RAND Mental Health Inventory (MHI)

Abstract

The Rand Mental Health Inventory (MHI) is a widely utilized psychological scale designed to measure the general mental and emotional well-being of adults. Developed as part of the extensive Health Insurance Study conducted by the RAND Corporation, the MHI consists of 38 items covering a broad spectrum of feelings and behaviors experienced during the past month. It is structured around six distinct subscales that capture both positive affect (e.g., happiness, life satisfaction) and negative states (e.g., anxiety, depression, and loss of behavioral control).

Keywords

Rand Mental Health Inventory, MHI, mental health, psychological scale, well-being, anxiety, depression, affect, life satisfaction, RAND Corporation, Health Insurance Study

Authors

John E. Ware, Robert H. Brook, Allyson Ross Davies, Kathleen N. Williams, Anita Stewart, William H. Rogers, Cathy A. Donald, Shawn A. Johnston

Purpose

The primary purpose of the MHI was to provide a robust and standardized measure of mental health status for large-scale population studies, specifically the RAND Health Insurance Study (HIS). The instrument was designed to capture changes in mental health outcomes resulting from variations in health care access and financing. It aims to assess the frequency and intensity of specific positive and negative emotional states, offering a comprehensive profile of an individual’s psychological functioning over the preceding four weeks.

The MHI serves as a critical tool for researchers and clinicians seeking to quantify aspects of emotional stability, distress, and overall satisfaction with life. Its utility lies in its ability to differentiate between various dimensions of mental health rather than providing a single, monolithic score, making it suitable for evaluating interventions and tracking population health trends.

Construct

The MHI is a multidimensional instrument constructed to capture the complexity of mental health, encompassing both psychological distress and subjective well-being. The inventory measures 38 items, 35 of which contribute to six core mental health subscales. These subscales represent key psychological constructs:

• Anxiety: Measures symptoms of nervousness, tension, worry, and restlessness.
• Loss of Behavioural / Emotional Control: Reflects feelings of depression, moodiness, and concerns about losing control over thoughts, feelings, or actions.
• General Positive Affect: Captures positive emotional states such as feeling cheerful, peaceful, and enjoying daily activities.
• Emotional Ties: Assesses the quality and completeness of love relationships and feelings of being loved or wanted.
• Life Satisfaction: Measures overall happiness, satisfaction, or pleasure with one’s personal life.
• Depression/General Distress: (Often combined with Loss of Control or measured by specific items like 9, 16, 19, 20, 21, 24, 27, 36, and 28, which relate to serious depressive symptoms and suicidal ideation.)

By including both positive (affective well-being) and negative (distress) dimensions, the MHI provides a more holistic assessment than instruments focused solely on pathology.

Validity

The MHI demonstrates strong evidence of construct validity, primarily established through its development within the rigorous framework of the RAND Health Insurance Study. The items were selected and refined based on extensive literature review and empirical testing to ensure they accurately reflect the defined dimensions of mental health.

Validation studies confirm that the MHI’s subscales correlate appropriately with measures of related constructs (convergent validity) and show independence from unrelated physical health measures (discriminant validity). Its ability to predict utilization of mental health services and response to treatment further underscores its predictive validity, establishing the MHI as a reliable measure of psychological status in diverse adult populations.

Reliability

The MHI exhibits high levels of internal consistency, indicating that the items within each subscale reliably measure the same underlying dimension. Across the various subscales, Cronbach’s alpha coefficients typically range well into the acceptable zone, particularly for the longer scales like Anxiety and General Positive Affect.

The scale’s reliability has been consistently demonstrated across numerous subsequent applications and population groups beyond the original Health Insurance Study cohort, supporting its stability and dependability as a general measure of psychometric properties. The standardized administration and scoring procedures further contribute to its high test-retest reliability over short periods.

Factor Analysis

The structure of the MHI was originally derived using factor analysis techniques applied to data collected during the initial development phase. This analysis confirmed the presence of distinct, yet correlated, factors underlying the 38 items, leading to the establishment of the six primary subscales.

The factor structure successfully separates positive mental health components (e.g., General Positive Affect, Life Satisfaction) from negative components (e.g., Anxiety, Loss of Behavioral/Emotional Control). Although the MHI contains 38 items, only 35 are actively used to calculate the six subscale scores, ensuring that each calculated score is based on items that load strongly onto their respective factors. Items 2 (lonely), 22 (relax without difficulty), and 38 (strain/stress/pressure) are typically omitted from the final subscale calculations but contribute to the overall descriptive profile.

Instrument

Test Type: Self-report questionnaire / Multi-dimensional psychological inventory

Format: 38 items using various 5- or 6-point Likert-style response scales (e.g., frequency scales, intensity scales, degree of satisfaction).

Language Available: Primarily English (widely translated and adapted for international use).

Population Group: General adult population

Age Group: Adults (18+)

Population Details: Developed initially on a large, demographically diverse sample of adults participating in the RAND Health Insurance Study.

Test Methodology: Respondents rate their feelings or experiences over the past month. Scoring involves summing or averaging item responses within each subscale, often requiring reverse scoring for negatively worded items to ensure consistency.

Keywords

Psychological well-being, emotional stability, self-report, health outcomes, distress measurement, General Positive Affect, Life Satisfaction, behavioural control, mental health assessment

Authors

Author ORCID Identifier: N/A (Information not available in source content)

Affiliation Email addresses: N/A (Information not available in source content)

Correspondence Address: RAND Corporation, Santa Monica, California

Permissions & Fee and Test Year

The Rand Mental Health Inventory (MHI) was developed in 1980 as part of the RAND Health Insurance Study (HIS). Information regarding current permissions and fees for commercial use should be sought directly from the RAND Corporation, which holds the intellectual property for the instrument and its associated documentation.

The original research report detailing the conceptualization and measurement of the instrument is available online, and the instrument itself can be found via the following RAND publication link: http://www.rand.org/pubs/reports/R1987z1.html.

The original PDF detailing emotional health outcome measures is available here: http://www.ircimh.org/local/uploads/content/files/Emotional%20Health%20Outcome%20Measures%202014_4_29kk(1).pdf

Reference’s

Ware, J. E., Brook, R. H., Davies, A. R., Williams, K. N., Stewart, A., Rogers, W. H., & Johnston, S. A. (1980). Conceptualization and measurement of health for adults in the Health Insurance Study.

Ware, John E., Robert H. Brook, Allyson Ross Davies, Kathleen N. Williams, Anita Stewart, William H. Rogers, Cathy A. Donald and Shawn A. Johnston, Conceptualization and Measurement of Health for Adults in the Health Insurance Study: Vol. I, Model of Health and Methodology, Santa Monica, Calif.: RAND Corporation, R-1987/1-HEW, 1980. As of April 17, 2015: http://www.rand.org/pubs/reports/R1987z1.html

Items of the Rand Mental Health Inventory (MHI)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. How happy‚ satisfied‚ or pleased have you been with your personal life during the past month?

1=Extremely Happy‚ 2= Very happy most the time‚ 3= Generally satisfied‚ 4= Sometimes Fairly Dissatisfied‚ 5= Generally Dissatisfied‚ 6=Very Dissatisfied

****

1=All 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

2. How much of the time have you felt lonely during the past month?

4. How much of the time have you felt that the future looks hopeful and promising?

5. How much of the time has your daily life been full of things that were interesting?

6. How much of the time did you feel relaxed and free from tension?

7. How much of the time have you generally enjoyed the things you do?

10. How much of the time have you felt loved or wanted?

11. How much of the time have you been a very nervous person?

13. How much of the time have you felt tense‚ or “high-strung”?

17. How much of the time have you felt calm and peaceful?

18. How much of the time have you felt emotionally stable?

19. How much of the time have you felt downhearted and blue?

22. How much of the time were you able to relax without difficulty?

23. How much of the time did you feel that your love relationships‚ loving and being loved were full and complete?

26. How much of the time has living been a wonderful adventure for you?

29. How much of the time have you felt restless‚ fidgety or impatient?

30. How much of the time have you been moody or brooded about things?

31. How much of the time have you felt cheerful or light hearted?

34. How much of the time were you a happy person?

36. How much of the time have you been in low or very low spirits?

****

1= Always‚ 2= Very Often‚ 3= Fairly Often‚ 4= Sometimes‚ 5= Almost Never‚ 6= Never

3. How often did you become nervous or jumpy when faced with excitement or unexpected situations?

12. When you have got up in the morning‚ about how often did you expect to have an interesting day?

15. How often did your hands shake when you tried to do something?

16. How often did you feel that you had nothing to look forward to?

20. How often have you felt like crying?

21. How often have you felt that other would be better off if you were dead?

24. How often did you feel that nothing turned out for you the way you wanted it to?

27. How often have you felt so down in the dumps that nothing could cheer you up?

32. How often did you get rattled‚ upset of flustered?

35. How often did you find yourself trying to calm down?

****

8. During the past month‚ have you had any reason to wonder if you were losing your mind‚ or losing control over the way you act‚ talk‚ think‚ feel or of your memory?

1= Not at All‚ 2= Maybe a little‚ 3= Yes‚ but not enough to be concerned‚ 4= Yes‚ been a little concerned‚ 5= Yes‚ quite concerned‚ 6= Yes‚ very concerned

9. Did you feel depressed during the past month?

1= Yes‚ to the did not care about anything for days‚ 2= Yes‚ very depressed almost every day‚ 3= Yes‚ quite depressed several times‚ 4= Yes‚ a little depressed now & then‚ 5= No‚ Never

14. During the past month‚ have you been in firm control of your behaviour‚ thoughts‚ emotions or feelings?

1= Yes‚ definitely‚ 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

25. How much have you been bothered by nervousness‚ or your nerves‚ during the past month?

1= Extremely‚ 2= Very Much‚ 3= Bothered quite a bit‚ 4= Bothered some‚ 5= Bothered a little‚ 6= Not bothered

28. During the past month‚ did you think about taking your own life?

1= Yes‚ Very often; 2= Yes‚ fairly often; 3= Yes‚ a few times; 4= Yes at one time; 5= Never

33. During the past month‚ have you been anxious or worried?

1= Extremely‚ 2= Very Much‚ 3= Quite a bit‚ 4= Some‚ 5= A little‚ 6= Not at all

37.How often during the past month have you been waking up feeling fresh and rested?

1= Always Every day; 2= Almost Every day; 3 Most days; 4= Some days not‚ usually; 5= Hardly; 6= Never

38. During the past month‚ have you been under or felt you were under any strain‚ stress or pressure?

1=More than I can bear; 2=Quite a bit; 3= Some more than usual; 4=Some‚ but about normal; 5=Yes‚ a little bit; 6=Not at all