The SF-36 offers a strong measure of mental health symptoms in survivors of acute respiratory failure: A tri-national analysis

Elizabeth R. Pfoh, Kitty S. Chan, Victor D. Dinglas, Brian H. Cuthbertson, Doug Elliott, Richard Porter, O. Joseph Bienvenu, Ramona O. Hopkins, Dale M. Needham

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Rationale: Survivors of acute respiratory failurecommonly experience long-term psychological sequelae and impaired quality of life. For researchers interested in general mental health, using multiple condition-specific instrumentsmaybe unnecessary and inefficientwhen using the Medical Outcomes Study ShortForm(SF)-36, a recommended outcome measure, may suffice. However, relationships between the SF-36 scores and commonly usedmeasures of psychological symptoms in acute survivors of respiratory failure are unknown. Objectives: Our objective is to examine the relationship of the SF-36 mental health domain (MH) and mental health component summary (MCS) scores with symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) evaluated using validated psychological instruments. Methods: We conducted a cross-sectional analysis of 1,229 participants at 6- and 12-month follow-up assessment using data from five studies from the United States, the United Kingdom, and Australia. Measurements and Main Results: Symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS), Depression Anxiety Stress Scales, the Davidson Trauma Scale, Impact of Event Scale (IES), and IES-Revised (IES-R). At 6-month assessment there were moderate to strong correlations of the SF-36 MH scores with HADS depression and anxiety symptoms (r =20.74 and 20.79) and with IES-R PTSD symptoms (r =20.60) in the pooled analyses. Using the normalized population mean of 50 on the SF-36 MH domain score as a cut-off, positive predictive values were 16 and 55% for substantial depression; 20 and 68% for substantial anxiety (Depression Anxiety Stress Scales and HADS, respectively); and 40, 44, and 67% for substantial PTSD symptoms (IES-R, IES, and Davidson Trauma Scale, respectively). Negative predictive values were high. The area under the receiver operating characteristics curve of the SF-36 MH score was high for depression, anxiety, and PTSD symptoms (0.88, 0.91, and 0.84, respectively). All results were consistent for the MCS, across the individual studies, and for the 12-month assessment. Conclusions: For researchers interested in general mental health status, the SF-36 MH or MCS offers a strong measure of psychological symptoms prevalent among survivors of acute respiratory failure. For researchers interested in specific conditions, validated psychological instruments should be considered.

Original languageEnglish (US)
Pages (from-to)1343-1350
Number of pages8
JournalAnnals of the American Thoracic Society
Issue number8
StatePublished - 2016


  • Acute respiratory failure
  • Anxiety
  • Depression
  • Medical outcomes study short form 36 survey
  • Post-traumatic stress disorder

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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