# The ubiquitous sex differences in adolescent mental health: Do we overlook parts of a more complex puzzle?

## TL;DR

This study explores how mental health assessments may show sex differences in adolescents due to biased indicators or measurement issues.

## Contribution

The study reveals potential sex-based biases in mental health instruments and highlights the complexity of measuring adolescent mental health.

## Key findings

- Some indicators contribute differently to mental health constructs for each sex.
- Several indicators in the instruments may be biased regarding sex.
- Measurement differences suggest a need for more nuanced approaches to adolescent mental health assessments.

## Abstract

This study investigates sex differences in three widely used mental health instruments: the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and the Hopkins Symptom Checklist (HSCL)-5, and HSCL-10. The psychometric properties and differential item functioning (DIF) of the instruments were explored using measurement invariance tests and multiple indicators multiple causes (MIMIC) models to more fully inspect potential indicator-level differences that may lead to bias.

There were two adolescent samples in this study. One sample was in grade 8 (ages range: 13–14; 49% females), and the other was in grade 11 (age range: 16–17; 45% females).

The results indicate (1) a dissimilar contribution of some indicators to their latent construct across sexes or a mean sex difference in indicators that are not captured by the construct, and (2) that several indicators of the instruments might be biased regarding sex.

This study contributes to our knowledge of the complexity of sex differences in the measurement of adolescent mental health.