{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T15:11:17Z","timestamp":1778685077203,"version":"3.51.4"},"reference-count":47,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"unspecified","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010661","name":"Horizon 2020 Framework Programme","doi-asserted-by":"publisher","award":["848180"],"award-info":[{"award-number":["848180"]}],"id":[{"id":"10.13039\/100010661","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Miguel Servet","award":["CP20\/00040"],"award-info":[{"award-number":["CP20\/00040"]}]},{"name":"National Health and Medical Research Council of Australia","award":["APP1195937"],"award-info":[{"award-number":["APP1195937"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,21]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To validate the cross-national psychometric properties of the Mental Health Quality of Life questionnaire (MHQoL) and to develop an open-source toolbox for its scoring, transformation and presentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Secondary analysis of data from a multicentre international randomised controlled trial (EMPOWER).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Workplace settings in small-sized and medium-sized enterprises (SMEs) and public sector organisations in Finland, Spain and the UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The sample included 564 employees: 122 from Finland, 114 from Spain and 328 from the UK. Most were white-collar workers in SMEs or public organisations, mainly in public administration, manufacturing, health\/life sciences or higher education. Women were the majority (56%\u201391% across countries), and mean age ranged from 43 to 48 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>No intervention was delivered for this analysis; data were drawn from baseline assessments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Primary outcomes were internal consistency and construct validity of the MHQoL, evaluated using Cronbach\u2019s alpha, measurement invariance testing and multilevel analyses of associations between MHQoL dimensions and its visual analogue scale (VAS). Secondary outcomes were convergent validity, assessed through correlations between MHQoL scores and other mental health and quality of life measures (EuroQol 5-Dimension 5- level questionnaire (EQ-5D-5L), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Insomnia Severity Index, Perceived Stress Scale-4 (PSS-4), Psychosocial Risk Scale, and World Health Organization Five Well-Being Index (WHO-5)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The MHQoL showed good internal consistency across countries, with Cronbach\u2019s alpha ranging from 0.741 in Finland to 0.806 in Spain (overall \u03b1=0.787). Measurement invariance across Finland, Spain and the UK supported construct validity. Multilevel regression analyses showed associations between MHQoL dimensions and the MHQoL-VAS, with strongest contributions from Self-Image, Daily Activities, Mood and Future. Convergent validity was supported by moderate to strong correlations between MHQoL, EQ-5D-5L and related mental health measures. An open-source R package and Shiny web application (\u2018MHQoL Toolbox\u2019) were developed for scoring, transformation and visualisation<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The MHQoL is a reliable and valid measure of mental health-related quality of life across countries. The MHQoL toolbox supports consistent, transparent implementation, facilitating use in research, clinical practice and economic evaluations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04907604\">NCT04907604<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-108598","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T14:25:28Z","timestamp":1778682328000},"page":"e108598","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cross-national validation of the MHQoL: psychometric evaluation and open-source tools for assessing mental health quality of life"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct04907604","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04907604","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3684-3584","authenticated-orcid":false,"given":"Stijn B","family":"Peeters","sequence":"first","affiliation":[{"name":"Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederick W","family":"Thielen","sequence":"additional","affiliation":[{"name":"Department of Health Technology Assessment, Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3447-5920","authenticated-orcid":false,"given":"Marleen","family":"De Mul","sequence":"additional","affiliation":[{"name":"Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9546-4905","authenticated-orcid":false,"given":"Marjo","family":"Sinokki","sequence":"additional","affiliation":[{"name":"L\u00e4nsirannikon Ty\u00f6terveys, Turku, Finland"},{"name":"Unit of Public Health, University of Turku, Turku, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatriz","family":"Olaya","sequence":"additional","affiliation":[{"name":"Universitat de Barcelona, Barcelona, Spain"},{"name":"CIBERSAM, Madrid, Spain"},{"name":"Autonomous University of Barcelona, Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6925-8956","authenticated-orcid":false,"given":"Christina Maria","family":"Van Der Feltz-Cornelis","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, York Biomedical Research Institute, University of York, Heslington, York, UK"},{"name":"Hull York Medical School, University of York, York, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leona","family":"Hakkaart-Van Roijen","sequence":"additional","affiliation":[{"name":"Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"2026051307252001000_16.5.e108598.1","unstructured":"Global health data exchange (GHDX). 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