Background: Adolescent mental health problems are rising globally, with growing recognition of mental toughness as a protective factor. However, significant disparities in mental toughness persist across sociodemographic and lifestyle groups, yet the drivers of these inequities remain poorly understood. This study examines how mental toughness is associated with sociodemographic factors, lifestyle behaviors, and health literacy, aiming to identify populations at greatest risk and inform targeted interventions.
Methods: This population-based study involved 1,423 participants and was conducted across 20 secondary schools. Mental toughness was assessed using the validated Mental Toughness Scale for Adolescents (MTS-A). Univariable and multivariable linear regression analyses were performed to examine the associations between mental toughness and key disparity-linked factors, including sociodemographic characteristics, lifestyle behaviors, and health literacy. The Survey and Behavioral Research Ethics Committee of the Chinese University of Hong Kong approved the study (approval No. SBRE-24-0029).
Results: For the total score of MTS-A, results showed positive association between male [β=3.59; 95% confidence interval (CI): 2.79, 4.38; P<0.001], daily breakfast consumption (β=1.31; 95% CI: 0.53, 2.10; P=0.001), sufficient physical activity (β=2.06; 95% CI: 0.90, 3.22; P=0.001), sufficient sleep (β=0.92; 95% CI: 0.13, 1.71; P=0.02), and higher-level of health literacy (β=4.32; 95% CI: 3.55, 5.10; P<0.001) and mental toughness adolescent, whiles older age, excessive screen time on video, and self-perceived obesity were negatively associated with the level of overall mental toughness. For MTS-A domains, health literacy emerged as the most consistent and substantial factor, showing significant positive associations with all six domains (β=0.52 to 4.32; all P<0.001).
Conclusions: These findings reveal uneven distributions of mental toughness, with clear gaps tied to gender, age, and lifestyle. Health literacy may help mitigate disparities, but systemic efforts—such as school-based health education, screen time regulations, and stigma reduction programs—are needed to ensure equitable resilience-building. Policymakers and educators should prioritize tailored, multi-level strategies to address these inequities and promote adolescent mental health.
