Neurocognitive outcome and associated factors in long-term, adult survivors of childhood acute lymphoblastic leukemia, treated without cranial radiation therapy.

OBJECTIVE: There is limited research on neurocognitive outcome and associated risk factors in long-term, adult survivors of childhood acute lymphoblastic leukemia (ALL), without treatment of cranial radiation therapy. Moreover, the impact of fatigue severity and pain interference on neurocognition has received little attention. In this cross-sectional study, we examined neurocognitive outcome and associated factors in this population. METHOD: Intellectual abilities, verbal learning/memory, processing speed, attention, and executive functions were compared to normative means/medians with one sample t tests or Wilcoxon signed-rank tests. Associations with risk factors, fatigue severity, and pain interference were analyzed with linear regressions. RESULTS: Long-term, adult survivors of childhood ALL (N = 53, 51% females, mean age = 24.4 years, SD = 4.4, mean = 14.7 years post-diagnosis, SD = 3.4) demonstrated above average intellectual abilities, but performed below average in attention, inhibition, processing speed, and shifting (p < 0.001). Executive functioning complaints were significantly higher than normative means, and positively associated with fatigue (p < 0.001). There was no interaction between sex and fatigue and no neurocognitive impairments were associated with pain interference, risk group, age at diagnosis, or sex. CONCLUSIONS: Long-term, adult survivors of ALL treated without cranial radiation therapy, demonstrate domain-specific performance-based neurocognitive impairments. However, continued research on the neurocognitive outcome in this population as they age will be important in the coming years. Executive functioning complaints were frequently in the clinical range, and often accompanied by fatigue. This suggests a need for cognitive rehabilitation programs.

Nursing Students' Experiences on Psychosocial Learning Environment, Personal and Social Challenges and Communication in Periods of Social Isolation: A Qualitative Study.

In March 2020, the World Health Organization declared the global COVID-19 pandemic outbreak and the Norwegian government declared lockdown to stop the virus from spreading. In Norway, universities were immediately closed, and all teaching and learning were done digitally for the rest of the spring semester 2020. Our aim was to explore nursing students experience with studying and learning, as well as the psychological consequences it may incur during a period of social isolation during the Covid-19 pandemic lockdown. The study is a qualitative study based on a focus group with 6 nursing students. The analysis was conducted following Kvale's approach to qualitative analysis. Three main categories were identified: (1) psychosocial learning environment, (2) personal and social challenges, and (3) communication. We found that the restrictions due to social isolation and pandemic restrictions such as closing of the university campus, has impacted students` study situation significantly, both psychosocially and academically. If social isolation should be necessary in the future, universities need to use methods such as group discussions, quizzes, and short breaks in the lectures to prevent unnecessary problems among the students. Personal challenges due to the social isolation, such as anxiety or other mental health issues are more difficult to avoid or prevent, but the universities must be better prepared to give students more personal communication, have unformal meetings and providing more information to the students in times of crisis.

Protective and risk factors in the grieving process among cancer-bereaved parents: A qualitative study.

This Norwegian nationwide study explored cancer-bereaved parents' perceptions of protective and risk factors in their grieving process. A total of 162 parents answered two open-ended questions 2-8 years after their child's death due to cancer. Qualitative analysis revealed three main themes: memories of the child's illness and death, going forward in life, and relationships-a resource and a barrier. The results support the perspective of going forward in life and accepting grief as part of life, contrary to the notion of "getting over" or "detaching" from the deceased child. Social support is also crucial for cancer-bereaved parents.

Validation of the brief instrument "Health Literacy for School-Aged Children" (HLSAC) among Norwegian adolescents.

Health literacy (HL) has been identified as an important and modifiable determinant of health. To succeed in promoting HL, it is crucial to evaluate interventions addressing HL using validated instruments. However, HL measurement is an under-researched area among adolescents. The Health Literacy for School-Aged Children (HLSAC) scale is developed in Finland to measure the subjective HL levels of school-aged children. The HLSAC has been used and validated across Europe. No validated instrument for measuring HL among Norwegian adolescents has been identified. Therefore, the aim of this study was to assess the psychometric properties of the HLSAC among Norwegian adolescents in upper secondary schools. Cross-sectional data were collected in 2017 from 1 054 adolescents with a response rate of 93.5%. The participants were students aged 16-21 (mean = 17.3) years from four upper secondary schools in an urban area in Mid-Norway. Confirmatory factor analysis (CFA) was utilized to investigate the underlying dimensionality of the data together with composite reliability based on Raykov's reliability coefficient and certain aspects of construct validity. The original ten-item one-dimensional version of the HLSAC revealed a poor fit. A one-dimensional version including six of the original ten items presented the best fit to our data, demonstrating good reliability and construct validity. This validation study suggests a one-dimensional solution of the HLSAC scale including six of the original ten items, i.e., the HLSAC-6 as a statistical valid and reliable measure for HL among adolescents in upper secondary schools. However, the modifications of the instrument indicate the need for further investigation of the HLSAC in this age group, i.e. by conducting cognitive interviews and focus-group discussions on the concept of HL among adolescents. Testing the wording of the HLSAC prior to additional psychometric evaluations of both the original HLSAC and the suggested HLSAC-6 is recommended. Finally, developing more age-appropriate items for the measurement of HL in this age-group is suggested.

Impact of resilience and social support on long-term grief in cancer-bereaved siblings: an exploratory study.

BACKGROUND: Bereavement research has mainly explored potential risk factors associated with adverse outcomes, and the role of protective factors has received less attention. More knowledge is needed about factors related to unresolved grief in bereaved siblings. This study aimed to assess grief adjustment and possible gender differences among bereaved young adults 2-10 years after losing a brother or sister to cancer. We also sought to explore how resilience and social support influenced their grief. METHODS: A total of 99 young adults (18-26 years) who had lost a brother or sister to cancer between the years 2009 and 2014 were invited to participate in this Norwegian nationwide study. The study-specific questionnaire was completed by 36 participants (36.4%). Social support during the sibling's illness, after the death, and during the past year, in addition to grief and resilience, were measured. RESULTS: Overall, the prevalence of unresolved grief was 47.2% among bereaved siblings, whereas 52.8% had worked through their grief. The level of having worked through grief and resilience was similar between male and female siblings. Bereaved siblings with higher Personal Competence reported lower unresolved grief. CONCLUSION: Approximately half of the young adults experience unresolved grief 2-10 years after losing a sibling to cancer. The findings also highlight the need for long-term support for bereaved siblings to help improve their resilience and better have worked through their grief.

Association between loneliness, self-esteem and outcome of life satisfaction in Norwegian adolescents aged 15-21.

AIMS: Adolescence is an important developmental stage for understanding the role of perceived loneliness and self-esteem on life satisfaction. This study investigated the association between loneliness, self-esteem and the outcome of life satisfaction, as well as potential interaction effects in association with life satisfaction, in a sample of Norwegian adolescents. METHODS: The study was based on a cross-sectional sample of 1816 adolescents aged 15-21 years. Data were collected in September 2016. The participants reported scores on the five-item Satisfaction with Life Scale, the 10-item Rosenberg Self-Esteem Scale and one item assessing loneliness. Control variables included sex, age, perceived family economy, parents' education, place of birth and perceived bullying. The data were analysed with descriptive and multiple linear regression analysis. RESULTS: A significant negative and moderately strong association was found between loneliness and life satisfaction, where the association was stronger for girls than for boys. Self-esteem showed a significant positive and strong association with life satisfaction; however, no significant interaction effect was found. CONCLUSIONS: The findings show the significant role of both loneliness and self-esteem in association with adolescents' perception of life satisfaction. The findings support promoting self-esteem, belongingness and social integration in all daily life contexts for adolescents to support their life satisfaction.

The role of perceived loneliness and sociodemographic factors in association with subjective mental and physical health and well-being in Norwegian adolescents.

AIMS: Adolescence is a particularly salient period for understanding the role of perceived loneliness for subjective health and well-being. This study investigated sociodemographic differences (sex, age, self-reported socio-economic status (SES)) in loneliness and associations between sociodemographic factors, loneliness and self-rated health (SRH), subjective health symptoms, symptoms of depression/anxiety and mental well-being (MWB) in a sample of Norwegian adolescents. METHODS: The study was based on a cross-sectional sample of 1816 adolescents aged 15-21 years. The participants reported scores on an 11-item scale assessing subjective health complaints (SHC), one item each assessing SRH and loneliness, the 10-item version of the Hopkins Symptom Checklist and the seven-item version of the Warwick-Edinburgh Mental Well-Being Scale. SES was assessed using perceived family economy and parents' education. Data were analysed with descriptive, comparative and multiple linear regression analyses. RESULTS: The multivariate results showed that boys scored significantly higher on MWB than girls did, whereas girls scored significantly higher on loneliness, depression/anxiety and SHC. Perceptions of poorer family finances were significantly associated with higher levels of SHC and depression/anxiety, lower levels of MWB and more negative SRH. Loneliness showed significant positive associations with depression/anxiety and SHC, and significant negative associations with MWB and SRH. A significant moderation effect of sex by loneliness was found in association with depression/anxiety, with stronger associations for girls. CONCLUSIONS: The findings in this study support the significant roles of sex, perceptions of family finances and loneliness in association with adolescent's subjective mental and physical health and well-being, especially mental health.

Bereaved parents' quality of life: resilience and professional support.

OBJECTIVES: The study aimed to compare the quality of life (QoL) among cancer-bereaved parents with a control group and explore how resilience and support from healthcare professionals associated with QoL of parents 2-8 years after the loss of a child to cancer. METHODS: This nationwide, cross-sectional survey was administered among parents (n=161) who lost their child to cancer between 2009 and 2014, compared with a matched control parent group (n=77). A study-specific questionnaire, Resilience Scale for Adults (six factors: 'Perception of self', 'Planned future', 'Social competence', 'Structured style', 'Family cohesion' and 'Social resources'), and a single-item measure of parents' QoL were included for the study. RESULTS: There was a lower QoL in both bereaved parents (mean=5.1) compared with the control parents (mean=5.8) (p<0.001). Two resilience factors, 'Perception of self' (OR=1.8, p=0.004) and 'Planned future' (OR=2.05, p<0.001), and given sufficient information during the child's last month (OR=2.63, p=0.003) were positively associated with long-term QoL in cancer-bereaved parents. CONCLUSION: The findings indicate lower QoL among both fathers and mothers 2-8 years after losing a child to cancer. The study also highlights the positive role of resilience and the importance of informational support on long-term QoL in cancer-bereaved parents. Bereavement support should be tailored for supporting individual needs.

Cognitive Rehabilitation for Neurocognitive Late Effects in Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Feasibility and Case-Series Study.

Neurocognitive late effects following the diagnosis and treatment of childhood acute lymphoblastic leukemia (ALL) commonly include impaired executive functions (EFs), with negative consequences for one's health-related quality of life and mental health. However, interventions for EF impairments are scarce. Thus, the aims of this study were to (1) explore the feasibility and acceptability of the cognitive rehabilitation program Goal Management Training (GMT) and (2) examine whether GMT is associated with positive outcomes across cases of ALL survivors with EF complaints. Four participants (median age 31.5 years) underwent nine GMT modules in a total of five group sessions. Rehabilitation was focused on compensatory strategies to improve real-life EFs. Participants were evaluated at 2-week and 6-month follow-ups. Evaluation of feasibility and acceptability included adherence, a semi structured interview, self-reports, and safety. Additionally, therapists' experience with implementation was evaluated. Outcome measures included self-reports and neurocognitive tests of attention, EF, and processing speed. All participants completed GMT and rated the intervention as useful, suitable, and satisfactory. The reliable change index showed improved daily life EFs (two participants) and neurocognitive performance (three participants) at 6-month follow-up. Additionally, all participants improved on a "real-life" task involving EF. A future randomized controlled trial is recommended.

Protective and risk factors associated with psychological distress in cancer-bereaved parents: A cross-sectional study.

PURPOSE: Research shows that knowledge about mental health status, both protective and risk factors, is limited in cancer-bereaved parents. The study aimed to investigate (1) the extent of psychological distress in bereaved parents 2-8 years after the loss of a child to cancer compared to non-bereaved parents, and (2) psychological distress in association with resilience, the extent of having coped with the grief, time since the loss, and past psychological distress in cancer-bereaved parents. DESIGN: Retrospective, cross-sectional study. METHODS: A Norwegian nationwide study-specific questionnaire was completed by 162 parents who had lost a child to cancer, and 77 matched non-bereaved parents. We used the Cohort Norway-Mental Health Index and Resilience Scale for Adults to measure psychological distress and resilience, respectively. The extent of having coped with grief was also measured. RESULTS: Bereaved parents experienced significantly more symptoms of psychological distress, albeit not clinical psychological distress, compared to non-bereaved parents. The bereaved parents who have coped with their grief or had higher resilience reported lower psychological distress. Positive "Perception of self" and well "Planned future" were the strongest predictors of psychological distress in both bereaved fathers and mothers. CONCLUSION: Both fathers and mothers experience more psychological distress symptoms 2-8 years after losing a child to cancer than non-bereaved parents. The findings also highlight the need for long-term support to bereaved parents in order to help to improve their resilience and to better cope with their grief.

Bullying, social support and adolescents' mental health: Results from a follow-up study.

Aims: The aim of this study was to examine the predictive roles of being bullied and perceived social support in association with adolescents' mental health. Methods: At two time points, September 2016 and April-June 2017, questionnaires were distributed to students between 15 and 21 years of age in four upper-secondary schools in Norway, with a total sample size of 351. Random- and fixed-effects regression models were used to estimate the effects of being bullied and social support on adolescents' mental health. Results: In the random-effects models, being bullied was associated with lower scores on mental well-being and higher scores on anxiety and depression symptoms. Social support from family and friends was associated with higher scores on mental well-being, as well as fewer anxiety and depression symptoms. However, the results from the fixed-effects model, with more realistic assumptions, indicated that being bullied was only associated with more anxiety and depression symptoms, while support from friends was associated with higher scores on mental well-being and fewer anxiety and depression symptoms. Conclusions: Based on the fixed-effects models, being bullied was associated with more anxiety and depression symptoms. However, being bullied was not significantly associated with mental well-being. Social support from family was not significantly associated with either aspects of mental health. Moreover, social support from friends was associated with higher scores on mental well-being and fewer anxiety and depression symptoms. The two sources of social support did not buffer the negative effects of being bullied on either aspect of mental health.

Resilience as a predictive factor towards a healthy adjustment to grief after the loss of a child to cancer.

INTRODUCTION: Grief among bereaved parents is known to cause psychological distress and physical illness, but knowledge concerning factors that can contribute to health promotion after bereavement is scarce. Childhood cancer remains the most common non-accidental cause of death among children in Norway. The aim of the present study was to explore if resilience factors among cancer-bereaved parents could predict whether they will be able to come to terms with their grief 2-8 years following the loss. METHODS: A Norwegian cross-sectional national survey was conducted among 161 cancer-bereaved parents using a study-specific questionnaire. Logistic regression was used to explore whether resilience factors predicted parents' grief outcome 2-8 years after their loss. RESULTS: On the Resilience Scale for Adults (RSA), three of the resilience factors contributed significantly in predicting whether the parents in the present study would come to terms with their grief 2-8 years after the loss their child: "Perception of self "(OR 2.08, p = .048), "Social resources" (OR 2.83, p = .008) and "Family cohesion" (OR .41, p = .025). The results showed a negative relationship between time since loss (2-6 years) and whether the parents answered that they had come to terms with their grief (p = < .05). The loss of a parent (OR .30, p = .030) combined with the loss of their child had a negative and significant effect on whether they indicated that they had processed their grief. CONCLUSION: The total score of RSA and three of the six resilient factors contributed significantly in predicting whether cancer-bereaved parents in the present study indicated that they had come to terms with their grief to a great extent. The present study supports hypotheses that regard resilience as an important contribution in predicting healthy outcomes in people exposed to adverse life events.

Life satisfaction in association with self-efficacy and stressor experience in adolescents - self-efficacy as a potential moderator.

AIM: This paper reports associations among socio-demographic variables, stressor experience, self-efficacy and life satisfaction among Norwegian adolescents aged 15-21 years and the potential moderating role of self-efficacy on the association between stressor experience and life satisfaction. METHODS: The cross-sectional school-based survey study involved 1816 upper-secondary school students from Mid-Norway. Data were analysed with independent samples t test, Pearson's product moment correlation and multiple linear regression analysis. RESULTS: Bivariate results showed that boys scored higher than girls on life satisfaction and self-efficacy, whereas girls scored higher than boys on all stressor domains. Multiple linear regression analysis showed that life satisfaction declined weakly with age, whereas stronger family economy and having parents who work full-time associated with higher life satisfaction. Stress with teacher interaction, peer pressure, home life, school attendance, school-leisure conflict and school performance were all negatively associated with life satisfaction, whereas self-efficacy associated positively and strongly with life satisfaction. Self-efficacy moderated the association between both interpersonal and school-related stressors and life satisfaction. CONCLUSION: The results provide support for the unique role of stressor experience and self-efficacy in association with adolescents' life satisfaction as well as self-efficacy as a stress moderator in relation to life satisfaction.

The Relationship Between Positive Mental Health Literacy and Mental Well-Being Among Adolescents: Implications for School Health Services.

Mental health education is a central part of school nurses' practice. Mental health literacy is an asset for health that educational initiatives can strengthen, and a significant determinant of mental health. This study was intended to examine the relationship between positive mental health literacy (PMeHL) and mental well-being to discuss its implications for school health services' mental health education. The relationship was assessed using a multiple linear regression model controlling for relevant covariates. Data were derived from a cross-sectional school-based survey including 1,888 adolescents aged 15-21 years (response rate 97.3%). A weak gender difference was found in PMeHL. The regression model accounted for 41% of the variance in adolescents' mental well-being; PMeHL was a significant explanatory variable of mental well-being. Accordingly, the current study found support for including PMeHL, or knowledge of how to obtain and maintain good mental health, as an integral component of school health services' mental health education among adolescents.

Spirituality and religious coping are related to cancer-bereaved siblings' long-term grief.

OBJECTIVE: Many bereaved siblings have still not come to terms with their grief many years after the loss, but few studies have focused on what can help. The aims of this study were to identify cancer-bereaved adolescents' and young adults' ways of coping with grief after loss of a sibling, and examine whether these ways of coping were related to their experience of having worked through their grief. METHOD: This nationwide survey of 174 cancer-bereaved siblings (73% participation rate) is based on one open-ended question about coping with grief ("What has helped you to cope with your grief after your sibling's death?") and one closed-ended question about siblings' long-term grief ("Do you think you have worked through your grief over your sibling's death?"). The open-ended question was analyzed with content analysis; descriptive statistics and Fisher's exact test were used to examine the relation between type of coping and siblings' long-term grief. RESULT: The siblings described four ways of coping: (1) thinking of their dead brother/sister and feeling and expressing their grief; (2) distracting or occupying themselves; (3) engaging in spiritual and religious beliefs/activities; and (4) waiting for time to pass. One of these categories of coping with grief, namely, engaging in spiritual and religious beliefs and activities, was associated with siblings' experience of having worked through their grief two to nine years after the loss (p = 0.016). SIGNIFICANCE OF RESULTS: Those siblings who had used spirituality, religious beliefs, and activities to cope were more likely to have worked through their grief than those who had not.

Exploring MEST: a new universal teaching strategy for school health services to promote positive mental health literacy and mental wellbeing among Norwegian adolescents.

BACKGROUND: Mental health among adolescents is an important public health challenge. School health services perform central public health functions in Norwegian municipalities, where school nurses are uniquely positioned to educate and promote mental health among adolescents. MEST (MEST is not an acronym; MEST is a short version of the Norwegian word for coping) is a newly developed universal working strategy for school health services that aims to promote positive mental health literacy (MHL) and mental wellbeing in the adolescent population. The aim of this study was to investigate the potential outcome mean differences in positive MHL and mental wellbeing between adolescents who participated and those who did not participate in MEST over a school year. METHODS: This study is based on cohort data collected from 357 adolescents (aged 15-21 years) in five Norwegian upper secondary schools at the beginning and end of the 2016/2017 school year. The data were analyzed by describing mean scores and estimating the average treatment effect (ATE) of MEST on positive MHL and mental wellbeing. RESULTS: Positive MHL increased significantly more among the MEST participants compared to the non-MEST participants (p = .02). No significant change in mental wellbeing was found between MEST and non-MEST participants (p = .98). Estimating the ATE of MEST on positive MHL, the MEST participants showed a significant 2.1% increase (p = .04) in the potential outcome mean of positive MHL compared to the nonparticipants. Estimating the ATE of MEST on mental wellbeing, the girls who attended MEST exhibited a significant 9.7% increase (p = .03) in the potential outcome mean of mental wellbeing compared with the girls who did not attend MEST, while no significant change (p = .99) was detected among boys or the entire sample of both genders combined (p = .12). CONCLUSION: This study found a significant ATE of MEST on positive MHL and on mental wellbeing among girls. The results support further investments in studying MEST as a promising work strategy for school health services to promote adolescent mental health. This initial study of MEST may be used as a foundation for investing in future evaluations of MEST.

Cancer-bereaved siblings' positive and negative memories and experiences of illness and death: A nationwide follow-up.

OBJECTIVE: Our aim was to explore bereaved siblings' positive and negative memories and experiences of their brother's or sister's illness and death. METHOD: In our nationwide Swedish study, 174 of 240 (73%) bereaved siblings participated, and 70% responded to two open-ended statements, which focused on siblings' positive and negative memories and experiences of illness and death. The data were analyzed using systematic text condensation. RESULTS: The bereaved siblings' responses were categorized into four different themes: (1) endurance versus vulnerability, (2) family cohesion versus family conflicts, (3) growth versus stagnation, and (4) professional support versus lack of professional support. The first theme expressed endurance as the influence that the ill siblings' strong willpower, good mood, and stamina in their difficult situation had on healthy siblings, whereas vulnerability was expressed as the feeling of emptiness and loneliness involved with having an ill and dying sibling. In the second theme, family cohesion was expressed as the bonds being strengthened between family members, whereas family conflicts often led siblings to feel invisible and unacknowledged. In the third theme, most siblings expressed the feeling that they grew as individuals in the process of their brother's or sister's illness and death, whereas others experienced stagnation because of the physical and mental distress they bore throughout this time, often feeling forgotten. In the last theme-professional support-most siblings perceived physicians and staff at the hospital as being warm, kind, and honest, while some siblings had negative experiences. SIGNIFICANCE OF RESULTS: The study shows that bereaved siblings can have positive memories and experiences. The significance of the positive buffering effect on bereaved siblings' own endurance, personal growth, family cohesion, and social support should be noted. This knowledge can be valuable in showing healthcare professionals the importance of supporting the siblings of children with cancer throughout the cancer trajectory and afterwards into bereavement.

Validation of two versions of the Warwick-Edinburgh Mental Well-Being Scale among Norwegian adolescents.

AIM: This study aimed to examine the psychometric properties of the original 14-item version of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) and the short 7-item version (SWEMWBS) to validate these scales for use among Norwegian adolescents. METHOD: Cross-sectional data were collected by distributing questionnaires among students in five upper secondary schools in Norway with a net sample of n = 1814. Exploratory- and confirmatory factor analyses (CFA) and a reliability analysis were conducted and possible floor and ceiling effects were examined to evaluate the scales. A correlation analysis was conducted to examine criterion-related validity. RESULTS: The preliminary exploratory factor analysis gave strong indications of a one-dimensional solution for both versions of the scale. Furthermore, both scales showed high internal consistency (Cronbach's α = .93 for the WEMWBS and α = .88 for the SWEMWBS). The SWEMWBS showed the best fit in the CFA and a strong correlation with the WEMWBS ( r = .94). The score distributions of both scales indicated the possibility of a small ceiling effect. Both scales showed high correlations with related constructs in the expected direction. CONCLUSIONS: In our study, based on the CFA results and the high correlation between the original scale and the short version, the SWEMWBS was found to be most suitable for use among Norwegian adolescents.

Positive mental health literacy: development and validation of a measure among Norwegian adolescents.

BACKGROUND: Mental health literacy (MHL), or the knowledge and abilities necessary to benefit mental health, is a significant determinant of mental health and has the potential to benefit both individual and public mental health. MHL and its measures have traditionally focused on knowledge and beliefs about mental -ill-health rather than on mental health. No measures of MHL addressing knowledge of good or positive mental health have been identified. AIM: This study aimed to develop and validate an instrument measuring adolescents' knowledge of how to obtain and maintain good mental health and to evaluate the psychometric properties of the instrument. More specifically, the factor structure, internal and construct validity, and test-retest reliability were assessed. METHODS: The participants were Norwegian upper secondary school students aged 15-21 years. The development and validation of the instrument entailed three phases: 1) item generation based on the basic psychological needs theory (BPNT), focus group interviews, and a narrative literature review, 2) a pilot study (n = 479), and 3) test-retest (n = 149), known-groups validity (n = 44), and scale construction, item reduction through principal component analysis (PCA), and confirmatory factor analysis (CFA) for factor structure and psychometric properties assessment (n = 1888). RESULTS: Thirty-two items were initially generated, and 15 were selected for the pilot study. PCA identified cross-loadings, and a one-factor solution was examined. After removing five problematic items, CFA yielded a satisfactory fit for a 10-item one-factor model, referred to as the mental health-promoting knowledge (MHPK-10) measure. The test-retest evaluation supported the stability of the measure. McDonald's omega was 0.84, and known-groups validity test indicated good construct validity. CONCLUSION: A valid and reliable one-dimensional instrument measuring knowledge of factors promoting good mental health among adolescents was developed. The instrument has the potential to complement current measures of MHL and may be useful when planning mental health promotion activities and evaluating public mental health education initiatives in adolescents.