MHI-5 Score Research Articles

Comparison of the SF-36 Five-item Mental Health Inventory and Beck Depression Inventory for the screening of depressive symptoms in chronic dialysis patients

The Beck Depression Inventory (BDI) is a standard and validated questionnaire to screen for depressive symptoms in chronic dialysis patients, but is relatively extensive to use repeatedly in clinical practice. We investigated whether the five-item Mental Health Inventory (MHI-5) of the 36-item Short-Form Health Survey Questionnaire (SF-36) could be applied to screen for depressive symptoms in dialysis patients. Moreover, we determined the optimal MHI-5 cut-off score to assess depressive symptoms. Chronic dialysis patients from three centres filled out the SF-36 and the BDI. A receiver operating characteristic (ROC) curve was constructed for the MHI-5 score with BDI ≥ 16 as reference standard to (i) calculate the area under the curve to determine whether the MHI-5 could be considered as a useful screening instrument for depressive symptoms and (ii) proxy the optimal cut-off score of the MHI-5 to assess depressive symptoms. The optimal cut-off score was determined by the value for which the sum of sensitivity and specificity had an optimum. Of 133 included patients, 23% had depressive symptoms as determined with BDI ≥ 16. The correlation of the BDI with MHI-5 was -0.64. The area under the ROC curve was 0.82 (95% confidence interval 0.74-0.90). The optimal cut-off point of the MHI-5 was 70. MHI-5 ≤ 70 had 77 sensitivity, 72 specificity, 44 positive predicting value and 91% negative predicting value with the presence of depressive symptoms determined with BDI ≥ 16. The MHI-5 may help clinicians to screen for depressive symptoms in dialysis patients without using an additional depression screening questionnaire once the SF-36 is completed. A cut-off value of 70 can be used safely for the purposes of screening applications.

Antidepressant use is related to larger white matter lesion volume in patients with symptomatic atherosclerotic disease: the SMART-MR study

Although a relation between depression and white matter lesions (WML) is frequently observed, the direction of causation remains unknown. We investigated whether depressed mood was associated with baseline severity and change in WML volume during 4 years of follow-up, and the relative contribution of mood symptoms and antidepressant use to this relation. Within the SMART-MR study 594 patients (58 ± 10 years) with symptomatic atherosclerotic disease had assessments of mood symptoms and antidepressant use and 1.5 T MRI at baseline and after 3.9 ± 0.4 years of follow-up. Mood symptoms were assessed using the Mental Health Index (MHI-5). Depressed mood was defined as antidepressant use and/or MHI-5 score ≤ 52. Volumetric WML measures (deep and periventricular) were obtained with automated segmentation. Linear regression analyses were adjusted for age, sex, baseline WML volume, follow-up time, vascular risk factors and infarcts. Depressed mood was not associated with larger WML volume at baseline. However, when separate contributions were distinguished, antidepressant use was associated with greater deep (B = 0.50 mL, 95 % CI 0.04-0.96) and periventricular WML volume (B = 0.47 mL, 95 % CI 0.05-0.89) at baseline, while mood symptoms were not. Antidepressants were associated with a modest but non-significant increase in progression of periventricular WML volume over 4 years of follow-up (B = 0.21 mL, 95 % CI -0.05 to 0.47). WML at baseline were not associated with new-onset depressed mood at follow-up. Antidepressants, but not mood symptoms, were associated with greater WML volume and a modest, although non-significant increase in periventricular WML volume in patients with symptomatic atherosclerotic disease. Future studies are needed to determine whether this may be a direct effect, or whether other underlying diseases for which antidepressants are prescribed influence this relation.

The association between neighborhood disorder, social cohesion and hazardous alcohol use: A national multilevel study

BackgroundEvidence on associations of alcohol use with neighborhood disorder and social cohesion is limited. The aim of this study was to further investigate these associations. MethodsIndividual data of 14,258 Dutch adults, living in 1546 neighborhoods across the Netherlands, were obtained from the 2006 to 2009 national health survey (POLS). Data on neighborhood disorder and social cohesion were derived from the 2006 Netherlands Housing Research (WoON). Hazardous drinking was measured as: ≥14, ≥21, and ≥28 drinks/week for women, and ≥21, ≥28, and ≥35 for men. Multilevel logistic regression models were adjusted for age, gender, ethnicity, marital status, education, income, wealth, predominant neighborhood religion, and population density. Potential mediation of psychological distress (depression and anxiety) and general mental health (MHI-5 score) was tested. ResultsHigh neighborhood disorder was associated with more hazardous alcohol use for women (OR cut-off 3: 3.72 [2.03–6.83]), but not for men (OR cut-off 3: 1.08 [0.72–1.62]). There was no mediation by psychological distress, and modest mediation by general mental health. Social cohesion had no linear association with hazardous alcohol use, but for males moderate social cohesion was associated with more hazardous alcohol use (OR cut-off 1: 1.29 [1.08–1.53]). In predominantly Protestant neighborhoods this association seemed weaker. ConclusionsHazardous alcohol use seems to have a stronger and more consistent relationship with neighborhood disorder than with social cohesion. This suggests that negative aspects of the social environment have more impact on the prevalence of hazardous alcohol use than positive factors related to sociability and support.

Validity of the mental health subscale of the SF-36 in persons with spinal cord injury

Cross-sectional study 5 years after discharge from inpatient rehabilitation. To examine the psychometric properties of the Mental Health subscale (MHI-5) of the 36-Item Short Form Health Survey (SF-36) in persons with spinal cord injury (SCI). Eight Dutch rehabilitation centres with specialised SCI units. Possible floor and ceiling effects were assessed, and Cronbach's α coefficient was calculated to assess internal consistency. Concurrent and divergent validity were assessed using Spearman correlations between the MHI-5 and measures of life satisfaction, neuroticism, vitality, general health, functional independence, participation, lesion characteristics and demographics. There were no floor or ceiling effects, but the total MHI-5 score was slightly skewed (-1.15). Internal consistency was good (α=0.79). Concurrent validity was shown by significant Spearman correlations between the MHI-5 and life satisfaction (0.53), neuroticism (-0.55), vitality (0.53) and general health (0.37). Divergent validity was shown by weak and, in part, non-significant correlations between the MHI-5 and functional independence (0.09), participation (-0.28) and lesion characteristics (range -0.01-0.19). The MHI-5 showed reliability and validity as a measure of mood in persons with SCI, and is a promising measurement instrument to assess mental health problems in this population.

Depression and the Risk of Stroke in Women

See related article, pages 2770–2775. Major depressive disorder is defined in the DSM-IV-TR as depressed mood or loss of interest or pleasure in usual activities, along with a constellation of other depressive symptoms that persist for >2 weeks, are atypical for usual behavior, cause significant distress or impairment, and are not attributable to bereavement or a medical condition.1 The lifetime prevalence of depression is ≈13% to 16% and is 5% to 7% in 1 year, more commonly affecting women than men.1 The presence of depressive symptoms has been established as an important outcome after stroke.2 The Northern Manhattan Study reported that early depressive symptoms are a risk for future disability.3 Multiple studies, though not all,4 now contribute to the evidence that depression is also a risk factor for first-ever stroke.5,6 Adding to these studies and published in this issue of Stroke , Pan et al7 have analyzed >80 000 women in the Nurses' Health Study cohort who were stroke-free at the time of the initial screen for depressive symptoms. Using the Mental Health Index (MHI-5) scores, a subscale of the Short-Form 36 Health Status Survey, collected in 1992, 1996, and 2000, the investigators assessed the relation between clinically significant depressive symptoms (MHI-5 score ≤52) and incident stroke from 2000 to 2006. For the purposes of analyzing depression, this was defined as an MHI-5 score ≤52, physician-diagnosed depression, or antidepressant medication use. For the 1033 incident strokes documented in the follow-up period, depression was associated with an ≈30% increased risk of total stroke (hazard ratio [HR]=1.29; 95% CI, 1.13–1.48).7 A past history of depression alone …

Clinical and behavioral characteristics of active smokers with squamous cell carcinoma of the head and neck (SCCHN) in an urban setting: Attitudes underlying high-risk disease.

e16027 Background: Cigarette smoking is associated with 85% of SCCHN, and active smoking has been associated with poor prognosis. The objective of this study was to examine the clinical, behavioral and psychosocial factors associated with tobacco use in patients (pts) with SCCHN undergoing curative-intent radiotherapy (RT). Methods: Self-report questionnaires were administered to 24 pts with SCCHN undergoing curative-intent RT at Montefiore Medical Center who had reported smoking within 6 months prior to diagnosis. Data collected at baseline included demographics, smoking behaviors and attitudes, mood state using MHI-5, and quality of life (QoL) using EORTC QLQ-C30 and QLQ-H&N35 questionnaires. Results: Most participants (79%) were male, 38% were married, and 70% had a high school education or less. Forty-six percent were African American and 21% were Hispanic. Most pts had oropharyngeal (33%) or laryngeal (42%) cancers, and 67% had stage IV disease. The mean number of cigarettes smoked per day was 21.6. Average duration of tobacco use was 39.3 yrs. Eight pts (33%) reported concomitant alcohol use. Only 57% felt that smoking was somewhat or very much related to their cancer diagnosis, though 92% were in action or contemplative stages of change. Most (63%) had tried to quit at least once in their lifetime but without formal guidance; 33% had used a form of nicotine replacement. Mean MHI-5 score was 52, previously shown to correlate with depression. Pts scored lower on the social functioning scale (71.4) relative to the general head and neck cancer population (82.6). The worst symptom scale scores were pain killer use, weight loss, coughing, swallowing difficulties, and financial difficulties. Five pts (21%) did not complete RT or had treatment delays ≥ 5 days. After a median of 16 months of follow-up, 5 (21%) have died of disease and 2 (8%) are alive with recurrence. Conclusions: Active cigarette smokers with SCCHN represent a population with impaired QoL at risk for poor outcomes despite curative-intent RT. Interventions targeting community education on cancer prevention and smoking cessation and addressing QoL in smokers with SCCHN are indicated.

Bidirectional Association Between Depression and Type 2 Diabetes Mellitus in Women

Although it has been hypothesized that the diabetes-depression relation is bidirectional, few studies have addressed this hypothesis in a prospective setting. A total of 65 381 women aged 50 to 75 years in 1996 were observed until 2006. Clinical depression was defined as having diagnosed depression or using antidepressants, and depressed mood was defined as having clinical depression or severe depressive symptoms, ie, a 5-item Mental Health Index (MHI-5) score of 52 or less. Self-reported type 2 diabetes mellitus was confirmed by means of a supplementary questionnaire validated by medical record review. During 10 years of follow-up (531 097 person-years), 2844 incident cases of type 2 diabetes mellitus were documented. Compared with referents (MHI-5 score of 86-100) who had the best depressive symptom scores, participants with increased severity of symptoms (MHI-5 scores of 76-85 or 53-75, or depressed mood) showed a monotonic elevated risk of developing type 2 diabetes (P for trend = .002 in the multivariable-adjusted model). The relative risk for individuals with depressed mood was 1.17 (95% confidence interval [CI], 1.05-1.30) after adjustment for various covariates, and participants using antidepressants were at a particularly higher relative risk (1.25; 95% CI, 1.10-1.41). In a parallel analysis, 7415 cases of incident clinical depression were documented (474 722 person-years). Compared with nondiabetic subjects, those with diabetes had a relative risk (95% CI) of developing clinical depression after controlling for all covariates of 1.29 (1.18-1.40), and it was 1.25 (1.09-1.42), 1.24 (1.09-1.41), and 1.53 (1.26-1.85) in diabetic subjects without medications, with oral hypoglycemic agents, and with insulin therapy, respectively. These associations remained significant after adjustment for diabetes-related comorbidities. Our results provide compelling evidence that the diabetes-depression association is bidirectional.

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.

Depressive symptoms predict the future risk of severe pruritus in haemodialysis patients: Japan Dialysis Outcomes and Practice Patterns Study

Recent reports suggest a cross-sectional association between psychiatric distress and pruritus in patients on haemodialysis (HD). However, no study has examined the likelihood of developing severe pruritus in patients on HD with depressive symptoms. To evaluate the relationship between baseline depressive symptoms and subsequent risk of developing severe pruritus. A longitudinal study with a 0.5-2.5-year follow-up period was performed using 1799 patients on HD who had no/mild pruritus at baseline, based on the Japan Dialysis Outcomes and Practice Patterns Study (1996-2004), a cohort study composed of a representative sample of patients on HD. We assessed pruritus after the follow-up period using a self-reported questionnaire and depressive symptoms using scores from the five-item version of the Mental Health Inventory (MHI-5). The 1799 patients had a mean age of 56.9 years, 59.5% were men, and 23.6% presented depressive symptoms. Multivariable analysis revealed that patients with depressive symptoms had significantly higher odds of developing severe pruritus during the 0.5-2.5-year follow-up period [adjusted odds ratio (AOR) 1.57, 95% confidence interval 1.22-2.01, P < 0.001]. In addition, a significant linear trend was observed between baseline MHI-5 scores and risk of developing severe pruritus, with AORs for third, second and first MHI-5 score quartiles of 1.08, 1.51 and 1.95, respectively (P for trend < 0.0001). Our results suggest that depressive symptoms measured by MHI-5 may predict the future risk of developing severe pruritus in patients on HD.

Depression and Risk of Sudden Cardiac Death and Coronary Heart Disease in Women: Results From the Nurses' Health Study

We assessed the association between depression and sudden cardiac death (SCD) and cardiac events among individuals without baseline coronary heart disease (CHD). Depression is a risk factor for cardiac events and mortality among those with CHD, possibly from arrhythmia. We studied depressive symptoms and a proxy variable for clinical depression consisting of severe symptoms and/or antidepressant medication use and their relationship to cardiac events in the Nurses' Health Study. Questionnaires in 1992, 1996, and 2000 assessed symptoms with the Mental Health Index (MHI-5), and antidepressant use was assessed in 1996 and 2000. Primary end points included SCD, fatal CHD, and nonfatal myocardial infarction. Among 63,469 women without prior CHD/stroke in 1992, 7.9% had MHI-5 scores <53, previously found to predict clinical depression. Depressive symptoms were associated with CHD events, and the relationship was strongest for fatal CHD, where the association remained significant even after controlling for CHD risk factors (hazard ratio [HR]: 1.49; 95% confidence interval [CI]: 1.11 to 2.00 for MHI-5 score <53). In models from 1996 onward, our proxy variable for clinical depression was most associated with SCD in multivariable models (HR: 2.33, 95% CI: 1.47 to 3.70), and this risk was primarily due to a specific relationship between antidepressant use and SCD (HR: 3.34, 95% CI: 2.03 to 5.50). In this cohort of women without baseline CHD, depressive symptoms were associated with fatal CHD, and a measure of clinical depression including antidepressant use was specifically associated with SCD. Although antidepressant use might be a marker of worse depression, its specific association with SCD merits further study.

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.

MENTAL HEALTH OF LOW INCOME UNINSURED MEN WITH PROSTATE CANCER

We evaluated mental health outcomes in a cohort of low income, uninsured men with prostate cancer and identified factors that influence mental health. We performed a retrospective cohort study of 277 subjects enrolled in a program that provides free care to men with prostate cancer who have an annual income of no more than 200% of the federal poverty level. We compared scores on the 5-item RAND Mental Health Inventory (MHI-5) to those in individuals with other chronic diseases. We also examined the relationship between MHI-5 scores and validated measures of general and disease specific health related quality of life. Disease specific quality of life included measures of distress related to urinary, sexual and bowel habits. Multivariate analyses were performed to evaluate factors associated with mental health score. Most men studied were Hispanic (51.6%) and had at most a high school education (85.9%). Mean MHI-5 score +/- SD was 68 +/- 23 on a 100-point scale, significantly worse than cohorts of men with diabetes, congestive heart failure and chronic pulmonary disease. Hispanic ethnicity, urinary bother and bowel bother were negatively associated with mental health. Spirituality and physical functioning were positively associated with mental health. Economically disadvantaged men with prostate cancer report worse mental health than people with other chronic diseases. Patients especially at risk are those with significant urinary or bowel distress, poor physical health, low spirituality and Hispanic ethnicity.

Testing the performance of the ENRICHD Social Support Instrument in cardiac patients

BackgroundPrevious investigations suggest an important role of social support in the outcomes of patients treated for ischemic heart disease. The ENRICHD Social Support Instrument (ESSI) is a 7-item self-report survey that assesses social support. Validity and reliability of the ESSI, however, has not been formally tested in patients undergoing percutaneous coronary intervention (PCI).MethodsThe ESSI, along with the Short Form-36 (SF-36), was sequentially administered to a cohort of 271 patients undergoing PCI. The test-retest reliability was examined with an intra-class correlation coefficient by comparing scores among 174 patients who completed both instruments 5 and 6 months after their procedure. Internal reliability was assessed using Cronbach's alpha at the time of patients' baseline procedure. The concurrent validity of the ESSI was assessed by comparing scores between depressed (MHI-5 score < 44) vs. non-depressed patients. The correlation between the ESSI and the SF-36 Social Functioning sub-scale, an accepted measure of social functioning, was also examined.ResultsTest-retest reliability showed no significant differences in mean scores among ESSI questionnaires administered 1 month apart (27.8+/-1.4 vs 27.8+/-1.5, p = 0.98). The intra-class correlation coefficient was 0.94 and Cronbach's alpha was 0.88. Mean ESSI scores were significantly lower among depressed vs. non-depressed patients (24.6+/-1.7 vs 27+/-1.4, p < 0.018) and a positive albeit modest correlation with social functioning was seen (r = 0.19, p = 0.002).ConclusionThe ESSI appears to be a valid and reliable measure of social support in patients undergoing treatment for coronary artery disease. It may prove to be a valuable method of controlling for patient variability in outcomes studies where the outcomes are related to patients' social support.