title: The positive mental health instrument: development and validation of a culturally relevant scale in a multi-ethnic Asian population.
abstract: BACKGROUND
  Instruments to measure mental health and well-being are largely developed and often used within Western populations and this compromises their validity in other cultures. A previous qualitative study in Singapore demonstrated the relevance of spiritual and religious practices to mental health, a dimension currently not included in exiting multi-dimensional measures. The objective of this study was to develop a self-administered measure that covers all key and culturally appropriate domains of mental health, which can be applied to compare levels of mental health across different age, gender and ethnic groups. We present the item reduction and validation of the Positive Mental Health (PMH) instrument in a community-based adult sample in Singapore.
  
  
  METHODS
  Surveys were conducted among adult (21-65 years) residents belonging to Chinese, Malay and Indian ethnicities. Exploratory and confirmatory factor analysis (EFA, CFA) were conducted and items were reduced using item response theory tests (IRT). The final version of the PMH instrument was tested for internal consistency and criterion validity. Items were tested for differential item functioning (DIF) to check if items functioned in the same way across all subgroups.
  
  
  RESULTS
  EFA and CFA identified six first-order factor structure (General coping, Personal growth and autonomy, Spirituality, Interpersonal skills, Emotional support, and Global affect) under one higher-order dimension of Positive Mental Health (RMSEA=0.05, CFI=0.96, TLI=0.96). A 47-item self-administered multi-dimensional instrument with a six-point Likert response scale was constructed. The slope estimates and strength of the relation to the theta for all items in each six PMH subscales were high (range:1.39 to 5.69), suggesting good discrimination properties. The threshold estimates for the instrument ranged from -3.45 to 1.61 indicating that the instrument covers entire spectrums for the six dimensions. The instrument demonstrated high internal consistency and had significant and expected correlations with other well-being measures. Results confirmed absence of DIF.
  
  
  CONCLUSIONS
  The PMH instrument is a reliable and valid instrument that can be used to measure and compare level of mental health across different age, gender and ethnic groups in Singapore.
authors: Research Division, Institute of Mental Health/Woodbridge Hospital, 10, Buangkok View, 539747, Singapore. janhavi_vaingankar@imh.com.sg
authors: Janhavi Ajit
authors: JA
authors: Vaingankar
authors: Mythily
authors: M
authors: Subramaniam
authors: Siow Ann
authors: SA
authors: Chong
authors: Edimansyah
authors: E
authors: Abdin
authors: Maria
authors: M
authors: Orlando Edelen
authors: Louisa
authors: L
authors: Picco
authors: Yee Wei
authors: YW
authors: Lim
authors: Mei Yen
authors: MY
authors: Phua
authors: Boon Yiang
authors: BY
authors: Chua
authors: Joseph Y S
authors: JY
authors: Tee
authors: Cathy
authors: C
authors: Sherbourne
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002681:China / Q000208:ethnology; D003466:Cultural Characteristics; D018864:Cultural Diversity; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007194:India / Q000208:ethnology; D008296:Malaysia / Q000208:ethnology; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D015203:Reproducibility of Results; D012846:Singapore / Q000453:epidemiology; D011795:Surveys and Questionnaires