Validity of the SF-36 Five-Item Mental Health Index for Major Depression in Functionally Impaired, Community-Dwelling Elderly Patients
ABSTRACT To examine criterion and construct validity of the five-item Mental Health Index (MHI-5) of the 36-item Short Form health survey (SF-36) in relation to the presence of major depression in functionally impaired, community-dwelling elderly patients and of eight subsamples defined by cognitive functioning, levels of functional impairment, and proxy report versus self-report.
Nineteen counties in western New York, West Virginia, and Ohio.
One thousand four hundred forty-four functionally impaired, community-dwelling Medicare beneficiaries aged 65 and older who participated in the Medicare Primary and Consumer-Directed Care Demonstration.
MHI-5, Mini-International Neuropsychiatric Interview Major Depressive Episode (MINI-MDE) module.
The MHI-5 demonstrated sufficient criterion validity (area under the receiver operating characteristic curve=0.837; sensitivity=78.7% and specificity=72.1% using a cutpoint of 59/60) with respect to the presence of depression for the entire sample. A significant correlation between MHI-5 scores and presence of major depression as identified using the MINI-MDE (Spearman correlation=-0.426, P<.001), a strong correlation between the MHI-5 and the SF-36 role emotional scale (Spearman correlation=0.522) and a weak correlation with the SF-36 physical functioning scale (Spearman correlation=0.133) provided evidence for construct validity. Additional evidence is provided by decline in mean MHI-5 score as level of formal education and number of close friends and relatives decreased. All eight subsamples demonstrated similar criterion and construct validity. A Cronbach alpha of 0.794 demonstrated internal consistency reliability.
This study provides evidence for adequate criterion and construct validity of the MHI-5 in relation to the presence of major depression among functionally impaired, community-dwelling elderly Medicare patients.
- SourceAvailable from: Peter Johansson
Open Journal of Nursing 01/2013; 3(01):33-41. DOI:10.4236/ojn.2013.31005
- "The 5 items focuses the anhedonic aspect of depression (i.e., sadness and loss of pleasure) and the scores can range from 0 (the worst) to 100 (best mental health). With a cut-off point of ≤60 the MH-5 seems valid and reliable to use in the screening for depressive symptoms indicating a high probability of a diagnosis of major depression   . The MH-5 can be said to assess a depressive symptomatology which might indicate the presence of different types of depressive disorders such as subsyndromal or minor depression, dysthymia or major depression . "
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- "The two positively worded questions are reverse coded so that lower scores indicate more depressive symptoms; all item scores are summed, and then the sum is rescaled to obtain a total score ranging from 0 to 100 (Ware et al. 2000). An MHI-5 score < 60 denotes the presence of severe depressive symptoms and predicts major depression as identified using the Mini- International Neuropsychiatric Interview Major Depressive Episode module with high sensitivity and specificity among adults ≥ 65 years of age (Friedman et al. 2005). We also used an alternative cutoff score of < 53, which has been validated for identifying major depression in younger populations (Berwick et al. 1991; Holmes 1998). "
ABSTRACT: Different lines of evidence suggest that low-level lead exposure could be a modifiable risk factor for adverse psychological symptoms, but little work has explored this relation. We assessed whether bone lead--a biomarker of cumulative lead exposure--is associated with depression and anxiety symptoms among middle-age and elderly women. Participants were 617 Nurses' Health Study participants with K-shell X-ray fluorescence bone lead measures and who had completed at last one Mental Health Index 5-item scale (MHI-5) and the phobic anxiety scale of the Crown-Crisp Index (CCI) assessment at mean ± SD age of 59 ± 9 years (range, 41-83 years). With exposure expressed as tertiles of bone lead, we analyzed MHI-5 scores as a continuous variable using linear regression and estimated the odds ratio (OR) of a CCI score ≥ 4 using generalized estimating equations. There were no significant associations between lead and either outcome in the full sample, but associations were found among premenopausal women and women who consistently took hormone replacement therapy (HRT) between menopause and bone lead measurement (n = 142). Compared with women in the lowest tertile of tibia lead, those in the highest scored 7.78 points worse [95% confidence interval (CI): -11.73, -3.83] on the MHI-5 (p-trend = 0.0001). The corresponding OR for CCI ≥ 4 was 2.79 (95% CI: 1.02, 7.59; p-trend = 0.05). No consistent associations were found with patella lead. These results provide support for an association of low-level cumulative lead exposure with increased depressive and phobic anxiety symptoms among older women who are premenopausal or who consistently take postmenopausal HRT.Environmental Health Perspectives 02/2012; 120(6):817-23. DOI:10.1289/ehp.1104395 · 7.03 Impact Factor
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- "Response options for this item were: 'all of the time', 'most of the time', 'a good bit of the time', 'some of the time', 'a little of the time' and 'none of the time'. This selfreport item has been successfully used to assess happiness in young adults and individuals with disabilities, and the larger Mental Health scale from which it is drawn is valid and reliable for use in depressed older adults (Perneger et al., 2004; Friedman et al., 2005; van Campen and Iedema, 2007). Higher scores indicate greater levels of happiness. "
ABSTRACT: Chronic medical problems might amplify suicide risk in later life. Feelings of happiness may reduce this risk. We tested the hypothesis that happiness attenuates the association between number of self-reported chronic diseases and suicidal distress. A sample of 1,801 depressed, primary care patients, 60 years of age or older, entering a clinical trial, were assessed for the presence of positive emotion, suicidal distress and self-reported chronic medical problems. Chronic medical problems are associated with suicide ideation and, as hypothesized, happiness attenuates the relationship between self-reported diseases and suicidal distress. Decreased risk for distressing thoughts of suicide in the context of medical illness is predicted by the presence of positive emotions. Our results suggest that treatments designed to help older primary care patients identify sources of joy and enhance happiness might decrease suicide risk.International Journal of Geriatric Psychiatry 07/2009; 24(7):671-9. DOI:10.1002/gps.2174 · 3.09 Impact Factor