INDICATORS

38. PSYCHOLOGICAL DISTRESS
Definition: Occurrence and extent of psychological distress during past month, measured
by the Mental Health Index (MHI-5) scale of the RAND Short Form 36. Perceived
psychological distress is a non-specific dimension of psychopathology and it indicates that
something is wrong but has not yield diagnostic assessment. It does not necessarily involve a
mental illness or require services from the mental health system. However, cultural variations
in experiencing and expressing the inner feelings and emotions have to taken into account
when interpreting the results.
Calculation:
1) An index or a score indicating a case of mental ill-health, derived from EHIS questions
(corresponding to the Mental Health Index (MHI-5) score from the RAND Short Form
36), SF.2–SF.10: How much of the time, during the past 4 weeks: SF.3 Have you been very
nervous? SF.4 Have you felt so down in the dumps that nothing could cheer you up? SF.5
Have you felt calm and peaceful? SF.7 Have you felt down-hearted and depressed? SF.9 Have
you been happy? The five response categories are: 1. All of the time; 2. Most of the time; 3.
Some of the time; 4. A little of the time; 5. None of the time. The precise operationlisation
to be defined later.
2) Recommendation by Mindful/Working Party Mental Health: A mean score of 56 or less
on the Mental Health Index (MHI-5) score (from the RAND Short Form 36 (SF–36 v1.0)
questionnaire) is taken to indicate a case of mental ill-health. MH-5 score is based on the
following five questions: How much of the time in the previous 4 weeks: 1. Have you been
a very nervous person? 2. Have you felt so down in the dumps that nothing could cheer you
up? 3. Have you felt calm and peaceful? 4. Have you felt downhearted and blue? 5. Have you
been a happy person? The six response categories are: 1. All of the time; 2. Most of the time;
3. A good bit of the time; 4. Some of the time; 5. A little of the time; 6. None of the time.
The score for the MHI-5 is computed by adding the scores of each question item and then
transforming the raw scores to a 0–100-point scale.
Notes: The MHI-5 is one of the eight scales that constitute the RAND Short Form 36. The
MHI-5 consists of three depression-related items and two anxiety-related items. It has a score
of 0 to 100, where a score of 100 represents optimal mental health.
The suggested population norm for the mean score is 76 and 56 for the cut-point. However,
each country may be advised to define national cut-points, because the results from the pilot
study and Eurobarometer imply culture based differences in the responses (MINDFUL). In
most studies the cut-point has been between 52 and 60.
The EHIS questions SF.2–SF.10 differ slightly from the questions of the original Mental
Health Index (MHI-5). Thus the scoring of MHI-5 defined in calculation (2) may be
applied as such. The same applies also to the Special Eurobarometer survey 248 on Mental
Well-Being, question QA5.
39. PSYCHOLOGICAL WELL-BEING
Definition: Occurrence and extent of psychological well-being during past month, measured
by the Energy and Vitality Index (EVI) scale of the RAND Short Form 36. Perceived
experience of energy and vitality is an important indicator of psychological well-being and
positive mental health. However, cultural variations in experiencing and expressing the inner
feelings and emotions have to taken into account when interpreting the results.
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