An Evolutionary Preamble Towards a Multilevel Framework to Understand Adolescent Mental Health: An International Delphi Study

Authors

• Federica Sancassiani
• Vanessa Barrui
• Fabrizio Bert
• Sara Carucci
• Fatma Charfi
• Giulia Cossu
• Arne Holte
• Jutta Lindert
• Simone Marchini
• Alessandra Perra
• Samantha Pinna
• Antonio Egidio Nardi
• Alessandra Scano
• Cesar A Soutullo
• Massimo Tusconi
• Diego Primavera

Language

English

Publication Date

9-5-2025

Journal

Children

DOI

10.3390/children12091189

PMID

41007054

PMCID

PMC12468673

PubMedCentral® Posted Date

8-5-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Background/objectives: Adolescence is a sensitive developmental window shaped by both vulnerabilities and adaptive potential. From an evolutionary standpoint, mental health difficulties in this period may represent functional responses to environmental stressors rather than mere dysfunctions. Despite increasing interest, integrative models capturing the dynamic interplay of risk and protective factors in adolescent mental health remain limited. This study presents a holistic, multi-level framework grounded in ecological and evolutionary theories to improve understanding and intervention strategies.

Methods: A two-round Delphi method was used to develop and validate the framework. Twelve experts in adolescent mental health evaluated a preliminary draft derived from the literature. In Round 1, 12 items were rated across five criteria (YES/NO format), with feedback provided when consensus thresholds were not met. Revisions were made using consensus index scores. In Round 2, the revised draft was assessed across eight broader dimensions. A consensus threshold of 0.75 was used in both rounds.

Results: Twelve out of thirteen experts (92%) agreed to join the panel. Round 1 item scores ranged from 0.72 to 0.85, with an average consensus index of 0.78. In Round 2, ratings improved significantly, ranging from 0.82 to 1.0, with an average of 0.95. The Steering Committee incorporated expert feedback by refining the structure, deepening content, updating sources, and clarifying key components.

Conclusions: The final framework allows for the clustering of indicators across macro-, medium-, and micro-level domains. It offers a robust foundation for future research and the development of targeted, evolutionarily informed mental health interventions for adolescents.

Keywords

Delphi technique, adolescent, mental health, social determinants of health, epigenesis, genetic

Published Open-Access

yes

Recommended Citation

Sancassiani, Federica; Barrui, Vanessa; Bert, Fabrizio; et al., "An Evolutionary Preamble Towards a Multilevel Framework to Understand Adolescent Mental Health: An International Delphi Study" (2025). Faculty, Staff and Student Publications. 4452.
https://digitalcommons.library.tmc.edu/uthmed_docs/4452