Validity of the SF-36 five-item Mental Health Index for major depression in functionally impaired, community-dwelling elderly patients

J Am Geriatr Soc. 2005 Nov;53(11):1978-85. doi: 10.1111/j.1532-5415.2005.00469.x.


Objectives: 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.

Design: Cross-sectional observational.

Setting: Nineteen counties in western New York, West Virginia, and Ohio.

Participants: 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.

Measurements: MHI-5, Mini-International Neuropsychiatric Interview Major Depressive Episode (MINI-MDE) module.

Results: 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.

Conclusion: 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.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Activities of Daily Living / classification*
  • Activities of Daily Living / psychology
  • Aged
  • Aged, 80 and over
  • Cognition Disorders / diagnosis
  • Cognition Disorders / epidemiology
  • Comorbidity
  • Cross-Sectional Studies
  • Depressive Disorder, Major / diagnosis*
  • Depressive Disorder, Major / epidemiology
  • Disabled Persons / psychology*
  • Female
  • Follow-Up Studies
  • Geriatric Assessment / statistics & numerical data*
  • Health Resources / statistics & numerical data
  • Humans
  • Male
  • Neuropsychological Tests / statistics & numerical data
  • Personality Assessment / statistics & numerical data*
  • Primary Health Care
  • Psychometrics / statistics & numerical data
  • Reproducibility of Results
  • Statistics as Topic