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 challenges such as isolation and peer victimization [3], low academic performance [3], school absenteeism [4] and an increased risk of suicide [5]. Moreover, 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 [8,9,10]. However, focusing exclusively on reducing clinical symptoms fails to capture the full complexity of mental health [11,12,13]. This requires adopting a holistic and multivariable approach that extends the traditional notion of mental health as merely the absence of clinical symptoms, integrates social contexts of development, while identifying and promoting adolescents’ strengths and capacities [9, 14].
The dual-factor models, also known as dual-continuum models, have been proposed as an alternative to the traditional deficit-based approach [13, 15, 16]. These models argue that the absence of psychopathology does not guarantee good mental health; instead, mental health should be assessed through two independent but related dimensions:
-
Well-being: The positive dimension of mental health, encompassing life satisfaction, happiness, and optimal functioning across different life domains, enabling individuals to experience a sense of personal fulfillment.
-
Psychopathology: The negative dimension of mental health, referring to the presence of symptoms and behaviors indicative of mental disorders, such as anxiety, depression, or other significant markers of distress.
By considering both positive and negative aspects of mental health, this model provides a framework for understanding how different risk and protective factors influence each dimension separately. Evaluating both factors is crucial, as it offers empirical evidence to support the design of preventive interventions that not only reduce specific problems but also actively promote a fulfilling and satisfying life during adolescence.
While this model broadens our understanding of adolescent mental health, it is essential to recognize that mental health outcomes are not solely determined by individual factors. Instead, they are shaped by broader structural and environmental conditions. Several scholars have emphasized that improving our understanding of health and enhancing interventions requires shifting the focus toward these underlying influences [10, 17, 18]. This perspective highlights the importance of examining social determinants as key factors shaping adolescents’ living conditions and mental well-being.
Recognizing their impact, 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” [19]. 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 [20, 21].
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 based on their socioeconomic position (SEP) within hierarchies of power, prestige and access to resources, ultimately affecting their health outcomes [19, 22]. The SDH model defines a set of proxy variables to assess socioeconomic position, each of which affects health in a distinct and significant way [20]:
-
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 leads to inaccuracies due to their limited knowledge of specific details about their family situation, increasing measurement error and the volume of missing data [23]. In response, indirect measures such as family wealth assessment [24, 25] or composite indicators are employed to obtain more accurate estimates [23].
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 [20, 26]. 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, 26,27,28,29]. From this perspective, human development is understood as a lifelong process embedded within key social contexts—such as family, school, peers, and the broader community—which are particularly influential during childhood and adolescence [30,31,32]. Consequently, young people are more likely to follow healthy developmental trajectories when their personal strengths align with the support and opportunities provided by their environment [33, 34].
Building upon this ecological and strengths-based perspective, the 5Cs model of PYD, proposed by Lerner [1, 35], has emerged as one of the most influential theoretical frameworks for understanding positive adolescent development [29, 36]. This model operationalizes the idea that adolescent growth is shaped by both individual strengths and supportive resources provided by their social environment. Based on both professional experience and an extensive literature review on adolescent development, Lerner [1, 35] 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, adherence to appropriate 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 [26]. According to Lerner et al. [35], 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” [37], 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 [35, 38]. 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 [39,40,41] and externalizing problems [42], as well as higher levels of well-being [43, 44], life satisfaction [45], and healthy lifestyles [46], 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 [47,48,49,50] and their ability to promote well-being [50]. By contrast, high levels of Caring have been associated with mixed and even maladaptive outcomes [51].
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 [52]. 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 [53], and that educational and socioeconomic vulnerability significantly impact mental health [54]. More recently, Marín-Gutiérrez et al. [55] 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. [56] 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 [48]. Similarly, Pérez-Díaz et al. [57] 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 SDH framework [19, 22] and the 5Cs of PYD [1, 35] and the dual-factor model of mental health [13, 15, 16].
This model proposes that experiences derived from SD, whether positive or adverse, directly impact adolescent mental health, encompassing both subjective well-being (SWB) and psychopathological symptoms (PTH; hereafter used interchangeably with ‘psychopathology’). Factors such as family socioeconomic conditions, parental educational level, gender, ethnicity, and migrant status significantly shape adolescents’ living conditions, acting as either facilitators or barriers to mental health. Additionally, SD shape positive youth development (PYD) by influencing the opportunities and resources available for adolescents to develop their strengths and capabilities. PYD plays a crucial role in adolescent mental health by fostering adaptive skills to navigate developmental challenges, acting as a protective factor against psychopathology, and promoting well-being through enhanced life satisfaction, personal growth, fulfillment, and stronger social connections. Furthermore, PYD mediates the relationship between SD and mental health, serving as a key pathway through which social conditions influence mental health outcomes. Adolescents with greater access to social and economic resources are more likely to develop personal and social strengths that enhance SWB and provide a buffer against PTH.
Based on this framework, the following hypotheses 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, with a positive direct effect on Subjective Well-Being and a negative direct effect on Psychopathology.
-
H4: The 5Cs of Positive Youth Development mediate the relationship between Social Determinants and Mental Health.
link
