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. 2006 Mar 24;12(2):85–91. doi: 10.1002/mpr.145

Measuring well‐being rather than the absence of distress symptoms: a comparison of the SF‐36 Mental Health subscale and the WHO‐Five well‐being scale

Per Bech 1,✉, Lis Raabaek Olsen 1, Mette Kjoller 2, Niels Kristian Rasmussen 2
PMCID: PMC6878541  PMID: 12830302

Abstract

The health status questionnaire Short‐Form 36 (SF‐36) includes subscales measuring both physical health and mental health. Psychometrically, the mental health subscale contains a mixture of mental symptoms and psychological well‐being items, among other things, to prevent a ceiling effect when used in general population studies. Three of the mental health well‐being items are also included in the WHO‐Five well‐being scale. In a Danish general population study, the mental health subscale was compared psychometrically with the WHO‐Five in order to evaluate the ceiling effect. Tests for unidimensionality were used in the psychometric analyses, and the sensitivity of the scales in differentiating between changes in self‐reported health over the past year has been tested.

The results of the study on 9,542 respondents showed that, although the WHO‐Five and the mental health subscale were found to be unidimensional, the WHO‐Five had a significantly lower ceiling effect than the mental health subscale. The analysis identified the three depression symptoms in the mental health subscale as responsible for the ceiling effect. The WHO‐Five was also found to be significantly superior to the mental health subscale in terms of its sensitivity in differentiating between those persons whose health had deteriorated over the past year and those whose health had not.

In conclusion, the WHO‐Five, which measures psychological well‐being, reflects aspects other than just the absence of depressive symptoms. Copyright © 2003 Whurr Publishers Ltd.

Keywords: mental health, well‐being, SF‐36, WHO‐Five, ceiling effect

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References

  1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 4 edn (DSM‐IV). Washington DC: American Psychiatric Press, 1994, p. 32. [Google Scholar]
  2. Bech P. Quality‐of‐life measurements for patients taking which drugs? The clinical PCASEE perspective. PharmacoEconomics 1995; 7: 141–51. [DOI] [PubMed] [Google Scholar]
  3. Bech P. Male depression: stress and aggression as pathways to major depression In Dawson A, Tylee A. (eds) Depression: Social and Economic Timebomb. London: BMJ Books, 2001, pp. 63–6. [Google Scholar]
  4. Bech P, Gudex C, Staehr Johansen K. The WHO (Ten) Well‐Being Index: Validation in Diabetes. Psychother Psychosom 1996; 65: 183–90. [DOI] [PubMed] [Google Scholar]
  5. Bech P, Hackett D, Pitrosky B. Efficacy of Venlafaxine on a derived self‐rated scale on well‐being in generalized anxiety disorder (GAD) and major depressive disorder (MDD). Poster Abstract. Int J Neuropsychopharmacol 2002a; 5 (suppl 1): S212. [Google Scholar]
  6. Bech P, Moses R, Gomis R. The effect of prandial glucose regulation with repaglinide on treatment satisfaction, wellbeing and health status in patients with pharmacotherapy‐naïve Type 2 diabetes: a placebo‐controlled, multicentre study. Qual Life Res 2003; 12: 413–25. [DOI] [PubMed] [Google Scholar]
  7. Bech P, Rasmussen N‐A, Olsen LR, Noerholm V, Abildgaard W. The sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity. J Affect Disord 2001; 66: 159–64. [DOI] [PubMed] [Google Scholar]
  8. Bjorner JB, Damsgaard MT, Watt T, Groenvold. Tests of data quality, scaling assumptions and reliability of the Danish SF‐36. J Clin Epidemiol 1998b; 51: 1001–11. [DOI] [PubMed] [Google Scholar]
  9. Bjorner JB, Thunedborg K, Kristensen T, Modvig J, Bech P. The Danish SF‐36 health survey: translation and preliminary validity studies. J Clin Epidemiol 1998a; 51: 991–9. [DOI] [PubMed] [Google Scholar]
  10. Cortina JM. What is coefficient alpha? An examination of theory and applications. J Applied Psychol 1993; 78: 98–104. [Google Scholar]
  11. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika 1951; 16: 297–334. [Google Scholar]
  12. Dupuy HJ. The Psychological General Well‐Being (PGWB) Index In Wenger NK, Mattson ME, Furberg CD, Elison J. (eds) Assessment of quality of life in clinical trials of cardiovascular therapies. New York: Le Jacq Publishing, 1984, pp. 184–8. [Google Scholar]
  13. EuroQoL Group . EuroQoL – a new facility for the measurement of health‐related quality of life. Health Policy 1990; 16: 199–208. [DOI] [PubMed] [Google Scholar]
  14. Folker H, Jensen BM. Undersøgelse af udvalgte metoder til selvvurdering af helbred, livskvalitet og tilfredshed med behandling. [Study of selected methods for the self‐assessment of quality of life and treatment satisfaction – Danish]. Ugeskr Laeger 2001; 163: 3347–52. [PubMed] [Google Scholar]
  15. Gandek B, Ware JE Jr, Aaronson NK, Alonso J, Apolone G, Bjorner J, Brazier J, Bullinger M, Fukuhara S, Kaasa S, Leplege A, Sullivan M. Tests of data quality, scaling assumptions, and reliability of the SF‐36 in eleven countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 1998; 51: 1149–58. [DOI] [PubMed] [Google Scholar]
  16. Goldberg D. The detection of psychiatric illness by questionnaires. Oxford: Oxford University Press, 1972. [Google Scholar]
  17. Henkel V, Braun S, Kohnen R, Allgaier K, Poth E, Stefanek J, Maier W, Möller H‐J. Identifying Depression in Primary Care: a Comparison of Different Methods, 2002. (submitted). [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Heun R, Burkart M, Maier W, Bech P. Internal and external validity of the WHO Well‐Being Scale in the elderly general population. Acta Psychiatr Scand 1999; 99: 171–8. [DOI] [PubMed] [Google Scholar]
  19. Keller SD, Ware JE Jr, Bentler PM, Aaronson NK, Alonso J, Apolone G, Bjorner JB, Brazier J, Bullinger M, Kaasa S, Leplege A, Sullivan M, Gandek B. Use of structural equation modeling to test the construct validity of the SF‐36 Health Survey in ten countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 1998; 51: 1179–88. [DOI] [PubMed] [Google Scholar]
  20. Kjoller M, Rasmussen NK. (eds) Sundhed og sygelighed i Danmark 2000 ‐ og udviklingen siden 1994. [Health and morbidity in Denmark 2000 ‐ and the development since 1994. Danish.] København: Statens Institut for Folkesundhed, 2002. [Google Scholar]
  21. Kjoller M, Rasmussen NK, Keiding L, Petersen HC, Nielsen GA. Sundhed og sygelighed i Danmark 1994 ‐ og udviklingen siden 1987. [Health and Morbidity in Denmark 1994 – and the Development since 1987 – Danish.] København: DIKE, 1995. [Google Scholar]
  22. Mokken RJ. A Theory and Procedure of Scale Analysis. Paris: Mouton, 1971. [Google Scholar]
  23. Molenaar IW, Debets P, Systma K, Hemker BT. User's Manual MSP: A Program for the Mokken Scale Analysis for Polytomous Items (Version 3.0). Groningen: Lec ProGamma, 1994. [Google Scholar]
  24. Olsen LR, Noerholm V, Rasmussen N‐A, Watt T, Groenvold M, Bjorner J. Major depression and psychological well‐being in the general Danish population. Eur Psychiatry 2000; 15 (suppl 2): P02.248. [Google Scholar]
  25. Siegel S. Non‐parametric Statistics. New York: McGraw‐Hill, 1956. [Google Scholar]
  26. Spitzer RL, Williams JBW, Kroenke K, Linzer M, DeGruy FV 3rd, Hahn SR, Brody D, Johnson JG. Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME‐MD 1000 study. JAMA 1994; 272: 1749–56. [PubMed] [Google Scholar]
  27. Stewart AL, Ware JE, Sherbourne CD, Wells KB. Psychological distress/well‐being and cognitive functioning measures In Stewart AL, Ware JE. (eds) Measuring Functioning and Well‐being. Durham: Duke University Press, 1992, pp. 102–42. [Google Scholar]
  28. Ware JE, Sherbourne C. The MOS 36‐Item Short‐Form Health Survey (SF‐36). Conceptual framework and item selection. Med Care 1992; 30: 473–83. [PubMed] [Google Scholar]
  29. World Health Organization . Construction in Basic Documents. Geneva: WHO, 1948. [Google Scholar]
  30. World Health Organization . International Classification of Diseases. 10 edn (ICD‐10). Geneva: World Health Organization, 1993. [Google Scholar]
  31. Zierau F, Bille A, Rutz W, Bech P. The Gotland Male Depression Scale: a validity study in patients with alcohol abuse disorder. Nord J Psychiatry 2002; 56: 265–71. [DOI] [PubMed] [Google Scholar]
  32. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361–70. [DOI] [PubMed] [Google Scholar]

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