Early-stage profiles of adolescent mental health difficulties and well-being: A systematic review of cluster analyses in large school and community samples

Traditional diagnostic and services pathways often overlook the nuanced ways that mental health problems and strengths appear in community settings. Some researchers have therefore used person-centered statistics—or clustering analyses—to identify profiles of socioemotional and behavioral difficulties and well-being traits in preclinical settings such as schools and communities. The objective of this review was to synthesize common adolescent mental health profiles within the literature and examine the state of the science. A systematic review of the literature was completed. Only studies that assessed multiple types of difficulties and/or strengths across community and/or school samples were included. A total of 3960 studies were screened, and k = 13 were included. Data extraction focused on the types of clusters in each included study, along with associated information like standardized scores, qualitative descriptions, sample size, and demographic characteristics. Data were integrated using a narrative synthesis, and meta-analysis was used to investigate the prevalence of each cluster. Data were reviewed from n = 103,098 adolescents in 10 countries across 3 World Health Organization (WHO) Regions with a mean (SD) age of 13.72 ± 1.76 years. A total of 59 clusters were identified, and these consisted of 6 main cluster types. The 4 most prevalent cluster types described patterns of Flourishing, Moderate Mental Health, Struggling, and Mental Health Problems. The other 2 cluster types were less prevalent and associated with Languishing or Asymptomatic presentations. Cluster types also differed with respect to the intensity, complexity, and depth of the core profile features. This review describes commonly identified mental health profiles in large representative samples of adolescents. The quality of included studies was generally acceptable, but the literature suffers from variance in how clusters are generated and how mental health is assessed. Overall, this review can guide the development of new classifications of youth mental health and inform early-stage intervention approaches in community settings.