Authors: Lilly Augustine , Frida Lygnegård , Margareta Adolfsson och Mats Granlund


Adolescent mental health, operationalized as engagement in life situations, is one aspect of functioning. Engagement as mental health has a bi-directional relation with environmental factors.

Aim: To test the statistical utility of the International Classification of Functioning (ICF) classification in coding adolescent mental health and mental health problems.

Methods: Using data measuring mental health in a representative Swedish sample of 12–13-year-olds linking responses to the classification codes. The internal structure of the classification system constructs was tested using factor analysis.

Results: A factorial solution could be found for most chapters indicating that the ICF framework and coding system could be used; however, the variance explained was quite low. Linking worked better at code-level, rather than chapter level. Items measuring risk behavior or risk factors are loaded in separate constructs.

Conclusions: When coding items for statistical purposes, code-level rather than chapter level is to be preferred. Also, participation in risk behavior loads in separate factors indicating that these behaviors are separate from other types of participation.


  • Considering some challenges with varying level of detail in the ICF-CY’s chapters, the framework can be used to identify the content of mental health questionnaires to be used in rehabilitation.
  • To provide more detailed information in rehabilitation addressing mental health, a code-level solution is more appropriate than a chapter level solution.
  • Despite the use of same ICF-CY codes, negative participation, i.e., risk behavior, measures a different dimension than positive participation, is especially relevant in rehabilitation addressing mental health.

This reseach is financed by: Swedish Reseach Council, Vinnova, Formas, Forte.