Assessment of Population Well-Being With the Mental Health Quotient (MHQ): Development and Usability Study

JMIR Ment Health. 2020 Jul 20;7(7):e17935. doi: 10.2196/17935.


Background: Existing mental health assessment tools provide an incomplete picture of symptom experience and create ambiguity, bias, and inconsistency in mental health outcomes. Furthermore, by focusing on disorders and dysfunction, they do not allow a view of mental health and well-being across a general population.

Objective: This study aims to demonstrate the outcomes and validity of a new web-based assessment tool called the Mental Health Quotient (MHQ), which is designed for the general population. The MHQ covers the complete breadth of clinical mental health symptoms and also captures healthy mental functioning to provide a complete profile of an individual's mental health from clinical to thriving.

Methods: The MHQ was developed based on the coding of symptoms assessed in 126 existing Diagnostic and Statistical Manual of Mental Disorders (DSM)-based psychiatric assessment tools as well as neuroscientific criteria laid out by Research Domain Criteria to arrive at a comprehensive set of semantically distinct mental health symptoms and attributes. These were formulated into questions on a 9-point scale with both positive and negative dimensions and developed into a web-based tool that takes approximately 14 min to complete. As its output, the assessment provides overall MHQ scores as well as subscores for 6 categories of mental health that distinguish clinical and at-risk groups from healthy populations based on a nonlinear scoring algorithm. MHQ items were also mapped to the DSM fifth edition (DSM-5), and clinical diagnostic criteria for 10 disorders were applied to the MHQ outcomes to cross-validate scores labeled at-risk and clinical. Initial data were collected from 1665 adult respondents to test the tool.

Results: Scores in the normal healthy range spanned from 0 to 200 for the overall MHQ, with an average score of approximately 100 (SD 45), and from 0 to 100 with average scores between 48 (SD 21) and 55 (SD 22) for subscores in each of the 6 mental health subcategories. Overall, 2.46% (41/1665) and 13.09% (218/1665) of respondents were classified as clinical and at-risk, respectively, with negative scores. Validation against DSM-5 diagnostic criteria showed that 95% (39/41) of those designated clinical were positive for at least one DSM-5-based disorder, whereas only 1.14% (16/1406) of those with a positive MHQ score met the diagnostic criteria for a mental health disorder.

Conclusions: The MHQ provides a fast, easy, and comprehensive way to assess population mental health and well-being; identify at-risk individuals and subgroups; and provide diagnosis-relevant information across 10 disorders.

Keywords: anxiety; attention deficit disorder with hyperactivity; autistic disorder; behavioral symptoms; depression; diagnosis; global health; internet; mental disorders; mental health; methods; mhealth; population health; psychiatry; psychopathology; public health; social determinants of health; symptom assessment.