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

Health and Quality of Life Outcomes

Cathy Sherbourne²  Joseph YS Tee¹  Boon Yiang Chua¹  Mei Yen Phua¹  Yee WeiLim²  Louisa Picco¹  Maria Orlando Edelen²  Edimansyah Abdin¹  Siow Ann Chong¹  Mythily Subramaniam¹  Janhavi Ajit Vaingankar¹ 

[1] Research Division, Institute of Mental Health/Woodbridge Hospital, 10, Buangkok View, 539747, Singapore;RAND Corporation, Santa Monica, California, United Sates of America

关键词: item response theory;    factor analysis;    item reduction;    instrument development;    multi-dimensional;    Positive mental health;   

Others  :  826326
DOI  :  10.1186/1477-7525-9-92

 received in 2011-05-09, accepted in 2011-10-31,  发布年份 2011

【 摘 要 】

Background

Instruments 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.

Methods

Surveys 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.

Conclusions

The 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.

【 授权许可】

   
2011 Vaingankar et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]World Health Organization Promoting Mental Health: Concepts emerging evidence and practice. Summary report 2004.
• [2]Merrill RM, Aldana SG, Pope JE, Anderson DR, Coberley CR, Vyhlidal TP, Howe G, Whitmer RW: Evaluation of a Best-Practice Worksite Wellness Program in a Small-Employer Setting Using Selected Well-being Indices. J Occup Environ Med 2011, 53:448-454.
• [3]Ford E, Clark C, Stansfeld SA: The influence of childhood adversity on social relations and mental health at mid-life. J Affect Disord 2011, 133:320-7.
• [4]Lehman AF: The Well-being of Chronic Mental Patients: Assessing their quality of life. Arch Gen psychiatry 1983, 40(4):369-373.
• [5]Sorrell JM: Mental Health of the Oldest-Old. J Psychosoc Nurs Ment Health Serv 2011, 13:1-3.
• [6]Singapore Department of Statistics [http://www.singstat.gov.sg/pubn/popn/population2009.pdf] webcitePopulation Trends 2009.
• [7]Tennant R, Hiller L, Fishwick R, Platt S, Joseph S, Weich S, Parkinson J, Secker J, Stewart-Brown S: The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health Qual of Life Outcomes 2007, 5:63. BioMed Central Full Text
• [8]Watson D, Clark LA, Tellegen A: Development and validation of brief measures of positive and negative affect: The PANAS Scales. J Pers Soc Psychol 1988, 47:1063-1070.
• [9]Kafka GJ, Kozma A: The Construct Validity of Ryff's Scales of Psychological Well-Being (SPWB) and their Relationship to Measures of Subjective Well-Being. Social Indicators Research 2002, 57:171-190.
• [10]Lehtinen V, Sohlman B, Kovess-Masfety V: Level of positive mental health in the European Union: results from the Eurobarometer 2002 survey. Clin Pract Epidemiol Ment Health 2005, 1:9. BioMed Central Full Text
• [11]Ware JE, Snow KK, Kosinski M, Gandek B: SF-36 Health Survey: Manual and interpretation guide. Boston MA, Health Institute. New England Medical Center; 1993.
• [12]Andrews FM, Crandall R: The validity of measures of self reported well-being. Social Indicators Research 1976, 3:1-19.
• [13]Oishi S, Schimmack U: Culture and well-being: A new inquiry into the psychological wealth of Nations. Perspectives on Psychological Science 2010, 5(4):463-71.
• [14]Kammann R, Flett R: A scale to measure current level of general happiness. Aust Psychol 1983, 35:259-265.
• [15]Auquier P, Simeoni MS, Saplin C, Reini G, Aghababian V, Cramer J, Lancon C: Development and validation of a patient-based health related quality of life questionnaire in Schizophrenia: the S-QoL. Schiz Res 2003, 63(1-2):137-49.
• [16]Berzon H, Hayz RD, Shumaker SA: International use, application and performance of health-relayed quality of life instruments. Qual Life Res 1993, 2(6):367-8.
• [17]Diener E, Emmons RA, Larsen RJ, Griffin S: The satisfaction with life scale. Journal of Personality Assessment 1985, 49:71-75.
• [18]Carver CS: You want to measure coping but your protocol's too long: Consider the Brief COPE. International Journal of Behavioral Medicine 1997, 4:92-100.
• [19]Friborg O, Hjemdal O, Rosenvinge JH, Martinussen M: A new rating scale for adult resilience: What are the central protective resources behind healthy adjustment? International Journal of Methods in Psychiatric Research 2003, 12:65-76.
• [20]Robitschek C: Personal Growth Initiative: The Construct and Its Measure. Measurement and Evaluation in Counseling and Development 1998, 30:183-198.
• [21]Zimet GD, Dahlem NW, Zimet SG, Farley GK: The Multi-dimensional Scale of Percieved Social Support. J Pers Assess 1988, 52:30-41.
• [22]Underwood LG, Teresi JA: The Daily Spiritual Experience Scale: Development, Theoretical Description, Reliability, Exploratory Factor Analysis, and Preliminary Construct Validity Using Health-Related Data. Ann Behav Med 2002, 24:22-33.
• [23]Stewart-Brown S, Tennant A, Tennant R, Platt S, Parkinson J, Weich S: Internal construct validity of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS): a Rasch analysis using data from the Scottish Health Education Population Survey. Health and Quality of Life Outcomes 2009, 7:15. BioMed Central Full Text
• [24]Brooks R, EuroQoL Group: EuroQol: the current state of play. Health Policy. 1996, 37:53-72.
• [25]Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Lo" we B: Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity and Detection. Ann Intern Med 2007, 146:317-325.
• [26]Kroenke K, Spitzer RL: The PHQ-9: A New Depression Diagnostic and Severity Measure. Psychiatric Annals 2002, 32:509-521.
• [27]Sheehan DV, Harnett-Sheehan K, Raj BA: The measurement of disability. International Clinical Psychopharmacology 1996, 11(suppl 3):89-95.
• [28]Center for Disease Control and Prevention: Measuring Healthy Days: Population Assessment of Health-Related Quality of Life. US Department of Health and Human Services 2000.
• [29]Van der Linden, Hambleton R, (Eds.): Handbook of modern item response theory. Berlin: Springer; 1997.
• [30]Muthen LK, Muthen BO: MPLUS User's Guide (6th edition);.1998-2010.
• [31]Brown TA: Confirmatory factor analysis for applied research. New York: Guilford; 2006.
• [32]Hu L, Bentler PM: Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Modeling 1999, 6(1):1-55.
• [33]Steiger JH: Structural model evaluation and modification: An interval estimation approach. Multivariate Behav Res 1990, 25:173-180.
• [34]Bentler PM: Comparative fit indexes in structural models. Psychol Bull 1990, 107:238-246.
• [35]Cai L, du Toit SHC, Thissen D: IRTPRO: Flexible, multi-dimensional, multiple categorical IRT modeling. Chicago, IL: Scientific Software International, in press.
• [36]Samejima F: Estimation of Latent Ability Using a Response Pattern of Graded Scores. In Psychometric Monograph. Richmond, VA: Psychometric Society; 1969:17.
• [37]Orlando M, Thissen D: Likelihood-based item fit indices for dichotomous item response theory models. Appl Psychol Meas 2000, 24:50-64.
• [38]Orlando M, Thissen D: Further investigation of the performance of S-X2: An item fit index for use with dichotomous item response theory models. Applied Psychological Measurement 2003, 27:289-298.
• [39]Benjamini Y, Hochberg Y: Controlling the false discovery rate: A practical and powerful approach to multiple testing. J Royal Stat Soc 1995, 57:289-300.
• [40]Cronbach LJ: Coefficient alpha and internal structure of tests. Psychometrika 1951, 16:297-334.
• [41]Kammann R, Flett R: Affectometer 2: A scale to measure current level of general happiness. Aust J Psychol 1983, 35(2):259-265.
• [42]Ashton CM, Holt CL, Wray NP: A patient self-assessment tool to measure communication behaviors during doctor visits about hypertension. Patient Educ Couns 2010, 81(2):275-314.
• [43]Ryff C, Keyes C: The structure of psychological well-being revisited. Journal of Personality and Social Psychology 1995, 69:719-27.
• [44]DiStefano C, Zhu M, Mîndrilă D: Understanding and Using Factor Scores:Considerations for the Applied Researcher. Practical Assessment, Research & Evaluation 2009, 14(20):1-11.
• [45]Erhart M, Hagquist C, Auquier P, Rajmil L, Pwer M, Ravens-Sieberer U: A comparison of Rasch item-fit and Cronbach's alpha item reduction analysis for the development of a Quality of Life scale for children and adolescents. Child Care Health Dev 2010, 36:473-484.
• [46]Gerstorf D, Ram N, Röcke C, Lindenberger U, Smith J: Decline in life satisfaction in old age: longitudinal evidence for links to distance-to-death. Psychol Aging 2008, 23(1):154-68.