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The positive mental health instrument: development and validation of a culturally relevant scale in a multi-ethnic asian population

Janhavi Ajit Vaingankar1*, Mythily Subramaniam1, Siow Ann Chong1, Edimansyah Abdin1, Maria Orlando Edelen2, Louisa Picco1, Yee Wei Lim2, Mei Yen Phua1, Boon Yiang Chua1, Joseph YS Tee1 and Cathy Sherbourne2

Author Affiliations

1 Research Division, Institute of Mental Health/Woodbridge Hospital, 10, Buangkok View, 539747, Singapore

2 RAND Corporation, Santa Monica, California, United Sates of America

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Health and Quality of Life Outcomes 2011, 9:92  doi:10.1186/1477-7525-9-92

Published: 31 October 2011



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.


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.


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.

Positive mental health; multi-dimensional; instrument development; item reduction; factor analysis; item response theory