Article

Validity of the SF-36 Five-Item Mental Health Index for Major Depression in Functionally Impaired, Community-Dwelling Elderly Patients

Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.22). 11/2005; 53(11):1978-85. DOI: 10.1111/j.1532-5415.2005.00469.x
Source: PubMed

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.
Cross-sectional observational.
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.

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    • "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 [21] [22] [23]. 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 [15]. "
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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). "
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