Conceptualization and Measurement of Health for Adults in the Health Insurance Study

The third volume in a series reviewing published literature and documenting conceptualization and construction of health status measures used in the Health Insurance Study (HIS). Scaling studies supported construction of six multi-item summated ratings scales (anxiety, depression, positive well-being, self-control, general health, vitality) and two aggregate indicators (Mental Health Index, General Well-Being Index) from the HIS General Well-Being Battery. Four of these scales and the Mental Health Index appear sufficiently reliable and valid for testing hypotheses about the effects of different health care financing arrangements and fee-for-service compared with prepaid group practice on mental health status in general populations. Investigators using HIS measures may choose among several options in scoring mental health, depending on their study's purpose, constructs of interest, and tradeoffs in reliability, validity, and precision.

This report discusses the conceptualization and measurement of the mental health of individual members of general populations in developed countries. The first part of the report presents a review of the literature performed to identify conceptual and methodologic issues that needed to be addressed during development of measures for use in the Health Insurance Study (HIS), and to provide a framework for better understanding the strengths and shortcomings of HIS mental health measures. The second part describes operational definitions of mental health adopted for the HIS, with particular reference to results of their administration in the first HIS site (Dayton, Ohio) and to revisions made for subsequent administrations.