Carole Poulin

THE STRUCTURE OF MENTAL HEALTH: HIGHER-ORDER CONFIRMATORY FACTOR ANALYSES OF PSYCHOLOGICAL DISTRESS AND WELL-BEING MEASURES

This paper addresses the question of whether psychological distress and subjective well-being are the opposite poles of the same axis of mental health or independent constructs that should be measured on two independent axes. The measures used in this study originate from a preliminary ethnosemantic study and the content analysis of narratives of psychological distress and well-being episodes experienced by a random sample of francophone Quebecers (Canada). Two scales were produced: a Psychological Distress Manifestation Scale (PDMS) based on 23 items and four factors (Anxiety/Depression, Irritability, Self-Depreciation, and Social Disengagement), and a Psychological Well-Being Manifestation Scale with 25 items and six factors (Self-Esteem, Social Involvement, Mental Balance, Control of Self and Events, Sociability, and Happiness). Structural equation modeling analyses confirm that these 10 factors can be viewed as components of two correlated dimensions (psychological distress and well-being) (r = −0.65) of a two-dimensional latent construct which reflects a higher-order concept of mental health. We conclude that assessment of mental health in general populations should use concomitant measures of psychological distress and well-being.

Validation study of a nonspecific psychological distress scale

BackgroundPsychological distress scales are often used in national epidemiological surveys to monitor the mental health status and predict demands in mental health services. These scales have the advantage of being easy to administer and inexpensive to use. The goal of this study is to assess the clinical validity of the Psychological Distress Manifestations Measure Scale (PDMMS) by comparing it to a standard criterion.MethodThe validation study is based on data from a large-scale mental health survey conducted in 1999 in the Montreal area (Canada). The target population was constituted of adults living in private households. A telephone survey was carried out with a probability sample of 4,704 respondents using the Composite International Diagnostic Interview Simplified (CIDIS) to detect mental disorders. Then, subsequent face-to-face interviews with a subsample of 359 of these respondents were conducted to validate other measures for assessing mental health needs for care and services including the PDMMS.ResultsOur study showed that high psychological distress is highly associated with mental disorder (OR=5.94). However, a large majority of the people in the high psychological distress category does not have a known mental problem.ConclusionsThese data confirm that like other psychological distress scales, the PDMMS is not a diagnostic tool. Rather, it is designed to explore comorbidity among symptoms, independent of caseness. The prevalence of psychological distress in the population allows us to identify people who have subclinical symptoms substantial enough to precipitate dysfunctioning in everyday life and who utilize health services more frequently. The use of this tool for epidemiological surveys is useful for mental health service planning because it provides information on the needs of individuals whose state of mental health affects social functioning even though they do not suffer from pathology.