The positive mental health instrument: development and validation of a culturally relevant scale in a multi-ethnic Asian population
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BACKGROUND: Instruments to measure mental health and well-being are largely developed and often used within Western populations and this compromises their validity in other cultures. A previous qualitative study in Singapore demonstrated the relevance of spiritual and religious practices to mental health, a dimension currently not included in exiting multi-dimensional measures. The objective of this study was to develop a self-administered measure that covers all key and culturally appropriate domains of mental health, which can be applied to compare levels of mental health across different age, gender and ethnic groups. We present the item reduction and validation of the Positive Mental Health (PMH) instrument in a community-based adult sample in Singapore. METHODS: Surveys were conducted among adult (21-65 years) residents belonging to Chinese, Malay and Indian ethnicities. Exploratory and confirmatory factor analysis (EFA, CFA) were conducted and items were reduced using item response theory tests (IRT). The final version of the PMH instrument was tested for internal consistency and criterion validity. Items were tested for differential item functioning (DIF) to check if items functioned in the same way across all subgroups. RESULTS: EFA and CFA identified six first-order factor structure (General coping, Personal growth and autonomy, Spirituality, Interpersonal skills, Emotional support, and Global affect) under one higher-order dimension of Positive Mental Health (RMSEA=0.05, CFI=0.96, TLI=0.96). A 47-item self-administered multi-dimensional instrument with a six-point Likert response scale was constructed. The slope estimates and strength of the relation to the theta for all items in each six PMH subscales were high (range:1.39 to 5.69), suggesting good discrimination properties. The threshold estimates for the instrument ranged from -3.45 to 1.61 indicating that the instrument covers entire spectrums for the six dimensions. The instrument demonstrated high internal consistency and had significant and expected correlations with other well-being measures. Results confirmed absence of DIF. CONCLUSIONS: The PMH instrument is a reliable and valid instrument that can be used to measure and compare level of mental health across different age, gender and ethnic groups in Singapore.
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Authors frequently quoted the WHO definition of health as 'a state of complete physical, mental and social well-being, not merely the absence of a disease'.
“Authors frequently quoted the WHO definition of health as ‘a state of complete physical, mental and social well-being, not merely the absence of a disease’.93 104”
From Review of 99 self-report measures for assessing well-being in adults: exploring dimensions of well-being and developments over time (2016) · cites this paper as [93]
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Wong, H. H., Abdin, E., Vaingankar, J. A., Chua, Y. C., Yong, Y. H., Shahwan, S., Cetty, L., Hon, C., Chan, W. Q. J., Lee, H. Y., et al. (2020) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2020.102271 · Cited by 8 · see citing works
Peasgood, T., Chang, J.-Y. A., Mir, R., Mukuria, C., & Powell, P. A. (2021) · Quality of Life Research · doi:10.1007/s11136-021-02801-9 · Cited by 7 · see citing works
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Toledano‐Toledano, F., Jiménez, S. E., de la Rubia, J. M., Merino‐Soto, C., & Rivera-Rivera, L. (2023) · Cancers · doi:10.3390/cancers15102744 · Cited by 7 · see citing works
Mental Health in the Times of Corona: A model for Positive Mental Health During the Global Pandemic
Mathew, J., Gomes, R. F., Bhaskar, S., Yadav, P., & Nair, S. (2021) · Psychological Studies · doi:10.1007/s12646-021-00606-x · Cited by 6 · see citing works
Bican, B., Başar-Gençer, D., & Satıcı, S. A. (2025) · Current Psychology · doi:10.1007/s12144-024-07173-0 · Cited by 6 · see citing works
Positive Mental Health Questionnaire (PMHQ) for Healthcare Workers: A Psychometric Evaluation
Sienra-Monge, J. J. L., Luna, D., Figuerola-Escoto, R. P., Montufar-Burgos, I. I., Hernández-Roque, A., Soria-Magaña, A., & Toledano‐Toledano, F. (2023) · Healthcare · doi:10.3390/healthcare11233041 · Cited by 5 · see citing works
Aslan, O., & Topuz, İ. (2025) · Aging & Mental Health · doi:10.1080/13607863.2025.2606354 · Cited by 3 · see citing works
Propiedades Psicométricas del Continuo de Salud Mental (MHC-SF) en Jóvenes Mexicanos
Pérez, L. T., & Palos, P. A. (2023) · Revista Iberoamericana de Diagnóstico y Evaluación - e Avaliação Psicológica · doi:10.21865/ridep68.2.11 · Cited by 4 · see citing works
Verstraete, J., Schieskow, S., Jelsma, J. M., Herdman, M. J., Morrow, B. M., Dalziel, K., & Bidgood, E. (2025) · The European Journal of Health Economics · doi:10.1007/s10198-025-01865-5 · Cited by 2 · see citing works
Depression and Suicidality: The Roles of Social Support and Positive Mental Health
Seet, V. A. L., Koh, Y. S., Vaingankar, J. A., Shahwan, S., Chang, S. S. H., Verma, S. K., Chow, W. L., Chong, S. A., & Subramaniam, M. (2022) · Archives of Suicide Research · doi:10.1080/13811118.2022.2151955 · Cited by 2 · see citing works
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Positive mental health of patients at a psychiatric hospital, Gauteng province, South Africa
Gulla, S. S. R. K., Helberg, E. A., & Vagiri, R. V. (2023) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v29i0.2016 · Cited by 2 · see citing works
Nguyen, T. V., Quang, M. T., Nguyen, T. A. H., Ta, T. T. T., & Pham, T. P. T. (2024) · Journal Of Advanced Pharmacy Education And Research · doi:10.51847/pxvvrn5sjk · Cited by 2 · see citing works
Hansen-Oja, M. L., Dluzniewski, A., Baker, R. T., & Casanova, M. P. (2025) · Psychology International · doi:10.3390/psycholint7010015 · Cited by 1 · see citing works
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Personal Growth Initiative and Well-Being Among Pre-University Teachers: A Correlational Study
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Boş Zaman Doyumu ve Mental İyi Oluş: Engelli Sporcuların Ailelerine Yönelik Bir Araştırma
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Development of the Singapore workplace wellbeing scale
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Mental İyi Oluşun Yordayıcıları Olarak Aile Aidiyeti ve Çeşitli Demografik Değişkenlerin İncelenmesi
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- Authors
- Vaingankar, J., Subramaniam, M., Chong, S. A., Abdin, E., Orlando Edelen, M., Picco, L., Lim, Y. W., Phua, M. Y., Chua, B. Y., Tee, J. Y., & Sherbourne, C.
- Affiliations
- Institute of Mental Health (SG)
- RAND Corporation (US)
- Corresponding author
- Vaingankar, Janhavi
- ORCID
- Venue
- Health and Quality of Life Outcomes
- Published
- 2011
- Volume
- 9
- Issue
- 1
- Pages
- 92
- ISSN
- 1477-7525 (ISSN-L)
- PMC
- PMC3229450
- OpenAlex
- W2155928802
- Cited by
- 89
- References
- 43
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 8 · 2023: 6 · 2022: 7 · 2021: 5 · 2020: 13 · 2019: 4 · 2018: 1 · 2017: 6 · 2016: 7 · 2015: 8 · 2014: 2 · 2013: 4
- FWCI
- 2.60
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Health and Quality of Life Outcomes (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- National University of Singapore (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Singapore Millennium Foundation
- Topics
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Psychology › Social Psychology › Psychological Well-being and Life Satisfaction
- Social Sciences › Health › Religion, Spirituality, and Psychology
- Keywords
- positive mental health, well-being measurement, coping, social skills, emotional support, differential item functioning, multi-ethnic Asian population, Singapore
- MeSH terms
- Adult, Aged, Mental Disorders, China, Cultural Characteristics, Factor Analysis, Statistical, Female, Humans, India, Malaysia, Male, Middle Aged, Psychiatric Status Rating Scales, Psychometrics, Surveys and Questionnaires, Singapore, Reproducibility of Results, Chi-Square Distribution, Cultural Diversity
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