MHI-5 Scores Research Articles

Late life changes in mental health: a longitudinal study of 9683 women

Objectives: To identify latent subgroups of women in late life who are alike in terms of their mental health trajectories.Method: Longitudinal data are for 9683 participants in the 1921–1926 cohort of the Australian Longitudinal Study on Women's Health, who completed at least two surveys between 1999 (aged 73–78 years) and 2008 (aged 82–87 years). Mental health was measured using the five-item mental health inventory (MHI-5). Latent profile analysis uncovered patterns of change in MHI-5 scores.Results: Three patterns of change were identified for women who were still alive in 2008 (n = 7061), and three similar patterns for deceased women (n = 2622): (1) ‘poor mental health’ representing women with low MHI-5 scores, (2) ‘good mental health’ and (3) ‘excellent’ mental health, where scores remained very high. Deceased women had lower mental health scores for each class. Remote areas of residence, higher education, single marital status, higher Body Mass Index (BMI) and falls were the covariates associated with mental health in the survivor group. For the deceased group, education, BMI and falls were significant. Arthritis, stroke, heart disease, bronchitis/emphysema, diabetes and osteoporosis were associated with worse mental health for both groups, while asthma increased these odds significantly for the survivor group only. Hypertension and cancer were not significant predictors of poor mental health.Conclusion: The results show associations between chronic disease and level of mental health in older age, but no evidence of a large decline in mental health in the period prior to death.

Recurrence analysis of the EEG during sleep accurately identifies subjects with mental health symptoms

Analysis of brain recurrence (ABR) is a novel computational method that uses two variables for sleep depth and two for sleep fragmentation to quantify temporal changes in non-random brain electrical activity. We postulated that ABR of the sleep-staged EEG could identify an EEG signature specific for the presence of mental health symptoms. Using the Mental Health Inventory Questionnaire (MHI-5) as ground truth, psychological distress was assessed in a study cohort obtained from the Sleep Heart Health Study. Subjects with MHI-5 <50 (N=34) were matched for sex, BMI, age, and race with 34 subjects who had MHI-5 scores >50. Sixteen ABR markers derived from the EEG were analyzed using linear discriminant analysis to identify marker combinations that reliably classified individual subjects. A biomarker function computed from 12 of the markers accurately classified the subjects based on their MHI-5 scores (AUROC=82%). Use of additional markers did not improve classification accuracy. Subgroup analysis (20 highest and 20 lowest MHI-5 scores) improved classification accuracy (AUROC=89%). Biomarker values for individual subjects were significantly correlated with MHI-5 score (r=0.36, 0.54 for N=68, 40, respectively). ABR of EEGs obtained during sleep successfully classified subjects with regard to the severity of mental health symptoms, indicating that mood systems were reflected in brain electrical activity.

Prospective Association of Morning Salivary Cortisol with Depressive Symptoms in Mid-Life: A Life-Course Study

ObjectiveAssociations of cortisol and depression vary at different life-stages, yet population-based, prospective studies are scarce. We aimed to assess associations of morning cortisol with depressive symptoms in mid-life taking account of lifetime psychological health.MethodsParticipants were 5,403 men and women from the 1958 British Birth Cohort whose salivary cortisol was assessed at 45y (45min after waking (T1) and 3h later (T2)) and who completed the 5-item Mental-Health Index (MHI-5) about depressive symptoms at age 50y. Lifetime psychological health was identified from child and adult measures.ResultsFor women, higher T2 cortisol at 45y predicted depression (MHI-5 scores ≤52) at 50y (odds ratio [OR]=1.17; 95% confidence intervals [CI] 1.05,1.30 per standard deviation increase in T2 cortisol), attenuating when adjusted for current (45y) and previous (7-42y) psychological health (OR=1.11; 95% CI 0.98, 1.24). Similarly, an association in women of flatter cortisol delta (T2-T1) with depressive symptoms at 50y weakened after adjustment for current (45y) and previous (7-42y) psychological health. For men, lower T2 cortisol at 45y predicted greater depressive symptoms at 50y and the association strengthened when adjusted for lifetime psychological health. Likewise, lower cortisol AUC predicted higher risk of depression for men after adjusting for prior psychological health (OR=0.85; CI 0.72, 1.00). Associations were largely unaltered by control for covariates.ConclusionsIn women, higher cortisol in late morning at 45y is prospectively associated with depressive symptoms at 50y through a link with lifetime psychological health. In men, lower cortisol predicts subsequent symptoms, independent of depressive history.

Association Between Depressive Symptoms and Incidence of Crohn's Disease and Ulcerative Colitis: Results From the Nurses' Health Study

Depression and psychosocial stress are believed to contribute to the pathogenesis of Crohn's disease (CD) and ulcerative colitis (UC). Although many mechanisms have been proposed to link these disorders, few prospective studies have examined the relationship between depressed mood and incidence of CD or UC. We analyzed data from 152,461 women (aged 29-72 years) enrolled since 1992-1993 in the Nurses' Health Study cohorts I and II. Self-reported depressive symptoms were assessed by using the Mental Health Index (MHI)-5, a validated 5-item subscale of the 36-item Short-Form health survey, which is designed to estimate psychological distress on the basis of scores that range from 0 to 100. Self-reported CD and UC were confirmed through blinded record review by 2 gastroenterologists. Cox proportional hazards models were used to associate recent (within 4 years) and baseline MHI-5 scores with risk for CD or UC, adjusting for other risk factors. During 1,787,070 person-years of follow-up, we documented 170 cases of CD and 203 cases of UC. Compared with women with recent MHI-5 scores of 86-100, women with recent depressive symptoms (MHI-5 scores <52) had an increased risk of CD (multivariate-adjusted hazard ratio [HR], 2.39; 95% confidence interval [CI], 1.40-3.98; P trend = .001). Baseline depressive symptoms, assessed from the baseline MHI-5 score, were also associated with CD, although with a lower HR (1.62; 95% CI, 0.94-2.77). Recent (HR, 1.14; 95% CI, 0.68-1.92) and baseline depressive symptoms were not associated with increased risk of UC (HR, 1.07; 95% CI, 0.63-1.83). On the basis of data from the Nurses' Health Study, depressive symptoms increase the risk for CD, but not UC, among women. Psychological factors might therefore contribute to development of CD. Further studies are needed to determine the mechanisms of this association.

Relation of Cumulative Low-Level Lead Exposure to Depressive and Phobic Anxiety Symptom Scores in Middle-Age and Elderly Women

Background: 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.Objective: We assessed whether bone lead—a biomarker of cumulative lead exposure—is associated with depression and anxiety symptoms among middle-age and elderly women.Methods: 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.Results: 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.Conclusions: 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.

RELATION OF CHRONIC ENVIRONMENTAL LEAD EXPOSURE TO DEPRESSION AND ANXIETY SYMPTOMS IN OLDER WOMEN

Background and Aims: Environmental lead exposure has been associated with adverse cardiovascular and cognitive outcomes, which are themselves correlated with psychological symptoms. Yet few studies have examined links between lead exposure and psychological symptoms. We explored the association between bone lead—a biomarker of cumulative lead exposure—and depression and anxiety symptoms among older women. Methods: We measured patella and tibia bone lead by K-X-Ray-Fluorescence, and obtained repeated measures of depression and anxiety symptoms using the Mental Health Index 5-item subscale (MHI-5) and Crown-Crisp Index phobic anxiety scale (CCI) in 615 women in the Nurses Health Study. We analyzed MHI scores as a continuous variable using linear regression and estimated the odds of a CCI score ≥4 using generalized estimating equations, in both cases accounting for correlation between repeated outcomes (MHI: 3; CCI: 2) and adjusting for potential confounders. Results: The average age of participants was 61 (sd=6) years at the time of bone lead measurement. While tibia lead was associated with moderately worse MHI-5 and CCI scores among all women, results were much stronger among women who, at bone lead measurement, were premenopausal or had been consistently on hormone replacement therapy (HRT) since menopause. In these analyses, women in the highest tibia lead tertile scored 8.16 points worse (95% CI: -11.60, -4.72; p-trend&lt;0.0001) on the MHI-5 than women in the lowest tertile, and had increased odds of high phobic anxiety (CCI ≥4; OR=2.41; 95% CI: 1.06-5.50; p-trend=0.04). We found no relation of patella lead to depression and anxiety symptoms. Conclusions: Our results support an association of cumulative environmental lead exposure with increased risk of depression and anxiety symptoms among older women. Weaker results when including women not consistently on HRT after menopause may be an artifact of increased error in estimating cumulative exposure with bone lead among these women.

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.

Improving Treatment Seeking Among Adolescents with Depression: Understanding Readiness for Treatment

To examine readiness for treatment among adolescents with depression in primary care. This article draws upon data from 184 depressed patients, aged 13 to 17, who participated in the Teen Depression Awareness Project. Adolescents were screened assessed along a number of domains at baseline and 6 months. Seventy-eight percent of the depressed teens acknowledged they had a problem with depression, yet only 25% were currently getting any sort of counseling or treatment for depression. A total of 40.8% of depressed adolescents were "ready" to get care, whereas 26.6% were "unsure" and 32.1% were "not ready." Significant differences among these groups were observed for race/ethnicity and household income. Adolescents in the ready group also had more depressive symptoms and lower MHI-5 scores. Being in the ready group versus being "unsure" was a significant predictor of service use at the 6-month follow-up, as was the average number of days impaired and overall mental health functioning. Race, gender, and age were not significant predictors of readiness, yet average number of depressive symptoms was significantly associated with greater readiness. Because teens in primary care settings are not seeking mental health treatments even when depression is detected, providers should be mindful that adolescents may be at different stages of recognition and readiness for treatment. Teens who are less ready for care may need follow-up primary care visits or consultation to help them become more active in seeking care.

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.

Usefulness of five-item and three-item Mental Health Inventories to screen for depressive symptoms in the general population of Japan

BackgroundThe five-question Mental Health Inventory (MHI-5) is a brief questionnaire that can be used to screen for depressive symptoms. Removing the 2 anxiety-related items from the MHI-5 yields the MHI-3. We assessed the performance of the Japanese versions of the MHI-5 and MHI-3 in detecting depressive symptoms in the general population of Japan.MethodsFrom the population of Japan, 4500 people 16 years old or older were selected by stratified-random sampling. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36, which includes the MHI-5) and the Zung Self-rating Depression Scale (ZSDS) were included in a self-administered questionnaire. ZSDS scores of 48 and above were taken to indicate the presence of moderate or severe depressive symptoms, and scores of 56 and above were taken to indicate the presence of severe depressive symptoms. We computed the correlation coefficient between the ZSDS score and the scores on the MHI-5 and MHI-3. We also computed the sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve.ResultsOf the 3107 subjects (69% of the 4500 initially selected), 14.0% had moderate or severe depressive symptoms, and 2.0% had severe depressive symptoms as measured with the ZSDS. The correlations of ZSDS scores with MHI-5 scores and with MHI-3 scores were similar: -0.63 and -0.61, respectively. These correlation coefficients were almost the same whether or not the data were stratified by age and sex. For detecting severe depressive symptoms with the MHI-5, the area under the ROC curve was 0.942 (95%CI: 0.919 – 0.965); for the MHI-3, it was 0.933 (95%CI: 0.904 – 0.962).ConclusionThe MHI-5 and MHI-3 scores were correlated with the ZSDS score, and can be used to identify people with depressive symptoms in the general population of Japan.

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.

Mental health status of clients from three HIV/AIDS palliative care projects

To describe mental health status and its correlates among clients of three palliative care programs targeting underserved populations. Mental Health Inventory (MHI-5) scores of clients from programs in Alabama (n = 39), Baltimore (n = 57), and New York City (n = 84) were compared. Mean MHI-5 scores did not differ among sites and were indicative of poor mental health. Significant differences were noted among sites with regard to client sociodemographics, physical functioning, and perceptions of interpersonal relations. Results of multivariate regression models estimated for each site suggest variation in the relative importance of potential predictors among sites. Whereas poorer mental health was primarily associated with history of drug dependence at Baltimore and more physical symptomatology at New York, better mental health was most strongly correlated with more positive perceptions of interpersonal relationships at Baltimore and increasing age and more positive perceptions of meaning and purpose in life at New York. The data presented suggest the importance of assessing clients' history of and current need for mental health services. Evidence of a relationship between positive perceptions of meaning and purpose and better psychological function underscores the importance of existential issues for the overall well-being of those who are seriously ill.

Patient volume, staffing, and workload in relation to risk-adjusted outcomes in a random stratified sample of UK neonatal intensive care units: a prospective evaluation

UK recommendations suggest that large neonatal intensive-care units (NICUs) have better outcomes than small units, although this suggestion remains unproven. We assessed whether patient volume, staffing levels, and workload are associated with risk-adjusted outcomes, and with costs or staff wellbeing. 186 UK NICUs were stratified according to volume of patients, nursing provision, and neonatal consultant provision. Primary outcomes were hospital mortality, mortality or cerebral damage, and nosocomial bacteraemia. We studied 13515 infants of all birthweights consecutively admitted to 54 randomly selected NICUs. Multiple logistic regression analyses were done with every primary outcome as the dependent variable. Staff wellbeing and stress were assessed by anonymous mental health index (MHI)-5 questionnaires. Data were available for 13334 (99%) infants. High-volume NICUs treated the sickest infants and had highest crude mortality. Risk-adjusted mortality and mortality or cerebral damage were unrelated to patient volume or staffing provision; however, nosocomial bacteraemia was less frequent in NICUs with low neonatal consultant provision (odds ratio 0.65, 95% CI 0.43-0.98). Mortality was raised with increasing workload in all types of NICUs. Infants admitted at full capacity versus half capacity were about 50% more likely to die, but there was wide uncertainty around this estimate. Most staff had MHI-5 scores that suggested good mental health. The implications of this report for staffing policy, medicolegal risk management, and ethical practice remain to be tested. Centralisation of only the sickest infants could improve efficiency, provided that this does not create excessive workload for staff. Assessment of increased staffing levels that are closer to those in adult intensive care might be appropriate.

Scores on the SF-36 Scales and the Beck Depression Inventory in Assessing Mental Health among Patients on Hemodialysis

45 patients on hemodialysis were administered both the Medical Outcomes Study SF-36 and the Beck Depression Inventory. The Mental Health Inventory subscale scores of the SF-36 were regressed stepwise on the Role Emotional subscale scores of the SF-36 and the Beck inventory. 46% of the variance in the MHI-5 scores was accounted for by age category and the other two measures of emotional status. Age category was not significant. Discussion includes the potential utility of the combination of inventories in assessing mental health among patients on hemodialysis.