Five-item Mental Health Index Research Articles

Objective performance tests assess aspects of function not captured by self-report in knee osteoarthritis

Purpose: Knee osteoarthritis (OA) may lead to substantial functional limitation, which can be assessed objectively with validated performance tests or using self-report data. The relationships between the findings of objective performance tests and self-report measures of functional status have received little investigation. We sought to determine whether the performance tests are independent of one another, whether they capture different information from self-report measures of function, and whether they are influenced by features of chronic pain including anxiety and depression, neuropathic pain, widespread pain, and pain catastrophizing. Methods: We used baseline data from participants enrolled in the ORBIT Registry (Osteoarthritis Registry of Biomarker and Imaging Trajectories). At study entry, participants were 40+ years old and had evidence of both symptomatic and radiographic knee OA (Kellgren-Lawrence grade 2-3) in at least one knee. Self-reported pain of the most bothersome knee (index knee) was ascertained using the Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain scale and functional status with the KOOS ADL scale (0-100, 100 best). Subjects completed the five-item Mental Health Index (MHI-5, a measure of anxiety and depressive symptoms), the Neuropathic Pain Scale (NPS), a widespread pain index (WPI; sum of 23 possible musculoskeletal pain locations), and the Pain Catastrophizing Scale (PCS). Performance testing included the 40-meter fast paced walk (40m Walk), Timed-Up-and-Go (TUG), timed single leg balance test (SLB), and 30-second sit-to-stand (30s STS) tests. We used Pearson correlation coefficients to examine linear associations among the four performance tests and the associations between each performance test and the self-report measures of pain, functional status and chronic pain features. We further investigated the associations between performance tests and self-reported knee pain and function with adjustment for MHI-5, WPI, PCS and NPS using partial correlations. Results: We assessed 78 subjects with mean age 63.1 (SD 10.0), mean body mass index (BMI) 30.2 (SD 5.4), 69% female. The mean (SD) values for the performance tests included: 40m Walk 27.9 (5.6) seconds, TUG 9.1 (2.2) seconds, SLB 21.8 (19.7) seconds, and 30s STS 11.7 (4.5) stands. The individual performance measures had modest correlations with one another (Pearson r ranging from 0.33 to 0.74). The highest correlation (r = 0.74) was between TUG and 40m Walk, indicating that just 50% of the variability in TUG was explained by variability in 40m Walk. ORBIT participants had an average KOOS ADL score of 66.1 (18.2) and KOOS Pain of 74.6 (19.8). The correlations between performance tests and KOOS Pain, KOOS ADL, PCS, NPS, WPI and MHI-5 are shown in the Table. None of the correlations exceeded 0.40. Correlations were weakest for the associations between widespread pain and MHI-5 scores and the performance tests (all ≤ 0.23). Partial correlations between KOOS ADL scores and the performance tests were 28-64% lower than the crude correlations, adjusting for PCS, NPS, widespread pain and MHI-5 (Table).Table 1Pearson correlation coefficients for associations between performance tests and self-report measures of pain, function and chronic pain features40 Meter WalkTimed Up and GoTimed Single Leg Balance30-Second Sit to StandKOOS Pain-0.25-0.260.290.40KOOS ADL-0.33-0.290.400.40Pain Catastrophizing0.340.26-0.19-0.24Neuropathic Pain Scale0.320.20-0.24-0.23Widespread Pain0.15-0.08-0.23-0.18Mental Health Index-0.10-0.050.170.03Partial correlations adjusting for pain catastrophizing, NPS, widespread pain, MHI-5KOOS Pain-0.15-0.240.280.30KOOS ADL-0.12-0.200.290.25 Open table in a new tab Conclusions: 40m Walk, TUG, SLB and 30s STS each assess different aspects of functional capacity in knee OA patients. Self-reported functional status in persons with knee OA has weak to modest correlations with objective measures of functional status, which are further attenuated with adjustment for pain catastrophizing, neuropathic symptoms, widespread pain and anxiety and depression. These data suggest that objective performance tests capture elements of physical functional status in persons with knee OA that are not assessed well by frequently used self-report measures of functional status. Objective performance tests are not influenced strongly by other features of chronic pain such as catastrophizing, neuropathic pain symptoms, widespread pain or depression and anxiety. These data point to the importance of adding objective measures to the assessment of functional status in OA trials.

Musculoskeletal Symptomatic Areas After Total Knee Replacement for Osteoarthritis.

ObjectiveThe objective of this study was to measure cumulative incidence and incidence rate and identify factors associated with new musculoskeletal (MSK) symptomatic areas after total knee replacement (TKR) for osteoarthritis (OA).MethodsUsing data from a randomized controlled trial of patients undergoing elective TKR for OA, we assessed for MSK symptomatic areas by region (neck, hands/wrists/arms/shoulders, back, hips, nonindex knee, and ankles/feet) at baseline (pre‐TKR), and at 3, 6, 12, 24, 36, and 48 months post‐TKR. Cumulative incidence and incidence rates were calculated for each region. Factors associated with incident MSK symptomatic areas were identified using generalized linear mixed models. Time to incident symptomatic area was assessed using Cox proportional hazards regression.ResultsAmong 293 subjects, the cumulative incidence of any new MSK symptomatic area over 4 years was 45%; the incidence rate was 19.2 per 100 person‐years. Body site–specific cumulative incidence and incidence rates were highest for nonindex knee and back. Predictors of incident MSK symptomatic areas included female sex (relative risk [RR] 1.64; 95% confidence interval [CI] 1.15‐2.34), body mass index of 35 or higher (RR 1.27; 95% CI 0.88‐1.85), Charlson Comorbidity Index 2 or more (RR 1.28; 95% CI 0.92‐1.78), baseline index knee Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score greater than 40 (RR 1.39; 95% CI 0.99‐1.95), and anxiety/depression (measured by the five‐item Mental Health Index) (RR 1.70; 95% CI 1.20‐2.40).ConclusionIncident MSK symptomatic areas occurred in roughly half of recipients of TKR in the 4 years after the operation. Further study is needed to examine the long‐term impact of MSK symptomatic areas on postoperative pain, function, and quality of life.

Clinical importance of personality difficulties: diagnostically sub-threshold personality disorders

BackgroundCurrent categorical classification of personality disorders has been criticized for overlooking the dimensional nature of personality and that it may miss some sub-threshold personality disturbances of clinical significance. We aimed to evaluate the clinical importance of these conditions. For this, we used a simple four-level dimensional categorization based on the severity of personality disturbance.MethodsThe sample consisted of 352 patients admitted to mental health services. All underwent diagnostic assessments (SCID-I and SCID-II) and filled in questionnaires concerning their social situation and childhood adversities, and other validated tools, including the Beck Depression Inventory (BDI), Alcohol Use Disorders Identification Test (AUDIT), health-related quality of life (15D), and the five-item Mental Health Index (MHI-5). The patients were categorized into four groups according to the level of personality disturbance: 0 = No personality disturbance, 1 = Personality difficulty (one criterion less than threshold for one or more personality disorders), 2 = Simple personality disorder (one personality disorder), and 3 = Complex/Severe personality disorder (two or more personality disorders or any borderline and antisocial personality disorder).ResultsThe proportions of the groups were as follows: no personality disturbance 38.4% (n = 135), personality difficulty 14.5% (n = 51), simple personality disorder 19.9% (n = 70), and complex/severe personality disorder 24.4% (n = 86). Patients with no personality disturbance were significantly differentiated (p < 0.05) from the other groups regarding the BDI, 15D, and MHI-5 scores as well as the number of Axis I diagnoses. Patients with complex/severe personality disorders stood out as being worst off. Social dysfunction was related to the severity of the personality disturbance. Patients with a personality difficulty or a simple personality disorder had prominent symptoms and difficulties, but the differences between these groups were mostly non-significant.ConclusionsAn elevated severity level of personality disturbance is associated with an increase in psychiatric morbidity and social dysfunction. Diagnostically sub-threshold personality difficulties are of clinical significance and the degree of impairment corresponds to actual personality disorders. Since these two groups did not significantly differ from each other, our findings also highlight the complexity related to the use of diagnostic thresholds for separate personality disorders.

Adaptation and Psychometric Properties of the Brazilian Version of the Five-item Mental Health Index (MHI-5)

This study presents the psychometric properties of the Brazilian version of the five-item Mental Health Index (MHI-5). Participants were 524 subjects (69.8% women), aged from 18 to 88 years old (M = 38.3; SD = 13.26), from 17 Brazilian states. Exploratory and confirmatory factor analyses supported a single-factor solution. Reliability was assessed using alpha reliability, average variance extracted and composite reliability. Convergent validity was presented using the MHI-5, the Subjective Happiness Scale, the Satisfaction with Life Scale, and the General Health Questionnaire (GHQ-12). Discriminant validity, using the GHQ-12, showed that MHI-5 is a reliable measure to evaluate mental health. The scale presented strong evidence of validity and seems appropriate to evaluate mental health in the Brazilian population.

Maternal psychosocial factors around delivery, and the behavior of 2‐year‐old children

The objectives of the present study were to explore whether maternal psychosocial factors, mental health and work stress around delivery, are related to the behavior of 2-year-old children. In a prospective cohort study design, pregnant women attending the National Taiwan University Hospital for delivery and post-partum care from April 2004 to January 2005 were recruited and their children were observed at 24 months. A total of 186 mother-term-born child dyads completed the measurement. The five-item Mental Health Index (MHI-5) self-report data of maternal psychosocial factors were selected from the Taiwanese version of the short form 36 (SF-36). The Child Behavior Checklist for age 1½-5 (CBCL/1½-5) was completed by the parents when the child was 2 years old. The mean score of mental health around delivery was 68.11. The proportion of mothers with work stress seldom and always was 61.8% and 24.7%, respectively. The mean of the total CBCL score, and internalizing, externalizing behavior and sleep problems scores was 45.95, 11.89, 15.59 and 4.23, respectively. After adjusting for the potential confounders, maternal work stress around delivery was found to have a significant effect on the total CBCL and externalizing, attention and aggressive, behavioral problems of 2-year old children. Maternal mental health around delivery, however, did not show significant effects on child behavior. Work stress around delivery seems to aggravate children's externalizing behavior problems at 2 years old. It is therefore important to improve the psychosocial health and reduce the stress of pregnant women.

Older Breast Cancer Survivors: Geriatric Assessment Domains Are Associated With Poor Tolerance of Treatment Adverse Effects and Predict Mortality Over 7 Years of Follow-Up

To evaluate geriatric assessment (GA) domains in relation to clinically important outcomes in older breast cancer survivors. Six hundred sixty women diagnosed with primary breast cancer in four US geographic regions (Los Angeles, CA; Minnesota; North Carolina; and Rhode Island) were selected with disease stage I to IIIA, age >or= 65 years at date of diagnosis, and permission from attending physician to contact. Data were collected over 7 years of follow-up from consenting patients' medical records, telephone interviews, physician questionnaires, and the National Death Index. Outcomes included self-reported treatment tolerance and all-cause mortality. Four GA domains were described by six individual measures, as follows: sociodemographic by adequate finances; clinical by Charlson comorbidity index (CCI) and body mass index; function by number of physical function limitations; and psychosocial by the five-item Mental Health Index (MHI5) and Medical Outcomes Study Social Support Survey (MOS-SSS). Associations were evaluated using t tests, chi(2) tests, and regression analyses. In multivariable regression including age and stage, three measures from two domains (clinical and psychosocial) were associated with poor treatment tolerance; these were CCI >or= 1 (odds ratio [OR] = 2.49; 95% CI, 1.18 to 5.25), MHI5 score less than 80 (OR = 2.36; 95% CI, 1.15 to 4.86), and MOS-SSS score less than 80 (OR = 3.32; 95% CI, 1.44 to 7.66). Four measures representing all four GA domains predicted mortality; these were inadequate finances (hazard ratio [HR] = 1.89; 95% CI, 1.24 to 2.88; CCI >or= 1 (HR = 1.38; 95% CI, 1.01 to 1.88), functional limitation (HR = 1.40; 95% CI, 1.01 to 1.93), and MHI5 score less than 80 (HR = 1.34; 95% CI, 1.01 to 1.85). In addition, the proportion of women with these outcomes incrementally increased as the number of GA deficits increased. This study provides longitudinal evidence that GA domains are associated with poor treatment tolerance and predict mortality at 7 years of follow-up, independent of age and stage of disease.

Temporal Relation among Depression Symptoms, Cardiovascular Disease Events, and Mortality in End-Stage Renal Disease

Temporal relationships among depression, medical comorbidity, and death or cardiovascular disease (CVD) events are complex. Clarifying temporal relationships may enhance current insight regarding the nature of the association of depression with poor outcomes. The temporal relation of depression symptoms (DS; score < or = 52 on five-item Mental Health Index) assessed at 6-mo intervals for 2 yr to CVD event, all-cause death, cardiovascular disease deaths, and non-cardiovascular disease deaths was studied in 917 incident dialysis patients. Cox regression models were used to assess whether the proximity of DS measurement and DS duration would change observed associations between DS and events. Whether increasing medical comorbidity was associated with worsening DS also was assessed. In time-varying models, DS were strongly associated with all-cause deaths, cardiovascular disease deaths, and CVD events (adjusted relative hazard [95% confidence interval]: 2.22 [1.36 to 3.60], 3.27 [1.57 to 6.81], and 1.68 [1.05 to 2.69], respectively). Persistent and current DS were associated with greater risks for all-cause death. Incorporating a 6-mo time lag between DS and outcomes attenuated risks for all-cause death, non-cardiovascular disease deaths, and CVD events. In a subgroup analysis, patients with worsening medical comorbidity (n = 32) during the first year of follow-up experienced a 2.42-point greater decline in mental health scores at 2 yr of follow-up compared with patients with no worsening in medical comorbidity (n = 123), but findings were not statistically significant. DS are strongly related to death and CVD events, with persistent/current DS most strongly associated with poor outcomes. Attenuated risks from time-lag analyses indicate a partial role for reverse causality, suggesting that medical comorbidity may precede DS.

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

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.

Depressive symptoms and risk of type 2 diabetes in women.

To explore the relationship between depressive symptoms and incidence of type 2 diabetes in women. We conducted an analysis of 72,178 female nurses aged 45-72 years who did not have diagnosed diabetes and who answered the Medical Outcomes Study 36-Item Short-Form Health Status Survey (SF-36) at baseline in 1992. We calculated relative risks (RR) of type 2 diabetes for women with presence of depressive symptoms (i.e., Five-Item Mental Health Index [MHI-5] score >52). During 4 years of follow-up (282,317 person-years), 973 incident cases of type 2 diabetes were documented. Age-adjusted RR of developing type 2 diabetes for women with presence of depressive symptoms was 1.55 (95% CI 1.27-1.90). Additional adjustment for BMI resulted in a RR of developing type 2 diabetes of 1.36 (1.11-1.67). The multivariate RR of developing type 2 diabetes was 1.22 (1.00-1.50). After excluding women diagnosed with diabetes between 1992 and 1994, 472 incident cases of type 2 diabetes were documented for the follow-up period from 1994 to 1996 (148,889 person-years). The multivariate RR of developing type 2 diabetes for women with depressive symptoms was 1.29 (0.96-1.72). Our data suggest that depressive symptoms are associated with a modest increase in the risk of type 2 diabetes.

Measuring the mental health status of the Norwegian population: A comparison of the instruments SCL-25, SCL-10, SCL-5 and MHI-5 (SF-36)

A great number of questionnaires and instruments have been developed in order to measure psychological distress/mental health problems in populations. The Survey of Level of Living in 1998 conducted by Statistics Norway used both Hopkins Symptom Checklist (SCL-25) and the Short Form 36 (SF-36), including the five-item mental health index (MHI-5). Five-item and 10-item versions of the SCL-25 have also been used in Norwegian surveys. The purpose of this study was to investigate the correlation between the various instruments, and to assess and to compare psychometric characteristics. A random sample of 9735 subjects over 15 years of age drawn from the Norwegian population received a questionnaire about their health containing SCL-25 and SF-36. Response rate was 71.9%. Reliability of the SCLs and MHI-5 were assessed by Cronbach alpha. The scores from full and abbreviated instruments were compared regarding possible instrument-specific effects of gender, age and level of education. The correlations between the instruments were calculated. The capacity of the various instruments to identify cases was assessed in terms of sensitivity, specificity, predictive values, receiver operating characteristics (ROC) and area under the curve (AUC). The reliabilities were high (Cronbach alpha>0.8). All instruments showed a significant difference in the mean scores for men and women. The correlation between the various versions of SCL ranged from 0.91 to 0.97. The correlation between the MHI-5 and the SCLs ranged from −0.76 to −0.78. The prevalence rate was 11.1% for SCL-25 scores above 1.75 and 9.7% for scores below 56 in MHI-5. AUC values indicated good screening accordance between the measures (AUC>0.92). The results suggest that the shorter versions of SCL perform almost as well as the full version. The corresponding cut-off points to the conventional 1.75 for SCL-25 are 1.85 for SCL-10 and 2.0 for SCL-5. MHI-5 correlates highly with the SCL and the AUC indicate that the instruments might replace each other in population surveys, at least when considering depression. An operational advantage of the MHI-5 over the SCL instruments is that it has been widely used not only in surveys of mental health, but also in surveys of general health.