Letter to the Editor regarding ‘Middle childhood profiles of social-emotional competencies and difficulties differentiate risk of health service presentations with adolescent mental disorders’

I read with great interest the recent study examining profiles of social-emotional competencies and their associations with adolescent mental disorder diagnoses within a dual-factor model of mental health (Carpendale et al., 2026). The authors should be commended for advancing a more integrative conceptualization that moves beyond the absence of psychopathology towards a more nuanced understanding of mental health. However, we wish to highlight two critical considerations that may limit the generalizability and implementation of these findings in low- and middle-income countries (LMICs), particularly in Southeast Asian contexts such as Indonesia.

First, the issue of cross-cultural generalizability warrants careful attention. Large-scale population-based studies are often situated within Global North contexts, where constructs such as ‘complete mental health’ are grounded in individualistic norms emphasizing autonomy, self-expression and personal well-being. In contrast, collectivistic societies like Indonesia conceptualize social-emotional competence through relational harmony, social conformity and respect for hierarchical structures (Nufi et al., 2025; Subu et al., 2026). Consequently, profiles categorized as ‘optimal’ or ‘low competence’ may not carry equivalent meanings across cultural contexts, raising concerns about potential cultural misclassification. Social-emotional functioning in Southeast Asia is frequently embedded in adherence to social norms rather than individual assertiveness, suggesting that the direct transferability of such profiles may obscure culturally grounded expressions of well-being (Subu et al., 2026).

Second, there are important implementation challenges when translating profile-based screening approaches into LMIC settings. The model implicitly assumes the availability of integrated mental health systems and longitudinal data infrastructures capable of tracking developmental trajectories. However, in countries like Indonesia, access to child and adolescent mental health services remains limited, unevenly distributed and often constrained by high levels of stigma (Nufi et al., 2025). Under such conditions, the feasibility of applying sophisticated screening models based on latent profiles is questionable. Without adequate infrastructure, trained personnel and culturally sensitive assessment tools, these approaches risk remaining theoretically robust but practically unattainable.

Taken together, these considerations underscore the need to adapt the dual-factor model for low-resource and culturally diverse settings. Rather than a direct application, we advocate for a context-sensitive approach that integrates cultural norms, family dynamics and systemic constraints into the conceptualization and operationalization of child mental health. Future research should prioritize cross-cultural validation and the development of scalable, culturally grounded screening and intervention strategies that are feasible within LMIC contexts.

Such efforts would not only enhance the global relevance of the dual-factor model but also ensure that it contributes meaningfully to reducing the burden of adolescent mental disorders in diverse sociocultural settings.