Progressing “Positive Epidemiology”: A Cross-national Analysis of Adolescents’ Positive Mental Health and Outcomes During the COVID-19 Pandemic

Purpose: “Positive epidemiology” emphasizes strengths and assets that protect the health of populations. Positive mental health refers to a range of social and emotional capabilities that may support adaptation to challenging circumstances. We examine the role of positive mental health in promoting adolescent health during the crisis phase of the COVID-19 pandemic. Methods: We used four long-running Australian and UK longitudinal cohorts: Childhood to Adolescence Transition Study (CATS; analyzed N = 809; Australia); Longitudinal Study of Australian Children (LSAC) – Baby (analyzed N =1,534) and Kindergarten (analyzed N = 1,300) cohorts; Millennium Cohort Study (MCS; analyzed N = 2,490; United Kingdom). Measures included prepandemic exposure: positive mental health (parent reported, 13–15 years) including regulating emotions, interacting well with peers, and caring for others; and pandemic outcomes: psychological distress, life satisfaction, and sleep and alcohol use outside of recommendations (16–21 years; 2020). We used a two-stage meta-analysis to estimate associations between positive mental health and outcomes across cohorts, accounting for potential confounders. Results: Estimates suggest meaningful effects of positive mental health on psychosocial outcomes during the pandemic, including lower risk of psychological distress (risk ratio [RR] = 0.83, 95% confidence interval [CI] = 0.71, 0.97) and higher life satisfaction (RR = 1.1, 95% CI = 1.0, 1.2). The estimated effects for health behaviors were smaller in magnitude (sleep: RR = 0.95, 95% CI = 0.86, 1.1; alcohol use: RR = 0.97, 95% CI = 0.85, 1.1). Conclusions: Our results are consistent with the hypothesis that adolescents’ positive mental health supports better psychosocial outcomes during challenges such as the COVID-19 pandemic, but the relevance for health behaviors is less clear. These findings reinforce the value of extending evidence to include positive health states and assets.