We used data that had been collected previously for a study of the validity of the Japanese version of the SF-36, and calculated national norm scores of all subscales of the SF-36 [8 (link),9 (link)]. Details of the nationwide survey have been described previously [9 (link)]. Briefly, a total of 4500 people 16 years old or older were selected from the entire population of Japan by stratified-random sampling in 1995. A self-administered questionnaire was mailed, and the subjects were visited to collect the questionnaires. The SF-36, the ZSDS [11 (link)] (described below), and questions about demographic characteristics were included in the questionnaire.
The ZSDS consists of 10 positively worded items and 10 negatively worded items asking about symptoms of depression. Several studies have established the ZSDS as a reliable and valid instrument for measuring depressive symptoms [12 (link)-14 (link)]. The ZSDS scores were used to define four categories of the severity of depression: within normal range or no significant psychopathology (below 40 points); presence of minimal to mild depression (40–47 points); moderate to marked depression (48–55 points); presence of severe to extreme depression (56 points and above). These score ranges result from the studies of Zung [15 (link)] and Barrett et al [16 (link)]. The ZSDS has been translated into Japanese and studies of the validity of the Japanese version have been published [17 (link)]. Because the ZSDS is not a clinical diagnostic tool, subjects with high scores are said to have depressive symptoms rather than "depression."
Like the rest of the SF-36, the MHI-5 was administered as a paper-and-pencil questionnaire. The instrument contains the following questions: 'How much of the time during the last month have you: (i) been a very nervous person?; (ii) felt downhearted and blue?; (iii) felt calm and peaceful?; (iv) felt so down in the dumps that nothing could cheer you up?; and (v) been a happy person?' For each question the subjects were asked to choose one of the following responses: all of the time (1 point), most of the time (2 points), a good bit of the time (3 points), some of the time (4 points), a little of the time (5 points), or none of the time (6 points). Because items (iii) and (v) ask about positive feelings, their scoring was reversed. The score for the MHI-5 was computed by summing the scores of each question item and then transforming the raw scores to a 0–100-point scale [18 ].
Items (i) and (iii) are almost identical to 2 items in the Zung Self-rating Anxiety Scale [10 (link)]. To make a scale that is even shorter than the MHI-5 and is focused on depression we removed those two anxiety-related items. Thus, the MHI-3 comprised only (ii), (iv), and (v) above. Possible scores on the MHI-3 ranged from 3 to 18 points.
The ZSDS consists of 10 positively worded items and 10 negatively worded items asking about symptoms of depression. Several studies have established the ZSDS as a reliable and valid instrument for measuring depressive symptoms [12 (link)-14 (link)]. The ZSDS scores were used to define four categories of the severity of depression: within normal range or no significant psychopathology (below 40 points); presence of minimal to mild depression (40–47 points); moderate to marked depression (48–55 points); presence of severe to extreme depression (56 points and above). These score ranges result from the studies of Zung [15 (link)] and Barrett et al [16 (link)]. The ZSDS has been translated into Japanese and studies of the validity of the Japanese version have been published [17 (link)]. Because the ZSDS is not a clinical diagnostic tool, subjects with high scores are said to have depressive symptoms rather than "depression."
Like the rest of the SF-36, the MHI-5 was administered as a paper-and-pencil questionnaire. The instrument contains the following questions: 'How much of the time during the last month have you: (i) been a very nervous person?; (ii) felt downhearted and blue?; (iii) felt calm and peaceful?; (iv) felt so down in the dumps that nothing could cheer you up?; and (v) been a happy person?' For each question the subjects were asked to choose one of the following responses: all of the time (1 point), most of the time (2 points), a good bit of the time (3 points), some of the time (4 points), a little of the time (5 points), or none of the time (6 points). Because items (iii) and (v) ask about positive feelings, their scoring was reversed. The score for the MHI-5 was computed by summing the scores of each question item and then transforming the raw scores to a 0–100-point scale [18 ].
Items (i) and (iii) are almost identical to 2 items in the Zung Self-rating Anxiety Scale [10 (link)]. To make a scale that is even shorter than the MHI-5 and is focused on depression we removed those two anxiety-related items. Thus, the MHI-3 comprised only (ii), (iv), and (v) above. Possible scores on the MHI-3 ranged from 3 to 18 points.
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