Mental health self-management questionnaire: Development and psychometric properties

Highlights

• Study aimed to develop and validate a self-report measure of self-management (MHSQ).

• MHSQ was based on a qualitative study with 50 people with mood/anxiety disorders.

• Factor analyses (N=149) revealed 3 factors: Clinical, Empowerment and Vitality.

• Findings support reliability (internal, test–retest) and construct validity of MHSQ.

• Self-management, as measured by MHSQ, is empirically distinct from recovery.

Abstract

Background

Through self-management, people living with depression, anxiety or bipolar disorders can play an active role in their recovery. However, absence of a validated questionnaire limits empirical research on self-management. The study aimed to develop a French instrument, the Mental Health Self-Management Questionnaire (MHSQ), and to investigate its psychometric properties

Methods

A pool of 86 items was created based on a qualitative study with 50 people in recovery from depression, anxiety or bipolar disorders. The 64 most pertinent items were identified following ratings from 14 experts. A sample of 149 people in recovery completed these items and criterion-related measures (specific aspects of self-management, clinical and personal recovery, social desirability), and 93 participants also completed MHSQ two weeks later

Results

Exploratory and confirmatory factor analyses show that MHSQ is composed of three subscales: Clinical (getting help and using resources), Empowerment (building upon strengths and positive self-concept to gain control) and Vitality (active and healthy lifestyle). These subscales had satisfying consistency and test–retest reliability, and were mostly unrelated to social desirability. Correlations with criterion variables support convergent and concurrent validity, especially for Empowerment and Vitality. Comparison of structural models provides evidence of the distinct nature of MHSQ in comparison to the constructs of clinical and personal recovery

Limitations

Longitudinal studies with larger samples are needed to explore the validity of MHSQ for predicting recovery over time

Conclusion

MHSQ is a psychometrically-sound instrument, useful for establishing the role of self-management in recovery and monitoring the efficacy of self-management support programs.

Introduction

Mood (depression and bipolar) and anxiety disorders are highly prevalent and associated with disability and premature deaths (World Health Organization, 2014). Pharmacological and psychotherapeutic interventions are not readily accessible to all, as barriers hinder people from benefiting from such services (Kohn et al., 2004, Peachey et al., 2013). The efficacy of pharmacological treatments for these disorders is moderate (Hidalgo et al., 2007, Pigott et al., 2010, Van Lieshout and MacQueen, 2010). Even with efficient treatment relapses are likely to occur. For example, major depression disorder presents a cumulative recurrence rate of 20-40% in the year following recovery and 60% in a five-year period (Hardeveld et al., 2010). Anxiety disorders have a recurrence rate of 24% in the two-year period following an episode (Scholten et al., 2013). Building on the active role of people in their recovery process (Deegan, 1997, Slade, 2009), guidelines recommend supporting self-management as a complementary approach to optimize recovery from depression, bipolar and anxiety disorders (National Institute for Health and Care Excellence, 2014, Patten et al., 2009, Swinson et al., 2006).

Self-management encompasses all the actions a person takes on a daily basis to manage symptoms, avoid relapse and optimize well-being (Lorig and Holman, 2003). Research has demonstrated the value of self-management for people living with a chronic physical illness (Barlow et al., 2002, Lorig and Holman, 2003). A few recent studies highlighted the potential benefits of self-management for people living with mental health disorders (Lorig et al., 2014, Ritter et al., 2014). However, a systematic review underscored the scarcity of empirical evidence (Houle et al., 2013), partly due to the absence of a validated questionnaire to measure self-management in the mental health domain. This study aimed to develop and validate a short but comprehensive questionnaire, the Mental Health Self-Management Questionnaire (MHSQ), to measure the use of self-management strategies in patients recovering from mood and anxiety disorders.

To our knowledge, no theoretical model exists concerning the classification of mental health self-management strategies that could have guided the development of MHSQ. Recovery is a related concept that has received further attention. Complete recovery implies more than a clinical aspect focused on symptom reduction; it also involves a personal aspect, experienced through a self-transformation process leading to increased emotional, psychological and social well-being (Drake and Whitley, 2014, Provencher and Keyes, 2011). Empowerment, achieved through self-management, is described as essential to recovery (Slade, 2009, Young and Ensing, 1999). Whitley and Drake׳s (2010) model highlights five dimensions of recovery: Clinical (e.g., symptoms, therapy), Functional (e.g., employment, housing), Physical (e.g., diet, exercise), Social (e.g., family, social activities) and Existential (e.g., agency, spirituality). This model was chosen as the basis for MHSQ because it integrates clinical and personal aspects in a manageable number of conceptual dimensions. This paper reviews the multiphasic development of MHSQ (see Fig. 1).