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: 4.57). 11/2005; 53(11):1978-85. DOI: 10.1111/j.1532-5415.2005.00469.x
Source: PubMed


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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    • "MHI-5 scores ranged from 0 (poor) to 100 (excellent). Good mental health was determined as having a score above 60 [59-63]. Self-perceived health was assessed using the question: ‘How would you classify your health in general?’, using a 5-point scale ranging from excellent to poor. "
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    ABSTRACT: Public health policy calls for intervention programmes to reduce loneliness in the ageing population. So far, numerous loneliness interventions have been developed, with effectiveness demonstrated for few of these interventions. The loneliness intervention described in this manuscript distinguishes itself from others by including multiple intervention components and targeting individuals and their environment. Intervention components included a mass media campaign, information meetings, psychosocial group courses, social activities organised by neighbours, and training of intermediaries. The aim of this manuscript is to study the effects of this integrated approach on initial and long-term outcomes. A quasi-experimental pre-test post-test intervention study was conducted among non-institutionalised elderly people aged 65 years and over to evaluate the effectiveness of the intervention by comparing the intervention community and the control community. Data on outputs, initial and long-term outcomes, and the overall goal were collected by self-administered questionnaires. Data of 858 elderly people were available for the analyses. To assess the effect linear regression analyses with adjustments for age, gender, church attendance, and mental health were used. In addition, the process evaluation provided information about the reach of the intervention components. After two years, 39% of the elderly people were familiar with the intervention programme. The intervention group scored more favourably than the control group on three subscales of the initial outcome, motivation (-4.4%, 95% CI-8.3--0.7), perceived social support (-8.2%, 95% CI-13.6--2.4), and subjective norm (-11.5%, 95% CI-17.4--5.4). However, no overall effects were observed for the long-term outcome, social support, and overall goal, loneliness. Two years after its initiation the reach of the intervention programme was modest. Though no effect of the complex intervention was found on social support and loneliness, more favourable scores on loneliness literacy subscales were induced.
    Full-text · Article · Oct 2013 · BMC Public Health
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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]. "

    Full-text · Article · Jan 2013 · Open Journal of Nursing
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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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    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.
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