Scientific Information System

Network of Scientific Journals from Latin America, the Caribbean, Spain and
Portugal

Susana C. Marques, José Luis Pais-Ribeiro, Shane J. Lopez

Use of the "Mental Health Inventory - 5" with Portuguese 10-15 Years Old The Spanish
Journal of Psychology, vol. 14, núm. 1, 2011, pp. 478-485,
Universidad Complutense de Madrid
España

Available in: http://www.redalyc.org/articulo.oa?id=17217456043

The Spanish Journal of Psychology,

ISSN (Printed Version): 1138-7416
psyjour@sis.ucm.es
Universidad Complutense de Madrid
España

How to cite Complete issue More information about this article Journal's homepage

www.redalyc.org
Non-Profit Academic Project, developed under the Open Acces Initiative
The Spanish Journal of Psychology Copyright 2011 by The Spanish Journal of Psychology
2011, Vol. 14 No. 1, 478-485 ISSN 1138-7416
doi:10.5209/rev_SJOP.2011.v14.n1.43

Use of the “Mental Health Inventory – 5”

with Portuguese 10-15 Years Old

Susana C. Marques1, José Luis Pais-Ribeiro1, and Shane J. Lopez2

1
Universidade do Porto (Portugal)
2
Clifton Strengths School and Gallup (USA)

The present study describes the psychometric properties of the Portuguese version of the Mental Health
Inventory-5 for use with young adolescents. A sample of 367 Portuguese students (aged 10-15 years)
completed the Portuguese-language versions of Mental Health Inventory-5 (MHI-5; Berwick et al., 1991),
Children’s Hope Scale (CHS; Snyder et al., 1997), Students’ Life Satisfaction Scale (SLSS; Huebner,
1991a), and Global Self-Worth Sub-scale (Harter, 1985). Analysis of readability, reliability (internal
consistency and 1-year stability), factor structure, and criterion-related validity suggested that the MHI-5
can be appropriately used in this age group. Implications of the findings are discussed.
Keywords: early-adolescents, Mental Health Inventory-5, metric properties, positive constructs.

El presente estudio describe las propiedades psicométricas de la versión en portugués del Mental Health
Inventory-5 para su uso con los jóvenes adolescentes. Una muestra de 367 estudiantes portugueses (10-15
años de edad) completaron la versión en portugués del Mental Health Inventory-5 (MHI-5; Berwick et al.,
1991), Children’s Hope Scale (CHS; Snyder et al., 1997), Students’ Life Satisfaction Scale (SLSS; Huebner,
1991a), y Global Self-Worth Sub-scale (Harter, 1985). Análisis de la comprensión de la lectura, de la fiabilidad
(consistencia interna y 1año de estabilidad), de la estructura factorial y de la validez relacionada con el
criterio sugiere que el MHI-5 puede ser utilizado con este grupo de edad. Se analizan las implicaciones de
los resultados.
Palabras clave: jóvenes adolescentes, Inventario de salud mental; propiedades métricas, variables positivas.

This research was funded via a Foundation for the Science and Technology (FCT) grant obtained by the first author. We wish also to
address our thanks to Dr. Joanna Mitchell (Monash University, Australia) for her comments on the manuscript.
Correspondence concerning this article should be addressed to Susana C. Marques. Faculty of Psychology and Educational Sciences.
University of Porto. (Portugal). E-mail: dscmarques@mail.telepac.pt

478
 MHI-5 IN 10-15 YEAR OLDS
The evolution of the mental health conceptualization
includes indicators that measure beyond a negative point to
desirable levels of functioning and examine mental health
in terms of traditional indicators of psychopathology
(e.g., symptoms of anxiety and depression) as well as
the presence of indicators of psychological well-being
(e.g., feeling cheerful, interest in and enjoyment of life)
(Ware, Snow, Kosinski, & Gandek, 1993). Psychological
well-being items have the potential to expanding the
scope of and improving the precision of mental health
measurement by distinguishing among persons who are
highly distressed (Veit & Ware, 1983).
Adolescence is a developmental period when individuals
may be particularly vulnerable to the negative effects
of stress and depressive symptoms (e.g. developmental
challenges inherent to adolescence, such as puberty,
school transitions and academic demands) (Hankin &
Abramson, 2001; McNamara, 2000). Research on mental
health indicators such as stress have been linked with
aggression (Jaser et al., 2005), academic underachievement
(Alva & de Los Reyes, 1999; Cunningham, Hurley,
Foney, & Hayes, 2002), depression (Martin, Kazarian,
& Breiter, 1995) and substance abuse (Chassin, Ritter,
Trim, & King, 2003). Students lower on neuroticism
and higher on conscientiousness, sense of coherence,
extraversion, and optimism perceive their mental health
to be better (Ebert, Tucker, & Roth, 2002). Specifically,
hope and life satisfaction represent salient dimensions of
individual adjustment and level of functioning. Mental
health problems have been related with compromised life
satisfaction (McKnight, Huebner, & Suldo, 2002) and hope
is modestly and inversely related to mental health problems
and psychopathology (Hagen, Myers, & Mackintosh,
2005; Snyder et al., 1997; Valle, Huebner, & Suldo, 2004).
Self-esteem is an important and well established concept
in the field of child and adolescent mental health. For
example, low self-esteem has repeatedly been reported as
a contributing factor to mental health problems including
depression, anxiety, conduct/antisocial personality disorder,
and suicidal ideation (Boden, Fergusson, & Horwood,
2008; Newbegin & Owens, 1996; Schroevers, Ranchor,
& Sanderman, 2003). In regard to social-demographic
characteristics, several studies (e.g. Loge & Kaasa, 1998;
Strand, Dalgard, Tambs, & Rognerud, 2003; Sullivan &
Karlsson, 1998) reported poorer subjective mental health
status among women, among the unemployed, among the
low educated and among the single/not married or not
living in partnerships/cohabitants.
There are few standardized instruments available for
assessing the mental health of adolescents who do not
manifest psychiatric symptoms and until the mid1990s
research on scales measuring positive indicators of
adolescent mental health was limited. One well validated
479
scale now available is the Mental Health Inventory (MHI),
a 38-item measure of psychological distress and well-
being, developed for use in general populations (Veit &
Ware, 1983). A shorter, five item version of the Mental
Health Inventory (MHI-5) has also been developed and
is based upon items that best reproduce the total score
of the MHI (Berwick et al., 1991). The MHI-5 behaves
similarly to the longer version with the advantage of
permitting earlier assessment (Berwick et al., 1991).
In contrast to other measures of mental health, MHI-
5 performs remarkably well against the longer Mental
Health Component Summary (MCS; Ware, Kosinksi, &
Dewey, 2000) (Kelly, Dunstan, Lloyd, & Fone, 2008), and
behaves similarly to the General Health Questionnaire
(GHQ-12; Goldberg & Williams, 1988) with the benefit
of the MHI-5 can be used in surveys of general health and
quality of life (Hoeymans, Garssen, Westert, & Verhaak,
2004). This last operational advantage of the MHI-5 is also
reported in the study of Strand et al., (2003) in comparison
with the Hopkins Symptom Checklist (SCL-25, SCL-10,
SCL-5 versions; Derogatis, 1983).
The MHI-5 has the distinct advantage of assessing both
psychological well-being and symptoms of psychological
distress, which makes it suitable for use with non-
psychiatric populations. In addition, because the MHI-
5 was developed on the basis of information from the
general population rather than psychiatric patients, it is
considered a suitable community population measure, and
could for example be used with school students. Moreover,
the MHI-5 seems to be sufficiently brief, psychometrically
sound, easy to complete, valid and reliable scores in
different subgroups and across various cultures including
United States (Ware et al., 1993), Norway (Strand et al.,
2003), Denmark (Bültmann et al., 2006), Portugal (Pais-
Ribeiro, 2001), Sweden (Sullivan & Karlsson, 1998)
and various other European countries (see the European
Values Survey, e.g. Bray & Gunnell, 2006).
Currently there are no published studies, of which
we are aware, studying the psychometric properties and
normative data of MHI-5 in an adolescent sample of youth.
A review of the literature shows that MHI-5 has been used
with subjects over 15 years (e.g. Bray & Gunnell, 2006)
although MHI has been used with subjects over 13 years
(e.g. Veit & Ware, 1983). Additionally, a study by Ostroff,
Woolverton, Berry, and Lesko (1996) recommended MHI
for the assessment of adolescents’ mental health. The
authors (Ostroff et al., 1996) analyzed the readability level
of the MHI and established a 3rd grade reading level to
comprehend the MHI English language version while key
words require 4th to 6th grade levels.
In the present study, we examine the psychometric
properties and potential utility of the MHI-5 in the
assessment of 10- to 15-year-old Portuguese students.
 480 MARQUES, PAIS-RIBEIRO, AND LOPEZ
Method
Participants
At Time 1 (Fall 2006), the MHI-5 was administered
to 367 students in grades 6 and 8. The sample mean age
was 11.78 years (SD = 1.22), range 10-15 years and 53.1%
female. The mean age for males was 11.87 years (SD =
1.27) and females was 11.70 years (SD = 1.16). Participants
were from seven schools in the north of Portugal. At Time
2 (Fall 2007), 215 of the 367 students completed the MHI-
5, yielding a return sample of 68%. Of the students who
did not participate at Time 2, 40.8% were part of a larger
study (Marques, Lopez, & Pais-Ribeiro, 2011), 53.2% had
moved/withdrawn and the remaining 5.93% of students
were absent on data collection dates. The mean age of the
215 participants retained for longitudinal analysis was 12.57
years (SD = 1.16), range 11-16 years and 53% were female.
Chi-square test and t-tests between students who completed
both assessments (Times 1 and 2) and those students lost
to attrition were conducted to test the potential effects of
sample attrition. The chi-square test comparing the number
of participant’s males and females at Time 1 to those at
Time 2 was not significant. Comparisons of mean scores
on the variables of mental health, hope, life satisfaction and
self-worth between students who participated in Time 2
data collection and those students lost to attrition indicated
no significant differences between the two groups.
Measures
The study used translated and validated measures of
additional constructs (i.e., hope, satisfaction with life and
self-worth) linked to children’ well-being (Huebner, 2004;
Riesen & Porath, 2004; Snyder, Feldman, Taylor, Schroeder,
& Adams, 2000) and generally regarded as key protective
factors in early-adolescent psychological development (e.g.
Snyder et al., 2000; Suldo & Huebner 2004).
Mental Health Inventory – 5 internal consistency of the SLSS has been reported as .82
MHI-5 is a short version of the Mental Health Inventory
with 38 items developed in 1975 for the Rand Health
Insurance Experiment and it is included in both versions of
the Medical Outcome Study (MOS) questionnaires: MOS
Short Form 20 (SF-20; Stewart, Hays, & Ware, 1988) and
MOS Short Form 36 (SF-36; Ware & Sherbourne, 1992). In
addition, MHI-5 is one of the eight dimensions (designated
as “mental health”) of the SF-36 (Short Form-36 Health
Survey) questionnaire (Ware et al., 1993). The MHI-5 was
developed for use in the general population and designed
to improve upon other instruments by including items that
assessed psychological well-being (Veit & Ware, 1983).
This inventory comprises five questions about mood over
the past month, measuring the experience of psychological
well-being and the absence of psychological distress (see
Table 1). Each of the items requires a response on a 6-point
rating scale, with possible scores range from 6 to 30, and the
instrument is scored such that higher scores indicate better
mental health. Internal consistency reliability coefficients
range from .80 to .96 across several studies (Ware, Kosinski,
& Keller 1994). The MHI-5 was validated by Pais-Ribeiro
(2001) for the Portuguese adult population and reported a
Cronbach’s alpha of .87.
Children’s Hope Scale (CHS)
The CHS is a dispositional scale developed by Snyder
et al. (1997) to measure goal-related hopeful thinking in
children and adolescents aged 8 to 16. This self-report
measure contains three questions to evaluate pathways
thinking and three questions to examine agency thinking
on a 6-point scale. The pathways and agency items are
alternated within the scale. Possible scores range from
6 to 36, with higher scores denoting higher levels of
hope. Previous studies with the CHS revealed adequate
psychometric properties, including internal consistencies
ranging between .72 and .86 for the total score (see Snyder
et al., 2003 for a review). The CHS has been validated
for Portuguese children (Marques, Pais-Ribeiro, & Lopez,
2009) and reported a Cronbach’s alpha of .81 for the total
score.
Students’ Life Satisfaction Scale (SLSS)
The SLSS (Huebner, 1991) is a self-report measure to
evaluate the satisfaction with life as a whole in individuals
ranging in age from 8-18 years. Respondents are asked
to answer the questions based on the thoughts that had in
the last few weeks. For each of the 7 items of the scale,
presented as an affirmation, there are six response choices.
The scale scores range from 7 to 42, with higher scores
denoting higher levels of global satisfaction with life. The
(Huebner, 1991) and .86 in a subsequent exploratory study
(Dew & Huebner, 1994). The SLSS has been validated
for Portuguese children (Marques, Pais-Ribeiro, & Lopez,
2007a) and reported a Cronbach’s alpha of .89.
Global Self-Worth Sub-Scale (SWS)
The SWS is one of the six sub-scales of the Self
Perception Profile for Children (Harter, 1985), which is a
self-report measure focused on children’s (8 to 16 years
old) domain-specific judgments of their competence, as
well as a global perception of self-worth. The SWS taps
the extent to which the child likes themselves as a person,
and constitutes a global judgment of personal worth. The
 MHI-5 IN 10-15 YEAR OLDS
general procedures are to score each of the 6 items on
a 4-point scale, with a score of 4 reflecting high self-
worth and a score of 1 designating low self-worth. Earlier
data from Harter (1985) indicates acceptable internal
consistency ranging from .78 to .84 for this sub-scale. The
Self Perception Profile for Children, including the SWS,
has been validated for Portuguese children (Alves-Martins,
Peixoto, Mata, & Monteiro, 1995; Faria & Fontaine, 1995)
with a reported Cronbach’s alpha of .62 and .73. A recent
study with 10-15 year olds reported a Cronbach’s alpha
of .80 (Gaspar, Ribeiro, Matos, Leal, & Ferreira, in press),
similar to the original version.
Procedure
Approval to collect data was secured through the
administrator from each school. A letter describing the
study and requesting permission for student participation
was sent home to parents of potential participants.
Approximately 31% of the students returned signed
parental permissions forms. Participant consent was then
sought and where provided participants were administered
each of the measures described above in groups of 15
to 30 students. The size of the group was dependent
upon the space available within each school, as well as
the amount of adult assistance available to promote the
full understanding of instructions and the confidential
completion of all measures. The measures completed by
all participants were presented in a counterbalanced order.
The students were first asked to complete the demographic
survey and then the psychological scales. They were then
thanked for their participation and dismissed. Research
assistants were available during all administration
sessions to answer questions and ensure confidentiality.
At time 2, student consent was re-obtained from all
participants and survey administration procedures were
the same described at time 1.
Statistical Analysis
Readability, internal consistency, intra-class
correlation coefficient, stability and descriptive statistics
were investigated. Next, we performed exploratory
factor analysis using a principal components procedure.
The criterion-related validity was investigated through
an examination of the relationships between MHI-5 and
the CHS, MHI-5 and the SLSS, and between MHI-5 and
SWS at Time 1. Time 2 data collection was part of a
larger study (Marques, Lopez, & Pais-Ribeiro, in press;
Marques, Pais-Ribeiro, & Lopez, 2011).
To assess the readability of MHI-5 in this age group, a
pilot study was conducted with 42 individuals, 6-8 grade
students with a mean age 12.9 years, range 10-16 years
481
and 61.9% female (Marques, Pais-Ribeiro, & Lopez,
2007b). These 42 students were not incorporated into the
sample of the present study. Participants were told ‘If
you don’t understand an item, leave it blank. If there are
words that you don’t understand, circle them’, and an
example of a circled word was provided. Participants left
no items blank and appeared to understand key words
(e.g., calm, peaceful, nervous) and so the readability was
considered acceptable.
Results
Reliability and descriptive statistics
A Cronbach alpha of .82 was found with item-scale
(corrected) correlations ranging from .78 and .81. The
intra-class correlation coefficient was .82 and the 1-year
test-retest reliability coefficient for the MHI-5 was .49.
The total scale has a M = 23.86 and a SD = 3.84. When
the mean item scores were translated to students’ response
they equated to students feeling “a good bit of the time”
calm and peaceful, and happy “most of the time”; Students’
felt nervous, upset and depressed “a little of the time”.
These results are presented in Table 1.
Relationships between MHI-5 scores and demographic
variables (gender, age) were considered. Main effects
for gender was found t(365) = 2.40, p = .02, with males
manifesting a better mental health (M = 24.30) than
females (M = 23.40). The MHI-5 correlation with age was
no significant.
Factorial Validity
We performed exploratory factor analysis to identify
the factor structure and the magnitude of the factorial
loading, replicating the analysis, principal component
analysis with a varimax rotation method, that Ostroff
and colleagues (1996) used in their study of MHI with
adolescents. The Kaiser test (i.e., eigenvalues > 1.0) was
used to determine the number of factors to be extracted.
We found a one component solution explaining 59.88% of
total variance. Additionally, an analysis of the scree plot
suggested that factors extracted beyond the first (Eigen
value = 2.99) did not account for much additional variance
(eigenvalues = .87, .52, .34, and .20, respectively, for the
second, third, fourth and fifth factors). Table 1 shows the
factorial loadings of the items.
All items loaded substantially on this general
component of mental health (range = .70-.81) indicating
that this component accounted for a substantial
proportion of the variance in each item. Thus, the one-
component solution appears to be a viable one among
young adolescents. The communality estimate for each
item varies between .60 and .73.
 482 MARQUES, PAIS-RIBEIRO, AND LOPEZ

Table 1
Means, Standard Deviations and Principal component analysis with a varimax rotation method and a one-factor solution,
with the factorial loading in bold (N = 367)

Factorial
Scale – Items M SD
Loading

1 - Quanto tempo, durante o mês passado, te sentiste muito nervoso?* (How much of the time, 4.58 .90 .70
during the last month, have you been a very nervous person?)
2 - Quanto tempo, durante o mês passado, te sentiste calmo e em paz? (How much of the time,
4.39 1.05 .75
during the last month, have you felt calm and peaceful?
3 - Quanto tempo, durante o mês passado, te sentiste triste e em baixo?* (How much of the
4.78 1.00 .81
time, during the last month, have you felt downhearted and blue?)
4 - Quanto tempo, durante o mês passado, te sentiste uma pessoa feliz? (How much of the time,
5.39 .82 .79
during the last month, have you been a happy person?)
5 - Quanto tempo, durante o mês passado, te sentiste triste e em baixo, de tal modo que nada te
conseguia animar?* (How much of the time, during the last month, have you felt so down in the 4.75 1.16 .79
dumps that nothing could cheer you up?)
* Items are reverse-scored

Table 2
Correlations between Portuguese Versions of the Mental Health Inventory-5, Children Hope Scale, Students Life Satisfac-
tion Scale and Self-Worth Sub-Scale (N = 367)

1 2 3

1. Mental Health Inventory-5 __

2. Children’s Hope Scale .45** __
3. Students’ Life Satisfaction Scale .56** .63** __
4. Self-worth Sub-scale .41** .60** .61**
** p < .01

Criterion-related Validity of the SLSS
Criterion-related validity of the MHI-5 was assessed
through analysis of correlations with other measures,
including measures of hope (CHS), satisfaction with life
(SLSS) and global self-worth (SWS). Table 2 shows these
correlations. MHI-5 scores were found to have a moderate
to strong, significant relationship to all the scales.
Discussion
This study provides the first data on the use of the
MHI-5 in a sample of 10-15 years old and supported the
reliability and validity of the MHI-5 in this population. In
particular, the students could read and understand the items,
the scale showed adequate internal consistency for research
purpose (Nunnaly, 1978) and replicated the adult factor
structure, and evidence of criterion-related validity was
promising. These results indicate that research on young
adolescents using a brief adult mental health inventory is
practicable and likely to be informative. The results also
imply that adult concepts of mental health and functioning
are appropriate for 10-15 year olds.
Specifically, the Portuguese language version of MHI-
5 shows acceptable readability for middle-school aged
children, which is consistent with the study of Ostroff et
al. (1996). In accord with last authors (Ostroff et al.), third
grade reading level is required to comprehend the MHI
English language version and key words require 4th to 6th
grade levels.
The scale internal reliability for this study (α = .82) was
similar to that of a range of other studies across cultures
(α = .74 - .87) including a Portuguese language version
sample of adults (Pais-Ribeiro, 2001), an English language
version samples of adults (e.g. McCabe, Thomas, Brazuer,
& Coleman, 1996; McHorney & Ware, 1995; Rumpf, Meyer,
Hapke, & John, 2001), a Norwegian language version
(Loge & Kaasa, 1998; Strand et al., 2003), and a Swedish
study using the MHI-5 with general adult population
(Sullivan & Karlsson, 1998). Test-retest reliability of .49
 MHI-5 IN 10-15 YEAR OLDS
over a 1-year interval indicates that a substantial proportion
of the reliable variance is moderately stable.
Exploratory factor analysis procedures supported the
notion of a single underlying mental health component,
at the same time, it calls attention to the fact that a
approximately 40% of the variance was unexplained by
the unidimensional model. Additionally, the communality
estimate for each item is appropriate (Thompson, 2004).
Criterion-related validity was considered by examining
its relationships to several different, but related measures.
MHI-5 scores were correlated positively with scores on
measures of hope, global life satisfaction and self-worth.
The moderate to strong relationship between mental health
and the three variables of life satisfaction, hope and self-
worth are consistent with other research in U.S. populations
(Huebner, Funk, & Gilman, 2000; Shorey, Snyder, Yang, &
Lewin, 2003, Spencer, Josephs, & Steele, 1993). These
findings indicate that MHI-5 shares a significant amount
of variance with positive thinking variables, providing
additional support for the criterion-related validity of the
MHI-5 for young adolescents. Significant associations were
found between MHI-5 and gender, with males reporting
better mental health than females, and 10-15 year olds
reporting better mental health compared to adults mean
scores (M = 19.83, Pais-Ribeiro, 2001). These age and
gender findings are consistent with Ostroff et al., (1996)
study using the MHI in an adolescent population.
At present, the MHI-5 can be considered a promising
tool for mental health assessment in children as young
as age 10. It is therefore a candidate for use in studies of
children on a wide range of topics. In adults, mental health
assessment is often used clinically to aid in diagnosis. For
example, Means-Christensen, Arnau, Tonidandel, Bramson,
& Meagher (2005) established the utility of the MHI-5 for
the detection of patients suffering from major depression
or panic disorder in primary care settings. A study of HIV
positive outpatients found that MHI-5 may be a useful
case-finding measure for these patients, namely to indicate
a diagnosis of recent major depression (Holmes, 1998). But
clinical applications may be of limited interest to those
psychologists who are predominantly concerned with
developmental processes that lead to a positive development
or to problems in adjustment and to understand the client
more fully. For them, studies of the interactions of mental
health and positive traits may be more relevant. For
example, Shorey et al., (2003) assessed the role of hope as
a mediator in recollected parenting, adult attachment, and
mental health.
The current study has a number of limitations which
need to be considered. First, the sample was not nationally
representative, and, therefore, generalizing results from
this study alone must be done with caution. Additional
samples are necessary to determine the generalizability of
the findings, and larger samples are necessary to determine
483
specific response patterns within each group (e.g., gender
differences). A second limitation is that the data collected
were self-report items. The reliability of self-report data
has been questioned repeatedly in the literature and it is
known that mulltimethod studies would enhance the
meaningfulness of the findings (Diener, 1994). However,
self-report is the usual method of gathering information
about personal perceptions. According to Lazarus and
Folkman’s (1984) theory, perceptions largely determine
what is and is not stressful to the individual. Nevertheless,
it is possible that shared method variance may have inflated
the observed relationships among variables. Finally,
the MHI-5 represents a brief screener of mental-health.
However past research (e.g. Strand et al., 2003) indicates
that MHI-5 behave similarly as MHI, SCL-25, GHQ-
12, or MCS. Moreover MHI-5 is widely used not only in
psychiatric surveys but also in surveys of general health, an
operational advantage comparing to other short form scales
(e.g. SCL-5; SCL-10).
While taking in to account the limitations of the current
study, the results indicate that the MHI-5 is a reliable, valid and
brief cross-cultural measure of both psychological distress
and psychological well-being in adolescent population
References
Alva, S. A., & de Los Reyes, R. (1999). Psychosocial stress,
internalized symptoms, and the academic achievement of
Hispanic adolescents. Journal of Adolescent Research, 14,
343-358. doi:10.1177/0743558499143004
Alves-Martins, M., Peixoto, F., Mata, L., & Monteiro, V. (1995).
Escala de auto-conceito para crianças e pré-adolescentes
[Self-perception profile for children and young adolescents].
In L. S. Almeida, M. R. Simões, & M. M. Gonçalves (Eds.),
Psychological Tests in Portugal (pp. 79-89). Braga: APPORT.
Berwick, D. M., Murphy, J. M., Goldman, P. A., Ware, J. E.,
Barsky, A. J., & Weinstein, M. C. (1991). Performance of a
five-item mental health screening test. Medical Care, 29, 169-
176. doi:10.1097/00005650-199102000-00008
Boden, J. M., Fergusson, D. M., & Horwood, L. J. (2008). Does
adolescent self-esteem predict later life outcomes? A test of the
causal role of self-esteem. Development and Psychopathology,
20, 319-339. doi:10.1017/S0954579408000151
Bültmann, U., Rugulies, R., Lund, T., Christensen, K. B., Labriola,
M., & Burr, H. (2006). Depressive symptoms and the risk of
long-term sickness absence. Social Psychiatry and Psychiatric
Epidemiology, 41, 875-880. doi:10.1007/s00127-006-0110-y
Bray, I., & Gunnell, D. (2006). Suicide rates, life satisfaction and
happiness as markers for population mental health. Social
Psychiatry and Psychiatric Epidemiology, 41, 333-337.
doi:10.1007/s00127-006-0049-z
Chassin, L., Ritter, J., Trim R. S., & King, K. M. (2003). Adolescent
substance use disorders. In E. J. Mash & R. A. Barkley (Eds.),
Child psychopathology (2nd ed.) (pp. 199-230). New York,
NY: Guilford Press.
 484 MARQUES, PAIS-RIBEIRO, AND LOPEZ
Cunningham, M., Hurley, M., Foney, D., & Hayes, D. (2002).
Influence of perceived contextual stress on self-esteem
and academic outcomes in African American adolescents.
Journal of Black Psychology, 28, 215-233. doi:10.1177/
0095798402028003003
Derogatis, L. R. (1983). SCL-90-R administration, scoring, and
procedures manual. Towson, MD: Clinical Psychometric
Research.
Dew, T., & Huebner, E. S. (1994). Adolescents’ perceived quality
of life: An exploratory investigation. Journal of School
Psychology, 32, 185-199. doi:10.1016/0022-4405(94)90010-8
Diener, E. (1994). Assessing subjective well-being: Progress
and opportunities. Social Indicators Research, 31, 103-157.
doi:10.1007/BF01207052
Ebert, S. A., Tucker, D. C., & Roth, D. L. (2002). Psychological
resistance factors as predictors of general health status and
physical symptom reporting. Psychology, Health & Medicine,
7, 363-375. doi:10.1080/13548500220139449
Faria, L., & Fontaine, A. M. (1995). Adaptação do Self Perception
Profile for Children (SPPC) de Harter a crianças e pré-
adolescentes [Adaptation of the self-perception profile for
children (SPPC) by Harter in children and young adolescents].
Psicologia, 10, 129-142.
Gaspar, T., Ribeiro, J., Matos, M., Leal, I., & Ferreira, A. (in press).
Revisão da Escala de auto-estima de Susan Harter em crianças
e adolescentes Potugueses [Revision of the self-esteem scale
for Portuguese children and adolescents by Susan Harter].
Psicologia da Criança e do Adolescente.
Goldberg. D., & Williams, P. (1988). A User’s Guide to the
General Health Questionnaire. Windsor, UK: NEFR-Nelson.
Hagen, K. A., Myers, B. J., & Mackintosh, V. H. (2005).
Hope, social support, and behavioral problems in at-risk
children. American Journal of Orthopsychiatry, 75, 211-219.
doi:10.1037/0002-9432.75.2.211
Hankin, B. L., & Abramson, L. Y. (2001). Development of
gender differences in depression: An elaborated cognitive
vulnerability-transactional stress theory. Psychological
Bulletin, 127, 773-796. doi:10.1037/0033-2909.127.6.773
Harter, S. (1985). Manual for the Self-Perception Profile for
Children. Denver, CO: University of Denver.
Hoeymans, N., Garssen, A., Westert, G., & Verhaak, P. (2004).
Measuring mental health of the Dutch population: a comparison
of the GHQ-12 and the MHI-5. Health and Quality of Life
Outcomes, 2, 23-29. doi:10.1186/1477-7525-2-23
Holmes, W. C. (1998). A short, psychiatric, case-finding measure
for HIV seropositive outpatients: Performance characteristics
of the 5-item mental health subscale of the SF-20 in a male,
seropositive sample. Medical Care, 36, 237-243.
Huebner, E. S. (1991). Initial development of the Student’ Life
Satisfaction Scale. School Psychology International, 12, 231-
240. doi:10.1177/0143034391123010
Huebner, E. S. (2004) Research on assessment of life satisfaction
of children and adolescents. Social Indicators Research, 66,
3-33. doi:10.1023/B:SOCI.0000007497.57754.e3
Huebner, E. S., Funk, B. A., & Gilman, R. (2000) Cross-sectional
and longitudinal psychosocial correlates of adolescent life
satisfaction reports. Canadian Journal of School Psychology,
16, 53-64. doi:10.1177/082957350001600104
Jaser, S. S., Langrock, A. M., Keller, G., Merchant, M. J., Benson,
M. A., Reeslund, K.,… Compas, B. E. (2005). Coping with the
stress of parental depression II: Adolescent and parent reports
of coping and adjustment. Journal of Clinical Child and
Adolescent Psychology, 34, 193-205. doi:10.1207/s153744
24jccp3401_18
Kelly, M. J., Dunstan, F. D., Lloyd, K., & Fone, D. L. (2008).
Evaluating cutpoints for the MHI-5 and MCS using the
GHQ-12: a comparison of five different methods. Bio Med
Central Psychiatry. Retrieved from http://www.biomedcentral.
com/1471-244X/8/10
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and
coping. New York, NY: Springer.
Loge, J. H., & Kaasa, S. (1998). Short Form 36 (SF-36) health
survey: normative data from the general Norwegian
population. Scandinavion Journal of Social Medicine, 4, 250-
258. doi:10.1080/14034949850153347
Manne, S., & Schnoll, R. (2001). Measuring Cancer Patients’
Psychological Distress and Well-Being: A Factor Analytic
Assessment of the Mental Health Inventory. Psychological
Assessment, 13, 99-109. doi:10.1037/1040-3590.13.99
Marques, S. C., Lopez, S. J., & Pais-Ribeiro, J. P. (2011). “Building
Hope for the Future” – A Program to Foster Strengths in
Middle-School Students. Journal of Happiness Studies, 12,
139-152. doi: 10.1007/s10902-009-9180-3.
Marques, S. C., Pais-Ribeiro, J. L., & Lopez, S. J. (2009).
Validation of a Portuguese Version of the Children’s Hope
Scale. School Psychology International, 30, 538-551. doi:10.
1177/0143034309107069
Marques, S. C., Pais-Ribeiro, J. L., & Lopez, S. J. (2009b). The
role of positive psychology constructs in predicting mental
health and academic achievement in Portuguese children
and adolescents: A two-year longitudinal study. Journal of
Happiness Studies. doi: 10.1007/s10902-010-9244-4.
Marques, S. C., & Pais-Ribeiro, J. L., & Lopez, S. J (2007a).
Validation of a Portuguese Version of the Students’ Life
Satisfaction Scale. Applied Research in Quality of Life, 2, 83-
94. doi:10.1007/s11482-007-9031-5
Marques, S. C., Pais-Ribeiro, J. L., & Lopez, S. J. (2007b). Estudo
preliminar das características psicométricas e estruturais
do Inventário de Saúde Mental-5 [Preliminary study of the
psychometric and structural characteristics of the Mental
Health Inventory-5]. Paper presented at the 7th National
Conference on Health Psychology. Porto, Portugal.
Martin, R. A., Kazarian, S. S., & Breiter, H. J. (1995). Perceived
stress, life events, dysfunctional attitudes, and depression in
adolescent psychiatric inpatients. Journal of Psychopathology
& Behavioral Assessment, 17, 81-95. doi:10.1007/BF02229205
Means-Christensen, A. J., Arnau, R. C., Tonidandel, A. M.,
Bramson, R., & Meagher, M. W. (2005). An Efficient Method
of Identifying Major Depression and Panic Disorder in
Primary Care. Journal of Behavioral Medicine, 28, 565-572.
doi:10.1007/s10865-005-9023-6
 MHI-5 IN 10-15 YEAR OLDS
McCabe, C., Thomas, K., Brazier, J., & Coleman, P. (1996)
Measuring the mental health status of a population: A
comparison of the GHQ-12 and the SF-36 (MHI-5).
British Journal of Psychiatry, 169, 516-521. doi:10.1192/
bjp.169.4.516
McHorney, C., & Ware, J. (1995). Construction and validation
of an alternate form general mental health scale for the
Medical Outcomes Study Short-Form 36-Item Health Survey.
Medical Care, 33, 15-28. doi:10.1097/00005650-199501000-
00002 short-form general health survey: Reliability and validity
McNamara, S. (2000). Stress in young people: What’s new and
what can we do? New York, NY: Continuum.
McKnight, C. G., Huebner, E. S., & Suldo, S. (2002). Relationships
among stressful life events, temperament, problem behavior,
and global life satisfaction in adolescents. Psychology in the
Schools, 39, 677-687. doi:10.1002/pits.10062
Newbegin, I., & Owens, A. (1996). Self-esteem and anxiety in
secondary school achievement. Journal of Social Behavior
and Personality, 11, 521-530.
Nunnally, J. (1978). Psychometric theory (2nd ed.). New York,
NY: McGraw-Hill.
Ostroff, J. S., Woolverton, K. S., Berry, C., & Lesko, L. M. (1996).
Use of the Mental Health Inventory With Adolescents: A
Secondary Analysis of the Rand Health Insurance Study.
Psychological Assessment, 8, 105-107. doi:10.1037/1040-
3590.8.1.105
Pais-Ribeiro, J. L. (2001). Inventário de Saúde Mental: Um estudo
de adaptação para a população Portuguesa [Mental Health
Inventory: A study of adaptation to Portuguese population].
Psicologia, Saúde & Doenças, 2, 77-99.
Riesen, Y., & Porath, M. (2004). Perceived social support of
martially abused women and their children’s global self-worth.
Canadian Journal of Community Mental Health, 23, 109-115.
Rumpf, H., Meyer, C., Hapke, U., & John, U. (2001). Screening
for mental health: validity of the MHI-5 using DSM-IV Axis I
Psychiatric disorders as a gold standard. Psychiatry Research,
105(3), 243-2453. doi:10.1016/S0165-1781(01)00329-8
Schroevers, M. J., Ranchor, A. V., & Sanderman, R. (2003). The
role of social support and self-esteem in the presence and
course of depressive symptoms: A comparison of cancer
patients and individuals from the general population. Social
Science and Medicine, 57, 375-385. doi:10.1016/S0277-
9536(02)00366-0
Shorey, H. S., Snyder, C. R., Yang, X., & Lewin, M. R. (2003).
The role of hope as a mediator in recollected parenting, adult
attachment, and mental health. Journal of Social and Clinical
Psychology, 22, 685-715. doi:10.1521/jscp.22.6.685.22938
Snyder, C. R., Feldman, D. B., Taylor, J. D., Schroeder, L. L.,
& Adams III, V. (2000). The roles of hopeful thinking in
preventing problems and enhancing strengths. Applied and
Preventive Psychology, 15, 262-295. doi:10.1016/S0962-
1849(00)80003-7
Snyder, C. R., Hoza, B., Pelham, W. E., Rapoff, M., Ware, L.,
Danovsky, M., … Stahl, K. J. (1997). The development and
validation of the Children’s Hope Scale. Journal of Pediatric
Psychology, 22, 399-421. doi:10.1093/jpepsy/22.3.399
485
Snyder, C. R., Lopez, S. J., Shorey, H. S., Rand, K. L., & Feldman,
D. B. (2003). Hope theory, measurements, and applications to
school psychology. School Psychology Quarterly, 18, 122-139.
doi:10.1521/scpq.18.2.122.21854
Spencer, S. J., Josephs, R. A., & Steele, C. M. (1993). Low
self-esteem, the uphill struggle for self-integrity. In R. F.
Baumeister (Ed.), Self-esteem: the puzzle of low self-regard
(pp. 21-36). New York, NY: Plenum.
Stewart, A. L., Hays, R. D., & Ware, J. E. (1988). The MOS
in a patient population. Medical Care, 26, 724-735. doi:10.
1097/00005650-198807000-00007
Suldo, S. M., & Huebner, E. S. (2004). Does life satisfaction moderate
the effects of stressful life events on psychopathological
behaviour in adolescence? School Psychology Quarterly, 19,
93-105. doi:10.1521/scpq.19.2.93.33313
Sullivan, M., & Karlsson J. (1998). The Swedish Health Survey III.
Evaluation of criterion-based validity: Results from normative
population. Journal of Clinical Epidemiology, 51, 1105-1113.
doi:10.1016/S0895-4356(98)00102-4
Strand, B. H., Dalgard, O. S., Tambs, K., & Rognerud, M.
(2003). Measuring the mental health status of the Norwegian
population: A comparison of the instruments SCL-25, SCL-10,
SCL-5 and MHI-5 (SF-36). Nordic Journal of Psychiatry, 57,
113-118. doi:10.1080/08039480310000932
Thompson, B. (2004). Exploratory and Confirmatory Factor
Analysis: Understanding Concepts and Applications.
Washington, DC: American Psychological Association.
Valle, M. F., Huebner, E. S., & Suldo, S. M. (2004). Further Evaluation
of the Children’s Hope Scale. Journal of Psychoeducational
Assessment, 22, 320-337. doi:10.1177/073428290402200403
Veit, C. T., & Ware, J. E., Jr. (1983). The structure of psychological
distress and well-being in general populations. Journal
of Consulting and Clinical Psychology, 51, 730-742.
doi:10.1037/0022-006X.51.5.730
Ware, J. E., Kosinksi, M, & Dewey, J. (2000). How to score
version 2 of the SF-36 health survey. Lincoln, RI: Quality
Metric Incorporated.
Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-itemshort-
form health survey (SF-36): I. Conceptual framework and item
selection. Medical Care, 30, 473-481. doi:10.1097/00005650-
199206000-00002
Ware, J. E., Snow, K., Kosinski, M., & Gandek, B. (1993). SF-
36 Health Survey: Manual and Interpretation Guide. Boston,
MA: Health Institute.
Ware, J. E., Kosinski, M., & Keller, S. D. (1994). SF-36 physical
and mental health summary scores: a user’s manual. Boston,
MA: Health Institute, New England Medical Center.
World Health Organization (2001). Strengthening mental health
promotion. Geneva: World Health Organization.
Received January 8, 2010
Revision received May 29, 2010
Accepted June 14, 2010