Evaluating cutpoints for the MHI-5 and MCS using the GHQ-12: a comparison of five different methods

BMC Psychiatry. 2008 Feb 19;8:10. doi: 10.1186/1471-244X-8-10.


Background: The Mental Health Inventory (MHI-5) and the Mental Health Component Summary score (MCS) derived from the Short Form 36 (SF-36) instrument are well validated and reliable scales. A drawback of their construction is that neither has a clinically validated cutpoint to define a case of common mental disorder (CMD). This paper aims to produce cutpoints for the MHI-5 and MCS by comparison with the General Health Questionnaire (GHQ-12).

Methods: Data were analysed from wave 9 of the British Household Panel Survey (2000), providing a sample size of 14,669 individuals. Receiver Operating Characteristic (ROC) curves were used to compare the scales and define cutpoints for the MHI-5 and MCS, using the following optimisation criteria: the Youden Index, the point closest to (0,1) on the ROC curve, minimising the misclassification rate, the minimax method, and prevalence matching.

Results: For the MHI-5, the Youden Index and the (0,1) methods both gave a cutpoint of 76, minimising the misclassification rate gave a cutpoint of 60 and the minimax method and prevalence matching gave a cutpoint of 68. For the MCS, the Youden Index and the (0,1) methods gave cutpoints of 51.7 and 52.1 respectively, minimising the error rate gave a cutpoint of 44.8 and both the minimax method and prevalence matching gave a cutpoint of 48.9. The correlation between the MHI-5 and the MCS was 0.88.

Conclusion: The Youden Index and (0,1) methods are most suitable for determining a cutpoint for the MHI-5, since they are least dependent on population prevalence. The choice of method is dependent on the intended application. The MHI-5 performs remarkably well against the longer MCS.

Publication types

  • Evaluation Study

MeSH terms

  • Anxiety Disorders / diagnosis*
  • Anxiety Disorders / epidemiology*
  • Cost of Illness
  • Data Interpretation, Statistical*
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / epidemiology*
  • Family / psychology*
  • Health Status*
  • Humans
  • Models, Psychological
  • Public Health
  • ROC Curve
  • Reproducibility of Results
  • Surveys and Questionnaires*