Positive Mental Health Instrument Research Articles

Positive mental health of patients at a psychiatric hospital, Gauteng province, South Africa.

Positive mental health (PMH) forms the basis of well-being and positive mind set, which includes a range of cognitive-emotional attributes and coping skills of an individual towards the family and society. Assessment of PMH in psychiatric patients is critical in understanding their needs, improving mental health and the treatment of their illnesses. To investigate the levels of PMH among patients attending the outpatient department at a public sector tertiary referral psychiatric hospital using the multidimensional PMH instrument. Adult psychiatric patients attending the outpatient department at a public sector tertiary referral hospital, Gauteng province, South Africa. A quantitative, cross-sectional and descriptive study was conducted using a multi-dimensional PMH instrument with a convenient sample of 346 outpatients who provided consent. Females reported significantly high PMH scores (3.86 vs 3.6; p = 0.018) compared to males. Patients with higher education (Gr. 0-7 vs Gr. 8-12 vs Tertiary education, PMH scores 3.34 vs 3.75 vs 4.18; p < 0.001), being married (single vs married, 3.67 vs 3.81, p = 0.342) and employed (unemployed vs employed, 3.62 vs 3.97, p = 0.005) reported significantly high total PMH score and across various domains. The results of the study highlighted the multi-dimensionality of mental health and justified importance of evaluating the domains of PMH in mental health care users. Identifying the reasons for the deficits in the PMH domains and implementing coping strategies will improve the emotional and psychological well-being of patients. Examining the PMH domains will assist healthcare workers intervene to improve the mental health of patients.

Mental Health in the Times of Corona: A model for Positive Mental Health During the Global Pandemic.

As the world comes to terms with the changes brought on by the appearance and spread of Covid-19, there is an increase in fear and anxiety levels. The World Health Organization has stressed on the need to focus on mental health, as the epidemic affects both young and old. One of the biggest challenges is that the situation has no precedent. This has led to the creation of uncertainty and doubt. The current study focusses on studying the positive mental health of the Indian population. For the study, the researchers have restricted the scope to include only Generation Y and Generation Z, as they form a majority of the working population and literature suggests that negative moods, stressors and apprehensions are far more prevalent among the younger sections of the society. The findings suggest that positive mental health is not dependent on gender or age. However, some of the dimensions do show significant variance. The researchers have also proposed a model of Positive Mental Health based on the dimensions of the Positive Mental Health Instrument.

Religious Affiliation in Relation to Positive Mental Health and Mental Disorders in a Multi-Ethnic Asian Population.

Background: This study investigated association of religious affiliation with positive mental health (PMH) and mental disorders. Methods: A cross-sectional survey of 2270 adults was conducted in Singapore. Participants reported their religious affiliation to Buddhism, Christianity, Hinduism, Islam, Sikhism, Taoism, or other religions. A PMH instrument measured total PMH and six subcomponents: general coping (GC), emotional support (ES), spirituality (S), interpersonal skills (IS), personal growth and autonomy (PGA), and global affect (GA). Lifetime history of mental disorders was assessed with the Composite International Diagnostic Interview. Results: Total PMH (mean ± SD) was 4.56 ± 0.66 for participants with any religion versus 4.12 ± 0.63 (p = 0.002) in those without any religion. After adjustment for all potential confounders, the mean difference in total PMH between these groups was 0.348 (95% CI: 0.248–0.448). Having any religion was significantly associated with higher scores for S, GC, ES, IS, but not with PGA, GA or mental disorders. Compared with individuals without any religion, total PMH and S levels were significantly higher across all religions. Additionally, Christianity was significantly associated with higher ES, Taoism with higher GC, Buddhism and Islam with higher GC, ES and IS, Hinduism with higher IS and Sikhism with higher ES and IS. Conclusion: Our results indicate that religious affiliation is significantly associated with higher PMH, but not with mental disorders in an Asian community setting. In addition, different religions showed unique patterns of association with PMH subcomponents.

Development of the Chinese, Malay and Tamil translations of the Positive Mental Health Instrument: Cross-cultural adaptation, validity and internal consistency.

This study describes the development and validation of Chinese, Malay and Tamil translations of the Positive Mental Health Instrument (PMHI) in a general population sample in Singapore. Translations were performed using two independent forward translations followed by expert panel discussions and tested for content, construct and language appropriateness using focus group discussions. The final translated tools were field-tested among 220 residents per language using self-administered questionnaires comprising the translated PMHI and other validity measures. Missing data, floor and ceiling effects, confirmatory factor analysis (CFA), internal consistency, item response theory differential item functioning (IRT-DIF) and criterion validity were assessed. A total of 10 PMHI-Chinese items, 26 PMHI-Malay items and six response categories and six PMHI-Tamil items were modified based on expert panel and focus group discussions. PMHI had low missing data and showed negative but acceptable skewness (<2) and kurtosis (<7) for all translations, except for the PMHI-Malay "spirituality" subscale (skewness: -2.8; kurtosis: 12.5). CFA showed that all three PMHI translations fulfilled the original six-factor-higher-order structure (RMSEA = 0.05, CFI = 0.962, TLI = 0.96). Cronbach's alpha coefficients for total PMHI were 0.958, 0.954, 0.945 and 0.949 in the overall sample and the Chinese, Malay and Tamil translations, respectively. The three translations of the PMHI showed expected and significant positive (r = 0.116 to 0.663) and negative correlations (r = -0.137 to -0.574) with established measures. The findings show that the Chinese, Malay and Tamil translations of the PMHI have high internal consistency and validity in this multi-ethnic population.

Sleep Duration, Sleep Quality and Physical Activity, but Not Sedentary Behaviour, Are Associated with Positive Mental Health in a Multi-Ethnic Asian Population: A Cross-Sectional Evaluation.

Background: We assessed the associations of sleep, physical activity and sedentary behaviour with positive mental health (PMH) in the multi-ethnic population of Singapore. Methods: The Singapore Health 2 study is a nationally representative cross-sectional survey among residents aged 18–79 years. A PMH instrument was administered to 1925 participants to obtain total PMH and six sub-component scores. Self-rated sleep duration, sleep quality, sedentary behaviour and physical activity were assessed. Multivariable linear regression analyses were conducted. Results: The mean age of the participants was 40.1 (SD 14.3) years. Sleep duration (≥8 h/night: β = 0.17,95% CI: 0.02–0.32; 7–< 8 h/night: β = 0.17,95% CI: 0.03–0.30 versus <6 h/night, p = 0.002), sleep quality (very good: β = 0.45,95% CI: 0.29–0.60; fairly good: β = 0.20,95% CI: 0.06–0.33 versus very/fairly bad; ptrend < 0.001) and physical activity (high: β = 0.19,95% CI: 0.05–0.32; moderate: β = 0.15, 95% CI: 0.03–0.27 versus low; ptrend < 0.001) were directly associated with total PMH. Sedentary behaviour was not significantly associated with PMH. Sleep duration, sleep quality and physical activity were directly associated with the PMH sub-components ‘emotional support’ and ‘personal growth and autonomy’. Conclusions: Duration and quality of sleep and physical activity were directly associated with PMH in an urban Asian population. These findings support incorporating sleep and physical activity interventions to improve population mental health.

Development and validation of the Rapid Positive Mental Health Instrument (R-PMHI) for measuring mental health outcomes in the population

BackgroundThe multidimensional Positive Mental Health Instrument (PMHI) has 47 items and six subscales. This study aimed to develop and validate a short unidimensional version of the PMHI among Singapore’s adult resident population.MethodsUsing pooled data from three earlier studies (n = 1050), PMHI items were reduced by Partial Credit Rasch Model (PCRM) runs in a random split-half sample, while psychometric properties of the resulting measure were tested through confirmatory factor analysis (CFA), item response theory-graded response model and internal consistency reliability in the other half. Its reliability, construct and concurrent validity, agreement with the original scale, floor and ceiling effect, and scale estimates were further investigated in an external representative general population sample (n = 1925).ResultsThe average age of the participants was around 41 years. Four PCRM re-runs for item selection resulted in a 6-item unidimensional Rapid PMHI (R-PMHI). CFA confirmed the unidimensional structure of the R-PMHI in the internal (RMSEA = 0.075, CFI = 0.985, TLI = 0.974) and external (RMSEA = 0.051, CFI = 0.992, TLI = 0.987) validation samples. In the external validation sample, the R-PMHI met concurrent validity criteria, showing high agreement with the 47-item version with intra-class correlation coefficient of 0.872 (95% CI: 0.861 to 0.882) and low floor and ceiling effects. Weight-adjusted mean (SE, 95% CI) R-PMHI score in the population was 4.86 (0.2, 4.82–4.90).ConclusionThe unidimensional 6-item R-PMHI offers brevity over the original multidimensional measure while appropriately representing the positive mental health construct. Prospective studies are needed to assess its responsiveness and test-retest reliability.

Understanding the relationships between mental disorders, self-reported health outcomes and positive mental health: findings from a national survey

BackgroundThe link between mental illness and mental health is gaining focus in research and practice. This study aimed to investigate the association of mental disorders with positive mental health (PMH), overall health and quality of life. In addition, the role of PMH in mediating the relationships between mental disorders and health outcomes was assessed.MethodsThe study sample comprised 2270 residents aged 18 years and above who participated in a nationally representative, cross-sectional survey estimating the lifetime prevalence of mood, anxiety and alcohol use disorders, and health outcomes (self-reported overall health, quality of life and PMH) in Singapore. The Positive Mental Health Instrument was used to estimate the level of Total PMH among the respondents with and without mental disorders. Associations between mental disorders and health outcomes were assessed through regression models. Path analyses were conducted to investigate mediating role of PMH.ResultsTotal PMH (Mean ± SD) was significantly lower among individuals having any of the studied lifetime mental disorders (4.23 ± 0.64 versus 4.50 ± 0.67 among those without these disorders). Although having a mood or anxiety disorder was associated with significantly lower Total PMH even after controlling for socio-demographic characteristics, similar relationship was not observed for alcohol use disorders. History of any mental disorders was also associated with lower overall health and quality of life. Total PMH mediated the relationships between mental disorders and overall health and quality of life by reducing the effect sizes for the associations between mental disorders and these health outcomes.ConclusionsMental disorders were associated with poor health outcomes in affected individuals. This study showed that PMH can mediate the relationships between mental disorders and health outcomes, and act as an underlying mechanism to improve overall health and quality of life in individuals with mental disorders. Findings thus highlight the significance of incorporating mental health promotion and interventions in clinical populations.

Psychometric properties and population norms of the positive mental health instrument in a representative multi-ethnic Asian population

BackgroundMeasures of mental well-being and positive mental health (PMH) have been largely developed and used in Western populations, however, data on representative Asian communities are lacking. Using data from a population sample, this study sought to establish psychometric properties and norms of the PMH Instrument (PMH-I), a measure of positive mental health developed in Singapore.MethodsWe conducted a nationally representative survey among 1925 adults aged 18–79 years of Chinese, Malay, Indian or other ethnicity. Participants reported socio-demographic characteristics and completed the PMH-I along with measures of health-related quality of life (HRQoL) and psychological distress. Construct validity of the PMH-I was assessed using confirmatory factor analysis and concurrent validity was tested through correlation with other psychological measures. Normative PMH values and differences in population subgroups were estimated.ResultsThe six-factor-higher-order structure of the PMH-I comprising six subscales of general coping, emotional support, spirituality, interpersonal skills, personal growth and autonomy and global affect was confirmed. Concurrent validity was shown through significant positive correlation of the total PMH score and its subscales with HRQoL and an inverse correlation with psychological distress. Weighted age, gender and ethnicity-specific norms were derived for the Singapore population. Total PMH was significantly higher in participants aged over 40 years as compared with 18–29 year olds and in non-Chinese ethnic groups as compared with Chinese. These differences were observed for all PMH-I subscales, with the exception of emotional support and interpersonal skills score differences by age. In contrast, gender, marital status, and education level were significantly associated with some of the subscales, but not with total PMH.ConclusionsThese results support the psychometric properties of the PMH-I in a multi-ethnic Asian population sample. The generalizable population-based norms support the application of the PMH-I for measuring mental health and assessing its determinants within the Singapore general population.

Influence of Positive Mental Health on Quality of Work Life of Government School Teachers

Positive mental health is the state of wellbeing wherein the individual is able to relate well with others, carry out his duties effectively and handle stress. It is a state that gives happiness and peace to the individual. When mental health is affected, it affects one’s thinking, behavior, and physical health. Positive mental health in workplace is necessary for a person to carry out his work successfully, and be innovative. It is necessary for an employer to constantly have a check on the mental health of the employees, as wellbeing has a great impact on the turnover of the organization. This article is an attempt to check the association between mental health and quality of work life of government school teachers of Salem city. Positive mental health instrument (Vaingankar, et al., 2011) and Quality of work life scale (Parameswari &amp; Kadhiravan, 2014) were used to collect the data. The collected data were analysed using appropriate statistical tools and the implications of the study is discussed.

Positive mental health in individuals with mental disorders

IntroductionGiven the emphasis on inclusion of well-being interventions in the treatment and rehabilitation of individuals with mental disorders, it is important to understand the level and determinants of positive mental health (PMH) among them.ObjectiveTo conduct a cross-sectional study among patients with schizophrenia, depression and anxiety spectrum disorders to estimate PMH.Aims(i) To estimate the level of PMH among patients with mental disorders and compare these with the established general population estimates; (ii) to identify socio-demographic and clinical determinants of PMH.MethodsFollowing ethics approval, 353 patients aged 21-65 years, receiving treatment at a psychiatric hospital in Singapore for schizophrenia, depression or anxiety spectrum disorders were included. Patients provided socio-demographic information and completed the multidimensional PMH instrument that provides total and domain-specific scores ranging from 1 to 6; higher scores indicate better PMH. Functioning was assessed with the Global Assessment of Functioning (GAF) scale and clinical data were obtained from administrative databases.ResultsSample comprised 142, 139 and 72 patients with schizophrenia, depression and anxiety spectrum disorders respectively, with a mean age of 39.2 years. Mean total PMH scores among them were 4.2, 3.7 and 3.8 respectively which were significantly lower than the general population mean of 4.5 (P &lt; 0.001). Patients of Chinese ethnicity, with lower education, depression or anxiety, and lower GAF scores were more likely to have lower PMH.ConclusionsThis study identified patient subgroups that are likely to have poorer PMH. Interventions facilitating PMH among these patient groups would be beneficial and are needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychometric properties of the positive mental health instrument among people with mental disorders: a cross-sectional study.

BackgroundThe Positive Mental Health (PMH) instrument was developed and validated to assess the level of PMH and its six dimensions in a multi-ethnic general population sample. This cross-sectional study examines the psychometric properties of the instrument for assessing the level of PMH among help-seeking patients with mental disorders.MethodsThe PMH instrument was tested among 360 out-patients with schizophrenia, depression or anxiety spectrum disorders, seeking treatment at a tertiary psychiatric hospital and its affiliated clinics in Singapore. All participants completed the PMH instrument along with measures of life satisfaction, mental and overall health and happiness. Reliability (internal consistency), construct (Exploratory Structural Equation Modeling (ESEM)) and criterion (convergent and divergent) validity of the PMH instrument were tested in this population. Items were also tested for item response theory and differential item functioning (IRT-DIF).ResultsESEM on the PMH instrument showed good fit with the model reflecting six factors (general coping, personal growth and autonomy, spirituality, interpersonal skills, emotional support, and global affect). Internal consistency was high (Cronbach’s alpha >0.85) for the instrument and its six subscales. The PMH instrument fulfilled expected correlations with related constructs and demonstrated adequate item discrimination and difficulty estimates; however, significant DIF was noted for few items for age, gender and ethnicity groups.ConclusionsThe PMH instrument is a reliable and valid instrument for measuring PMH dimensions in patients with mental disorders. Further studies in larger samples are needed to assess the impact of DIF on PMH scores. The implications for the shift in focus from just the negative aspects of mental disorders to including positive components in the assessment of patients with mental disorders are immense, and can be applied in routine mental health practice and policy making.

Positive mental health in outpatients with affective disorders: Associations with life satisfaction and general functioning

BackgroundPositive mental health (PMH) is an integral and essential component of health that encompasses emotional, psychological and social well-being. The Keyes' two continua model of mental health and illness posits that mental health status is not merely the absence of mental health problems, and it can be enhanced regardless of a diagnosis of mental illness. The present study hypothesized that mentally ill patients with higher levels of PMH would be associated with better life satisfaction and general functioning. Methods218 outpatients with affective disorders at a tertiary psychiatric hospital were recruited and administered the multidimensional Positive Mental Health instrument, which was validated and developed in Singapore to measure PMH. Depression and anxiety severity were also assessed. Associations of positive mental health with life satisfaction and general functioning were investigated in linear regression models. ResultsPMH scores varied largely within patients with depressive and anxiety disorders but did not differ statistically across the two diagnoses, except for emotional support. PMH was associated with both life satisfaction and general functioning with little evidence of confounding by sociodemographic and clinical status. LimitationsThe cross-sectional design of the study could not examine causal relationships. Findings may be restrictive to treatment-seeking population with specific affective disorders. ConclusionOur study provides evidence to support the notion that a good mental health state is not simply the absence of a mental disorder. Mentally ill patients can also have high levels of PMH that possibly have a moderating or mediating effect on the relationship between patients' clinical symptoms and life satisfaction or general functioning.

Development, validity and reliability of the short multidimensional positive mental health instrument

The 47-item positive mental health (PMH) instrument measures the level of PMH in multiethnic adult Asian populations. This study aimed to (1) develop a short PMH instrument and (2) establish its validity and reliability among the adult Singapore population. Two separate studies were conducted among adult community-dwelling Singapore residents of Chinese, Malay or Indian ethnicity where participants completed self-administered questionnaires. In the first study, secondary data analysis was conducted using confirmatory factor analysis (CFA) to shorten the PMH instrument. In the second study, the newly developed short PMH instrument and other scales were administered to 201 residents to establish its factor structure, validity and reliability. A 20-item short PMH instrument fulfilling a higher-order six-factor structure was developed following secondary analysis. The mean age of the participants in the second study was 41 years and about 53% were women. One item with poor factor loading was further removed to generate a 19-item version of the PMH instrument. CFA demonstrated a first-order six-factor model of the short PMH instrument. The PMH-19 instrument and its subscales fulfilled criterion validity hypotheses. Internal consistency and test-retest reliability of the PMH-19 instrument were high (Cronbach's α coefficient = 0.87; intraclass correlation coefficient = 0.93, respectively). The 19-item PMH instrument is multidimensional, valid and reliable, and most importantly, with its reduced administration time, the short PMH instrument can be used to measure and evaluate PMH in Asian communities.

Socio-demographic Correlates of Positive Mental Health and Differences by Depression and Anxiety in an Asian Community Sample

Positive Mental Health (PMH) instrument is a self-administered multidimensional measure that is validated in the adult multi-ethnic Asian population in Singapore and comprises General Coping (GC), Emotional Support (ES), Spirituality, Interpersonal Skills (IS), Personal Growth and Autonomy (PGA) and Global Affect (GA) domains. This paper aimed to (i) examine socio-demographic differences and identify correlates for the total PMH and domain-specific scores in the sample, and (ii) compare the PMH total score for respondents with and without depression or anxiety. Singapore residents aged 21 to 65 years, of Chinese, Malay or Indian ethnicity and residing in households across Singapore (n = 404) completed the 47-item PMH instrument in an anonymous survey. Socio-demographic information was obtained during the survey and respondents also completed the Patient Health Questionnaire (PHQ)-8 and Generalised Anxiety Disorder (GAD)-7 scale to establish depression and anxiety. Descriptive analyses were conducted to examine for differences in PMH scores by socio-demographic groups and between those with and without depression and anxiety. The total PMH score was significantly different across ethnicity and marital status in the bivariate analysis. After multivariate analysis, ethnicity remained a significant correlate for total PMH and the 6 domain-specific PMH scores, marital status correlated with Spirituality, educational level was associated with IS; while gender was associated with ES and PGA. Significantly lower PMH total scores were observed for those with depression and anxiety as compared to those without. Socio-demographic correlates of PMH were identified in an Asian community sample. PMH scores were significantly lower among those with depression and anxiety.

The positive mental health instrument: development and validation of a culturally relevant scale in a multi-ethnic asian population

BackgroundInstruments to measure mental health and well-being are largely developed and often used within Western populations and this compromises their validity in other cultures. A previous qualitative study in Singapore demonstrated the relevance of spiritual and religious practices to mental health, a dimension currently not included in exiting multi-dimensional measures. The objective of this study was to develop a self-administered measure that covers all key and culturally appropriate domains of mental health, which can be applied to compare levels of mental health across different age, gender and ethnic groups. We present the item reduction and validation of the Positive Mental Health (PMH) instrument in a community-based adult sample in Singapore.MethodsSurveys were conducted among adult (21-65 years) residents belonging to Chinese, Malay and Indian ethnicities. Exploratory and confirmatory factor analysis (EFA, CFA) were conducted and items were reduced using item response theory tests (IRT). The final version of the PMH instrument was tested for internal consistency and criterion validity. Items were tested for differential item functioning (DIF) to check if items functioned in the same way across all subgroups. Results: EFA and CFA identified six first-order factor structure (General coping, Personal growth and autonomy, Spirituality, Interpersonal skills, Emotional support, and Global affect) under one higher-order dimension of Positive Mental Health (RMSEA = 0.05, CFI = 0.96, TLI = 0.96). A 47-item self-administered multi-dimensional instrument with a six-point Likert response scale was constructed. The slope estimates and strength of the relation to the theta for all items in each six PMH subscales were high (range:1.39 to 5.69), suggesting good discrimination properties. The threshold estimates for the instrument ranged from -3.45 to 1.61 indicating that the instrument covers entire spectrums for the six dimensions. The instrument demonstrated high internal consistency and had significant and expected correlations with other well-being measures. Results confirmed absence of DIF.ConclusionsThe PMH instrument is a reliable and valid instrument that can be used to measure and compare level of mental health across different age, gender and ethnic groups in Singapore.