The SF-36 Offers a Strong Measure of Mental Health Symptoms in Survivors of Acute Respiratory Failure. A Tri-National Analysis

Ann Am Thorac Soc. 2016 Aug;13(8):1343-50. doi: 10.1513/AnnalsATS.201510-705OC.


Rationale: Survivors of acute respiratory failure commonly experience long-term psychological sequelae and impaired quality of life. For researchers interested in general mental health, using multiple condition-specific instruments may be unnecessary and inefficient when using the Medical Outcomes Study Short Form (SF)-36, a recommended outcome measure, may suffice. However, relationships between the SF-36 scores and commonly used measures of psychological symptoms in acute survivors of respiratory failure are unknown.

Objectives: Our objective is to examine the relationship of the SF-36 mental health domain (MH) and mental health component summary (MCS) scores with symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) evaluated using validated psychological instruments.

Methods: We conducted a cross-sectional analysis of 1,229 participants at 6- and 12-month follow-up assessment using data from five studies from the United States, the United Kingdom, and Australia.

Measurements and main results: Symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS), Depression Anxiety Stress Scales, the Davidson Trauma Scale, Impact of Event Scale (IES), and IES-Revised (IES-R). At 6-month assessment there were moderate to strong correlations of the SF-36 MH scores with HADS depression and anxiety symptoms (r = -0.74 and -0.79) and with IES-R PTSD symptoms (r = -0.60) in the pooled analyses. Using the normalized population mean of 50 on the SF-36 MH domain score as a cut-off, positive predictive values were 16 and 55% for substantial depression; 20 and 68% for substantial anxiety (Depression Anxiety Stress Scales and HADS, respectively); and 40, 44, and 67% for substantial PTSD symptoms (IES-R, IES, and Davidson Trauma Scale, respectively). Negative predictive values were high. The area under the receiver operating characteristics curve of the SF-36 MH score was high for depression, anxiety, and PTSD symptoms (0.88, 0.91, and 0.84, respectively). All results were consistent for the MCS, across the individual studies, and for the 12-month assessment.

Conclusions: For researchers interested in general mental health status, the SF-36 MH or MCS offers a strong measure of psychological symptoms prevalent among survivors of acute respiratory failure. For researchers interested in specific conditions, validated psychological instruments should be considered.

Keywords: Medical Outcomes Study Short Form 36 survey; acute respiratory failure; anxiety; depression; post-traumatic stress disorder.

Publication types

  • Multicenter Study
  • Validation Study

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Anxiety / epidemiology*
  • Australia
  • Cross-Sectional Studies
  • Depression / epidemiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Psychiatric Status Rating Scales*
  • Quality of Life
  • ROC Curve
  • Respiratory Insufficiency / psychology*
  • Respiratory Insufficiency / therapy
  • Stress Disorders, Post-Traumatic / epidemiology*
  • Survivors / psychology*
  • Time Factors
  • United Kingdom
  • United States