The Development The Development of of

Thai Mental Health Thai Mental Health Indicator (TMHI) : Indicator (TMHI) :

From past to presentFrom past to presentPresented By:

Apichai Mongkol (et al)Deputy Director-General Department of Mental Health,Thailand,

The ResearchersThe ResearchersMongkol, Apichai Deputy Director of Department of Mongkol, Apichai Deputy Director of Department of

Mental Health, Ministry of Public Health, ThailandMental Health, Ministry of Public Health, ThailandTangseree, Tavee Director of Khon Kanen Tangseree, Tavee Director of Khon Kanen

Rajanagarindra Psychiatric HospitalRajanagarindra Psychiatric HospitalUdomratn, Pichet Department of Psychiatry,Udomratn, Pichet Department of Psychiatry,

Faculty of Medicine, Prince of Songkla University Faculty of Medicine, Prince of Songkla University and et al.and et al.

IntroductionIntroduction

• Thailand have developed the variety of instruments to measure mental health of Thai people such as

- Thai Mental Health Indicator (Suwanee et. al, 1987).

- The Development of Mental Health Indicator (Amphorn et al, 1997).

- Quality of Life (Thai version) (Suwat et al, 1997).

- Thai Mental Health Questionnaire (Sucheera et al, 1999).

These instrument had som e weak point such as

* didn’t covered with in me ntal health definition.

* Data collection from pat ient population/ hospital

setting.

Department of Mental HealthDepartment of Mental HealthDeveloped Thai Mental Health Indicator (TMHI) Developed Thai Mental Health Indicator (TMHI)

since 2000 to measure mental health or happiness since 2000 to measure mental health or happiness of all Thai people (happiness and mental health are of all Thai people (happiness and mental health are the same subject in Thai culture) bythe same subject in Thai culture) by

• Cover with the mental health definition in the context of Thai culture.

• Data collection from general population.

• The aim of this paper is present The aim of this paper is present the process of developing the the process of developing the Thai Mental Health Indicator from Thai Mental Health Indicator from 2000 to nowadays2000 to nowadays

• Now this instrument has been Now this instrument has been used nationwide. used nationwide.

Result of development of TMHI : Result of development of TMHI : From past to presentFrom past to presentTMHI-new version (2003) was developed under TMHI-new version (2003) was developed under definition of mental heath :definition of mental heath :

““a good mental health or well-being resulted a good mental health or well-being resulted from mastering the competency of daily problem-from mastering the competency of daily problem-solving and the potential of self development solving and the potential of self development toward a better quality of life, which covering toward a better quality of life, which covering psychological quality under changing social psychological quality under changing social environment”environment”

Development in 3 PhasesDevelopment in 3 Phases

Phase 1Phase 1

* Reviewed related documents and * Reviewed related documents and researchesresearches

* finally it had 80 items included 4 domains * finally it had 80 items included 4 domains (21 sub-domain) :(21 sub-domain) :

1. mental state1. mental state 2. mental capacity 2. mental capacity3. mental quality3. mental quality 4. supporting factors.4. supporting factors.

Phase 2Phase 2• TMHI (2003) was studies the first TMHI (2003) was studies the first construct validity with 2,024 population from construct validity with 2,024 population from 15 provinces in 5 regions.15 provinces in 5 regions.

• reduced items by factor analysis with reduced items by factor analysis with experts meeting.experts meeting.

• TMHI remained the same domains and TMHI remained the same domains and sub-domains but reduced items from 80 to sub-domains but reduced items from 80 to 73 items.73 items.

Figure 1 : the sampling method in study IIFigure 1 : the sampling method in study II

All provinces in each region

Provinces with rich

economic statusDistrict

government (Or-bor-tor)

level 1-2

Provinces with

middle economic

statusDistrict

government (Or-bor-tor)

level 3

Provinces with poor

economic statusDistrict

government(Or-bor-tor)

level 4-5Metropolitan or

city municip

algovernment

administration

1 Village

of district government (Or-

bor-tor)level 1-

2

City municip

al government

administration

1 Village of

district

government

(Or-bor-tor)level

3

City municip

al government

administration

1 Village

of distric

t government

(Or-bor-tor)level 4-5

Phase 3 :Phase 3 :• TMHI (2003) was to study the second construct TMHI (2003) was to study the second construct validity and norm of the instrument with 73 items from validity and norm of the instrument with 73 items from phase 2phase 2

• data collected with the same determination of data collected with the same determination of sample size, added 380 samplessample size, added 380 samples

• reduced items by factor analysis with experts reduced items by factor analysis with experts meetingmeeting

• TMHI was divided into 2 forms : complete form TMHI was divided into 2 forms : complete form included 54 items and short form 15 items.included 54 items and short form 15 items.

Figure 2 : Domain and sub-domains of TMHI-54Figure 2 : Domain and sub-domains of TMHI-54

Domain

Sub-domai

n

TMHI54

Domain 1

Mental State(13

items)Domain 2

Mental Capaci

ty15

items)

1.1 General well-being positive affect (4 items)1.2 General well-being negative affect (6 items)1.3 Perceived ill-health and mental illness (3 items)

2.1 Interpersonal relationships (3 items)2.2 Expectation achievement congruence (3 items)2.3 Confidence in coping (5 items)2.4 Inadequate mental mastery (4 items)

Figure 3 : Domain and sub-domains of TMHI-54Figure 3 : Domain and sub-domains of TMHI-54

Domain

Subdomain

TMHI54

Domain 3

Mental Quality

(14 items)Domai

n 4 Suppor

tingFactor

s(12

items)

3.1 Kindness and altruism (6 items)3.2 Self esteem (2 items)3.3 Faith (3 items)3.4 Creative thinking and enthusiasm (3 items)

4.1 Social support (2 items)4.2 Family support (4 items)4.3 Physical safety and security (2 items)4.4 Health and social care (4 items)

• Construct validity study was used Construct validity study was used factor analysis.factor analysis.

• Cronbach’s Alpha coefficient to study Cronbach’s Alpha coefficient to study the reliability.the reliability.

• Kappa statistic to study the agreement Kappa statistic to study the agreement between the complete (TMHI-54) and between the complete (TMHI-54) and brief (TMHI-15).brief (TMHI-15).

Table 1 : Descriptive statistic and reliability value of domain 1,2,3 and 4 of TMHI-54 (n-2,401).

FactorDomain

1. Mental state 2. Mental capacity

3. Mental quality 4. Supporting factor

Number of item

13151412

X

2983.280027752289.

S.D.

470.497.512.459.

Potentialrang

-039-045-042-036

Obtainedrang

-539-845-042-036

Alpha

083.081.086083.

4 Domains 15 Sub-domains

Table 2 : The norm values of TMHI-54 and TMHI-15 Table 2 : The norm values of TMHI-54 and TMHI-15 (n-2,390).(n-2,390).Statistic

Mean Standard de

viationMedian25th percentile75 th percentileMaximumMinimum

Potential rang

Obtained ra nge

Range

-54TMHI

10830.144610900.9911716139-0162

-39161122

-15TMHI3102.475.

3100.2834459-045-94536

Score and meaning of TMHI-54Score and meaning of TMHI-54

118-162 (>75 th percentile) = better mental health

99-117 (>25 th- 75 th percentile) = average mental health

98 points or below (>25 th percentile) = lower mental health

Score and meaning of TMHI-15Score and meaning of TMHI-15

35-45 = better mental health

28-34 = average mental health

27 points or below = lower mental health

Pairs

TMHI-54 and TMHI-15

Kappa statistic

0.63

95% CI

0.60-0.66

Table3 : The value of agreem - ent study between TMHI 54

-and TMHI 15

Kappa statistic 0.61 – 0.80 = Substantial (Landis & Koch,1997)

TMHI includes 2 forms :TMHI includes 2 forms :

TMHI – 54 is a complete form TMHI – 54 is a complete form will be use if the user requires to will be use if the user requires to study complete mental health and study complete mental health and cover with all sub-domains.cover with all sub-domains.

TMHI – 15 is a brief form will TMHI – 15 is a brief form will be use if the user requires to study be use if the user requires to study with rapid and convenient condition.with rapid and convenient condition.

TMHI has been TMHI has been developed to be a reliable developed to be a reliable instrument for assessing the instrument for assessing the mental health of the Thai mental health of the Thai population under the context of population under the context of Thai society and culture.Thai society and culture.

It has been used to investigate the It has been used to investigate the country-wide happiness of Thai people in 2003, country-wide happiness of Thai people in 2003, 2005 and 2007 (on process of clean data and 2005 and 2007 (on process of clean data and analyzing).analyzing).

The results of the three time surveys could The results of the three time surveys could be compare to show the trend of happiness of be compare to show the trend of happiness of Thai people.Thai people.

Year Better Average Lower 2003 20.2 % 58.6 % 21.1 % 2005 24.4 % 43.7%

31.9 %