactory and are reported in the results section.

Mental Health. Mental health was assessed via the dual-factor model through the joint application of the Depression, Anxiety, and Stress Scales (DASS-21; 50) for Negative Mental Health (NMH) and the Personal Well-Being Index (PWI; 51) for Positive Mental Health (PMH). The DASS-21, adapted into Spanish for Chilean adolescents by Mella et al. (52), uses a four-point Likert response format, ranging from 0 (Did not apply to me at all over the past week) to 3 (Applied to me very much, or most of the time). Based on previous evidence (53), a global measure was calculated from its items as an indicator of vulnerability to mental disorders. Regarding the PWI scale, adapted to the Chilean school context by Bilbao Ramírez et al. (54), its items use an 11-point Likert scale, ranging from 0 (completely dissatisfied) to 10 (completely satisfied), allowing participants to express their level of satisfaction in various areas of their lives. The sum of all the items provides a global measure of subjective well-being. The internal consistency coefficients for both instruments are detailed in the results section.

Procedure

This research received approval from the Scientific Ethics Committee of the University of Tarapacá (CEC-UTA). The fieldwork began with coordination with educational institutions and continued with technical meetings with school principals and teachers to plan data collection. The objectives, procedures, and participants’ rights were detailed in meetings with parents and were directly explained to students before the questionnaires were administered. Informed consent was obtained from parents, and assent was obtained from the students who agreed to participate. Data collection took place in the school facilities, in group sessions lasting approximately 30 minutes. The questionnaires were administered in a paper-and-pencil format, under the supervision of two trained surveyors and/or at least one researcher present in each session. Participation was anonymous and voluntary, allowing students to withdraw from the study at any time without consequences. The responses were digitized and stored in an electronic database for analysis.

Data analysis

The statistical analysis was conducted using IBM SPSS v.26 (55) and Mplus 8.2 (56). The analysis began with an assessment of missing data, where 15 cases with more than 10% missing values in the instrument battery were eliminated, representing a loss of 2.63% of the sample. A multiple imputation procedure using the Expectation-Maximization (EM) method was applied to replace the remaining missing values. Before the main analysis, 20 non-binary gender cases were excluded because of insufficient statistical representation of the group. The analysis plan continued with the data description, the assessment of internal consistency using Cronbach’s alpha (α) and McDonald’s omega (ω), and the verification of the univariate normality assumption through the Shapiro-Wilk test. Subsequently, latent variable measurement models were tested using the indicators from each instrument as specified in the corresponding section. Finally, the hypothesized structural models (described in Figs. 1, 2, and 3) were tested using the WLSMV estimator, which is appropriate for categorical variables and robust to non-normality. The goodness of fit of the measurement and structural models was evaluated considering multiple indicators with the following cutoff scores: RMSEA < 0.08, CFI and TLI > 0.90 as acceptable fit values, and RMSEA < 0.06, CFI, and TLI > 0.95 as indicators of excellent model fit (57, 58).

Preliminary Analysis

The final sample consisted of 612 adolescents (43.46% male and 56.54% female), with an average age of 14.92 years (SD = 1.50). In terms of their sociodemographic characteristics, 564 were Chilean (92.16%) and 48 were foreign (7.84%). In terms of ethnicity, 498 adolescents (81.37%) did not identify with any specific group, while 114 reported having ethnic ancestry (18.63%). Regarding family structure, 354 lived with both parents (57.84%), 236 lived with only one parent (38.56%), and 22 did not live with either parent (3.60%). In terms of parental education, 363 adolescents (59.31%) had parents with higher education, 236 (38.56%) with secondary education, 12 (1.96%) with basic education, and 1 (0.16%) without formal education. The other variables assessed showed non-normal distributions, with medium to medium-high scores for family affluence, 5Cs of PYD, and PMH, and low scores for NMH (see Table 1). The internal consistency reliability was satisfactory for all the measurements, with Cronbach’s alpha (α) and McDonald’s omega (ω) coefficients ranging from 0.748 to 0.950.

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INSERT TABLE 1 APPROX HERE

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Measurement Models of Positive Youth Development and Mental Health

The five-factor measurement model of PYD reported by Marín-Gutiérrez et al. (2024) was evaluated, which includes the correlated errors of three item pairs: items 3 and 19 (physical competence); items 14 and 31 (school connection); and items 17 and 34 (peers connection). This model showed a satisfactory fit to the data (χ2₍₅₁₄₎ = 2035.427; χ2/df = 3.959; RMSEA = 0.070 [90% CI = 0.066 – 0.073]; CFI = 0.925; TLI = 0.918; SRMR = 0.067), with significant loadings between all indicators and their corresponding latent variables (coefficients ranging from 0.389 and 0.901, p<0.001). Correlations between the latent variables indicated significant relationships between all dimensions of PYD, with coefficients ranging from 0.126 to 0.782 (p<0.001).

On the other hand, the dual-factor mental health measurement model was tested using the indicators from the PWI-SC and DASS-21, which form the dimensions of Positive Mental Health (PMH) and Negative Mental Health (NMH) respectively, as reported by Marín-Gutiérrez et al. (43). This model includes the correlated errors of two item pairs: items 4 and 7 from the PWI-SC, and items 10 and 21 (both from the depression subscale) from the DASS-21. This model showed an acceptable fit (χ2₍₄₀₂₎ = 1340.536; χ2/df = 3.334; RMSEA = 0.062 [90% CI = 0.058 – 0.065]; CFI = 0,951; TLI = 0.947; SRMR = 0.047), with significant factor loadings between all indicators and their latent variables (coefficients ranging from 0.439 and 0.890, p<0.001). Additionally, the correlation between PMH and NMH was negative and significant (r = -0,541; p<0.001).

Effects of Social Determinants on the 5Cs of Positive Youth Development and Mental Health

Two structural equation models were tested to evaluate the impact of social determinants (parental educational level, family affluence, gender, migration status, and ethnicity), with the first model focusing on the 5Cs of PYD (Figure 1A) and the second on mental health (Figure 1B). The standardized effects of both structural models are detailed in their respective panels in Figure 1.

The goodness of fit indices for the first model were adequate (χ2₍₆₅₉₎ = 2384.937; χ2/df = 3.619; RMSEA = 0.065 [90% CI = 0.063 – 0.068]; CFI = 0.914; TLI = 0.904; SRMR = 0.065. The model explained 16% of the variability in Competence (p<0.001), 9.6% in Confidence (p<0.001), 8.9% in Connection (p<0.001) and 4.2% in Caring (p=0.012). Only 2.5% of the variability in Character was explained by the model, although the relationship with social determinants did not reach statistical significance (p=0.066). In terms of effects, parental educational level had positive effects on Character (β = 0.119, SE= 0.049, p=0.015) and Caring (β = 0.136, SE= 0.046, p=0.003). Family affluence showed positive effects on Competence (β = 0.209, SE= 0.044, p<0.001), Confidence (β = 0.126, SE= 0.040, p=0.002) and Connection (β = 0.223, SE= 0.043, p<0.001). Conversely, gender had differentiated effects on the evaluated variables, being associated with a decrease in levels of Competence (β = -0.327, SE= 0.042, p<0.001), Confidence(β = -0.273, SE= 0.039, p<0.001), and Connection (β = -0.193, SE= 0.042, p<0.001), and an increase in levels of Caring (β = 0,126, SE= 0.042, p=0.003). Regarding ethnicity, it was positively associated with Connection only (β = 0.091, SE= 0.042, p=0.031).

The second model, which examined the effects of social determinants on mental health, yielded satisfactory goodness of fit indices (χ2₍₅₄₂₎=1448.681; χ2/df = 2.672; RMSEA = 0.052 [90% CI = 0.049 – 0.056]; CFI = 0.951; TLI = 0.947; SRMR = 0.075). This model explained 14.5% of the variability in PMH (p<0.001) and 13.4% in NMH (p<0.001). Neither parental educational level nor ethnicity significantly affected adolescent mental health. However, family affluence had positive effects on PMH (β = 0,244, SE= 0.039, p<0.001) as well as a negative effect on NMH (β = -0.135, SE= 0.041, p<0.001). On the other hand, gender showed consistently unfavorable effects for adolescent girls, being associated with a reduction in their levels of PMH (β = -0.278, SE= 0.039, p<0.001), and an increase in NMH (β = 0.340, SE= 0.037, p<0.001). Surprisingly, migration status was positively related to an increase in PMH (β = 0.085, SE= 0.038, p=0.027) and a decrease in NMH (β = -0.104, SE= 0.037, p=0.005).

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Figure 1. Structural Equation Models of Social Determinants on the 5Cs of Positive Youth Development (A) and on Mental Health (B)

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Note. *p<0.05; **p<0.01; ***p<0.001. The observed indicators of the latent variables have been omitted for clarity. Dashed gray arrows indicate non-significant results, so regression coefficients for these paths are not shown.

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Effects of the 5Cs of Positive Youth Development on Mental Health

A structural equation model was used to assess how the 5Cs of Positive Youth Development (PYD) influence mental health. The goodness of fit indices indicated a satisfactory fit to the data (χ2₁₉₂₆ = 4228.652; χ2/df = 2.196; RMSEA = 0.044 [90% CI = 0.042 – 0.046]; CFI = 0.932; TLI = 0.929; SRMR = 0.058), supporting its capacity to describe the relationships between the 5Cs and the dimensions of mental health. This model accounted for a significant portion of the variance in adolescent mental health, explaining 67.7% for PMH (p<0.001) and 37.5% for NMH (p<0.001).

The standardized effects, detailed in Figure 2, show that only Confidence and Connection from PYD had an influence on mental health measures, underscoring their relevance as key predictors of mental health in Chilean adolescents. Specifically, Confidence had a direct positive effect on PMH (β = 0.394, p<0.000) and a negative effect on NMH (β = -0.480, p<0.001). Similarly, Connection had a direct positive effect on PMH (β = 0.454, p< 0.001) and a negative effect on NMH (β = -0.235, p=0.006).

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Figure 2. Structural Equation Model of the 5Cs of Positive Youth Development on Mental Health

INSERT FIGURE 2 APPROX HERE

Note. ***p<0.001. The observed indicators of the latent variables have been omitted for clarity. Dashed gray arrows indicate non-significant results, so regression coefficients for these paths are not shown.

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Mediating Role of Positive Youth Development Between Social Determinants and Mental Health

To assess the mediating role of Positive Youth Development (PYD), a structural equation model (SEM) was estimated, incorporating only those variables that showed significant effects on mental health in previous analyses. Specifically, gender, migration status, and family affluence were included as predictors, while the PYD dimensions of Confidence and Connection were analyzed as mediators, with PMH and NMH as dependent variables. A bootstrap procedure with 5000 samples was used to strengthen the confidence interval estimates. The goodness of fit indices demonstrated the adequacy of the model (χ2₍₁₀₁₂₎ = 2475.606, χ2/df = 2.446, RMSEA = 0.049 [90% CI= 0.046 – 0.051], CFI = 0.942, TLI = 0.938, SRMR = 0.058). This last one model explained 69.4% of the variance in PMH (p<0.001) and 38.1% in NMH (p<0.001). Detailed results on the direct and indirect effects from this model are presented in Figure 3 and Table 2, respectively.

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Figure 3. Direct Effects of Social Determinants and Positive Youth Development on Mental Health

INSERT FIGURE 3 APPROX HERE

Note. *p< 0.05; **p< 0.01; ***p< 0.001. The observed indicators of the latent variables have been omitted for clarity. Dashed gray arrows indicate non-significant results, so regression coefficients for these paths are not shown.

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In terms of direct effects, family affluence showed a significant impact on Confidence (β=0,143, SE=0.043 [95% CI: 0.057 – 0,230], p<0.001), Connection (β=0,218, SE=0.045 [95% CI: 0,128 – 0,307], p<0.001), and PMH (β=0,112, SE=0.028 [95% CI: 0.056 – 0,169], p<0.001). Additionally, partial mediation was observed in its effect on PMH through Confidence (β=0.063, SE=0.020 [95% CI: 0.027 – 0,108], p=0.002), and Connection (β=0.086, SE=0.021 [95% CI: 0.049 – 0,133], p<0.001), resulting in a total effect on PMH of 0.261 (SE=0.040 [95% CI: 0,180 – 0,340], p<0.001).

In contrast to previous analyses (Figure 1B), family affluence lost its direct statistical significance on NMH (β=-0.043, SE=0.038 [95% CI: -0.121 – 0.034], p=0.262). In this context, Confidence emerged as a full mediator in this relationship (β=-0.063, SE=0.021 [95% CI: -0.111 – -0.028], p=0.002), while Connection did not show a significant indirect effect on NMH (β=-0.023, SE=0.017 [95% CI: -0.064 – 0.005], p=0.183). Overall, the total effect of family affluence on NMH was -0.129 (SE=0.042 [95% CI: -0.214 – -0.046], p=0.002).

On the other hand, being female had a direct negative impact on Confidence (β=-0.278, SE=0.038 [95% CI: -0.352 – -0.201], p<0.001), Connection (β=-0.186, SE=0.043 [95% CI: -0.268 – -0.101], p<0.001), and PMH (β=-0.083, SE=0.029 [95% CI: -0.139 – -0.026], p=0.004), as well as a positive effect on NMH (β=0,199, SE=0,34 [95% CI: 0,132 – 0,266], p <0.001).

Partial mediation was identified in the effect of gender on PMH through reductions in Confidence (β=-0,123, SE=0.023 [95% CI: -0,172 – -0.082], p<0.001) and Connection (β=-0.073, SE=0.020 [95% CI: -0,117 – -0.038], p<0.001). Overall, the total effect of gender on PMH was -0.279 (SE=0.038, [95% CI: -0,347 – -0,200], p<0.001). Regarding the indirect effect of gender on NMH through the dimensions of PYD, Confidence was identified as a partial mediator, (β=0,122, SE=0.025 [95% CI: 0.077 – 0,177], p<0.001), indicating that a decrease in Confidence among females is associated with an increase in mental health problems. In contrast, Connection did not play a significant mediating role (β=0.020, SE=0.014 [95% CI: -0.005 – 0.055], p=0,174). Consequently, the total effect of gender on NMH reached a β coefficient of 0.341 (SE= 0.035 [IC = 0,273 – 0,407], p<0.001).

Regarding migration status, a direct negative effect was observed on NMH (β=-0.072, SE=0.034 [95% CI: -0,139 – -0.005], p=0.036), indicating a statistically significant difference in NMH levels, with migrant adolescents showing lower levels compared to their Chilean peers. No significant indirect effects of migration status on mental health were detected, mediated by the dimensions of PYD considered in the model.

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This study aimed to analyze the influence of social determinants (SD) and positive youth development (PYD) on the mental health (MH) of Chilean adolescents. As a starting point, three theoretical approaches were integrated: the Social Determinants of Health model, the 5Cs of Positive Youth Development, and the Dual-factor model of Mental Health, providing a comprehensive framework for analyzing the complex interactions between social context, individual capacities, and mental health.

In line with the first hypothesis (SD → 5Cs of PYD), the results indicate that parental educational level, family affluence, gender, and ethnicity have differentiated impacts on the 5Cs of PYD, contributing concrete evidence to an area of research that, to date, has received limited attention.

Parental educational level significantly influenced the Character and Caring dimensions, contrasting with the findings of Arshad et al. (59), where no such effect was observed in Pakistani youth. This divergence may be attributed to the use of specific PYD measures (5Cs) in the present study, compared to a global measure in Arshad et al. (59), potentially masking the effect of SD on individual components of positive development. Moreover, a considerable portion of the variability in Character and Caring remains unexplained in the present model, suggesting that other parental attributes, such as parenting practices (60), could play a significant role in moderating the impact of parental education on these two dimensions.

With respect to gender, Martin-Barrado and Gomez-Baya (61), identified a differential pattern in the expression of the 5Cs of PYD in Europe, where males tended to score higher in Confidence and Competence, while females showed higher scores in the remaining dimensions. The present findings partially corroborate this trend, albeit with some variations, as no significant differences were observed in Character, and females scored significantly lower in Connection. These differences may be rooted in gender stereotypes that: 1) promote empathy and sensitivity as desirable female qualities; 2) restrict adolescent girls' personal autonomy by limiting their ability to establish interpersonal networks beyond the immediate family caregiving context; and 3) challenge their competence in areas traditionally dominated by males, such as certain academic or sports disciplines (62).

Regarding family affluence and ethnicity, this study addresses a gap in the literature, as no previous studies have directly evaluated the impact of these determinants on PYD. The findings suggest that family affluence positively influences Competence, Confidence, and Connection, indicating that greater economic resources may facilitate the development of social and cognitive skills, and improve adolescents' social integration (63). In contrast, ethnicity had a significant influence only on Connection. This result may reflect the impact of cultural practices that promote communal life in indigenous populations, which could explain why family and community ties are stronger among this group of adolescents.

Concerning the second hypothesis (SD → MH), it was found that gender, family affluence, and migration status significantly influence both the adaptive and maladaptive aspects of mental health.

Family affluence was associated with increases in positive mental health (PMH) and reductions in negative mental health (NMH). These results are consistent with international evidence highlighting the effects of socioeconomic inequality on adolescent mental health (14, 40, 63) and have been corroborated in Chile by Caqueo-Urízar et al. (42), Varela et al. (64), and Vicente et al. (65). These findings underscore the importance of socioeconomic conditions as critical determinants of mental health and reinforce the need for public policies aimed at reducing social inequalities.

Gender had distinct effects on mental health, with adolescent girls exhibiting lower levels of PMH and higher levels of NMH compared to adolescent boys. These findings align with the review of mental health studies involving Latin American youth conducted by Sánchez-Castro et al. (40) and have been corroborated in Chilean adolescents by Caqueo-Urízar et al. (42), Crockett et al. (66), and Flores-Jara et al. (67), who found that girls tend to report higher mental health issues and lower levels of well-being.

For migration status, the evidence highlights a positive impact on mental health (MH), suggesting that migrant adolescents experience better levels of well-being and face fewer mental health issues compared to their Chilean peers. These findings appear to contradict the predictions of the Social Determinants of Health (SDH) model, which anticipates a negative impact of migration on mental health due to factors such as inequality, limited access to healthcare services, and social exclusion. However, this observation aligns with the study by Pinto-Cortez et al. (68), who found similar patterns when comparing Chilean and migrant children and adolescents. This phenomenon could be explained by both the greater resilience developed through migratory experiences and strong social support networks within migrant communities, as well as effective integration into the host country, facilitated by Chile's social policies over recent decades.

Regarding the third hypothesis (5Cs of PYD → MH), the results highlight the influence of two of the five PYD dimensions—Confidence and Connection—on improving adolescent mental health.

It was observed that the Confidence and Connection dimensions have significant effects both in promoting PMH and reducing NMH. These findings are consistent with the study by Marín-Gutiérrez et al. (36) on Chilean adolescents, where the same dimensions played a role in reducing anxiety, stress, depression, and emotional distress. Similarly, Pérez-Díaz et al. (45) found that Confidence, Character, and Connection positively impact the psychological well-being of Chilean university students. Other studies in Peru and Spain (37), Croatia (38), and Norway (69), have corroborated the protective effect of these PYD dimensions with various mental health outcomes. However, Martin-Barrado and Gomez-Baya (61) caution that cultural differences may influence these results, suggesting the need for further research. Although the evidence on the 5Cs in the Chilean context remains limited, the findings reinforce the importance of fostering youth capacities and competencies as key components in strategies to improve mental health.

In relation to fourth hypothesis (SD → 5Cs of PYD → MH), the results indicate that Confidence and Connection mediate the relationship between social determinants and adolescent mental health.

Confidence and Connection were found to partially mediate the relationship between family affluence and PMH, while Confidence fully mediated the relationship between this determinant and NMH. This suggests that economic security not only alleviates daily stressors and concerns, enhancing well-being and reducing mental health problems, but also provides essential resources for greater positive development, allowing adolescents to focus more on their personal and social growth, which translates into benefits for their mental health. Additionally, Confidence and Connection also partially mediate the effects of gender on both PMH and NMH. This implies that the influence of gender operates not only directly on mental health but also indirectly, by reducing adolescent girls' levels of Confidence and Connection, perpetuating gender inequalities in mental health.

These findings are consistent with previous evidence highlighting the mediating role of Confidence and Connection in the relationship between school empowerment and school satisfaction (70), as well as the role of Confidence between positive identity and psychological well-being (45). Together, our results underscore the importance of these dimensions as facilitators of positive adaptations in various areas of psychological functioning.

This study stands out for its innovative approach in analyzing the interaction between social determinants, positive youth development, and mental health, integrating three internationally renowned theoretical frameworks. The study provides novel evidence in the Chilean context regarding the impact of various social determinants on the 5Cs of PYD, highlighting the key mediating role of Confidence and Connection. These findings enhance the understanding of how family affluence and gender influence mental health, offering a solid foundation for the design of effective policies and interventions.

Several limitations should be noted. The cross-sectional design restricts the ability to infer causality between variables, making it impossible to determine whether socioeconomic conditions or the development of personal skills precede changes in mental health. The analyses are based on a convenience sample from Northern Chile, which may not be representative of other geographical areas of the country, restricting the generalization of the findings. Additionally, the use of self-reported measures may introduce biases, particularly in sensitive variables related to the family environment and mental health.

To overcome these limitations and expand the scope of these findings, future research should consider a longitudinal design, which would facilitate a better understanding of the trajectories of positive development and its causal effects. Expanding the sample to other regions of Chile would also help determine whether the observed effects are consistent across different socioeconomic and cultural contexts. Further studies could explore specific interventions aimed at strengthening Confidence and Connection, assessing their effectiveness in improving adolescent mental health in varied socioeconomic settings, and providing guidelines for relevant adaptations.

In conclusion, this study presents compelling empirical evidence suggesting that social determinants and positive youth development exert a significant influence on the mental health of Chilean adolescents. The findings indicates that family affluence and gender impact both the adaptive and maladaptive dimensions of mental health not only directly, but also indirectly through mediating factors such as Confidence and Connection. These results highlight the importance of incorporating both socioeconomic context and individual capacities into mental health promotion strategies. In doing so, it emphasizes the need to move beyond the traditional symptom-focused approach and shift toward interventions that promote holistic well-being throughout adolescence.

Ethics approval and consent to participate

The ethical aspects of this study were reviewed and approved by the Scientific Ethics Committee of the Universidad de Tarapacá (CEC-UTA). The study was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki and its subsequent amendments. Written informed consent was obtained from parents and guardians, while informed assent was obtained from adolescents.

Consent for publication

Not applicable.

Availability of data and material

The data analyzed in this research cannot be shared publicly at this time. This decision is based on the fact that the data in question are a critical part of an ongoing doctoral project led by the corresponding author. Since the research is still in progress, releasing the data at this stage could compromise the integrity and outcomes of the doctoral project.

Competing interests

The authors declare that they have no competing interests.

Funding

The present article is part of the doctoral research project of the first author, who is funded by the National Agency for Research and Development (ANID) of Chile through its Doctoral National Scholarship program (Year 2021 File No. 21210257). The research also received funding from ANID PIA CIE160007, the Center for Educational Justice (CJE).

Authors' contributions

M.M-G. and A.C-U. conceptualized the study. M.M-G. was responsible for the methodology, development, investigation process, data curation, formal analysis, and original draft writing. A.C-U. provided supervision and project administration and acquired the funding. M.M-G. and A.C-U. reviewed, edited, and approved the final manuscript.

Acknowledgements

We thank the adolescents and their families for participating in the study, as well as the school administrators and staff who facilitated the data collection.

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Table 1 Descriptive Statistics, Univariate Normality, and Internal Consistency

	Min.	Max.	M	SD	W	p	α	ω
Family Affluence	0	9	5.724	2.046	0.960	<0.001	–	–
Competence	1	5	3.260	0.804	0.987	<0.001	0.753	0.757
Character	1	5	3.759	0.638	0.974	<0.001	0.748	0.759
Confidence	1	5	3.331	1.025	0.969	<0.001	0.896	0.898
Caring/Compassion	1	5	3.990	0.789	0.927	<0.001	0.855	0.862
Connection	1	5	3.451	0.754	0.989	<0.001	0.811	0.812
Positive Mental Health	0	10	6.597	1.983	0.975	<0.001	0.894	0.895
Negative Mental Health	0	3	1.271	0.796	0.960	<0.001	0.950	0.950

Note. Min. and Max. values are the theoretical limits for each scale and are included to facilitate the interpretation of the results.

Table 2 Indirect Effects of Confidence and Connection on Social Determinants and Mental Health

Path							90% CI
Path					β	SE	LL	UL	p
Family Affluence	à	Confidence	à	PMH	0.063	0.020	0.027	0,108	0.002
		Confidence	à	NMH	-0.063	0.021	-0.111	-0.034	0.002
		Connection	à	PMH	0.086	0.021	0.049	0.133	0.000
		Connection	à	NMH	-0.023	0.017	-0.065	0.005	0.183
Gender	à	Confidence	à	PMH	-0.123	0.023	-0.172	-0.082	0.000
		Confidence	à	NMH	0.122	0.025	0.077	0,177	0.000
		Connection	à	PMH	-0.073	0.020	-0,117	-0.038	0.000
		Connection	à	NMH	0.020	0.014	-0.005	0.055	0.174
Migrant Status	à	Confidence	à	PMH	0.024	0.018	-0.011	0.060	0189
		Confidence	à	NMH	-0.024	0.019	-0.062	0.011	0.199
		Connection	à	PMH	0.033	0.019	-0.003	0.064	0.079
		Connection	à	NMH	-0.009	0.008	-0.033	0.001	0.284

Note. PMH = Positive Mental Health; NMH = Negative Mental Health; SE = Standard Error; LL = Lower Limit; UL = Upper Limit. Significant results are in bold.

No competing interests reported.

The Influence of Social Determinants and 5Cs of Positive Youth Development on the Mental Health of Chilean Adolescents

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Abstract

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Introduction

The present study

Methods

Design

Participants

Variables and Instruments

Procedure

Data analysis

Results

Discussion

Declarations

References

Tables

Additional Declarations

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