Health Opinion Survey

MacMillan, A. 1957

Description of Measure
Purpose
To provide a self-report measure of neurotic or psychosomatic symptoms in the general
population.

Conceptual Organization
The Health Opinion Survey (HOS) is a measure of general mental health in response to
temporary stressors. The HOS was developed as a tool to identify individuals with psychological
disturbances in the general population (MacMillan, 1957).The instrument contains 20 items, each
describing a physical symptom (e.g., “Are you bothered by your heart beating hard?”).

Item Origin/Selection Process

In the creation of the HOS, MacMillan (1957) borrowed items from the Army’s
Neuropsychiatric Screening Adjunct developed by Star (1950). From a pool of 75 items,
MacMillan selected the 20 items that best discriminated healthy, well-adjusted men and women
from hospital neurotics (MacMillan, 1957).

Materials
See also MacMillan, 1957.

Time Required
Less than 5 minutes

Administration Method
Interviewer- or self-administered. If all the respondents are literate, the form may be self-
administered with appropriate changes in the instructions. If the inventory is interviewer-
administered, it is helpful for the interviewer to hold a card in front of the respondent listing the
response choices.
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Training
Minimal

Scoring
Score Types
Responses are coded 1 (hardly ever), 2 (sometimes), or 3 (often). A total score is derived
by summing responses to all items (item 16 is reverse-coded). The total score can range from 20
to 60. In the development of the instrument, the author used discriminant function analysis to
derive item weights designed to produce total scores that would maximally distinguish normal
respondents from those with neurotic symptoms (MacMillan, 1957).

Score Interpretation
Higher scores indicate more psychosomatic symptoms. Some studies have used a cut-off
point of 32 to define individuals outside the normal range (Murphy, 1990).

Norms and/or Comparative Data

MacMillan (1957) administered the instrument to a community-based sample of White
adults (n=559) and to a sample of adults diagnosed with neuroses (n=78). He found that 92% of
the neurotic sample, and 25% of the community-based sample score, scored within the "neurotic
symptoms" range of the scoring scale

Psychometric Support
Reliability
The test-retest correlation coefficient (after 10 months) reported in a large study of adults
was .72 (Tousignant, Denis, & Lachapelle, 1974). The same study also found high internal
consistency among the 20 items (.85). Mexican Americans, particularly those with poor spoken
English skills, had higher scores compared to other ethnic groups (Vega, Kolody, & Warheit,
1985; Vega, Warheit, & Palacio, 1985).

Validity

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 Psychiatric patients manifest very high scores on the HOS. However, the validity of the
HOS as a tool to assess overall psychological functioning is questionable primarily due to the
instrument’s inability to distinguish between mental and physical illness (Butler & Jones, 1979;
Tousignant, Denis, & Lachapelle, 1974).

LONGSCAN Use
LONGSCAN administered a version of the form with the original 20 items reordered
and with slight modifications in the wording of items.

Data Points
Pre-Age 4: NW & MW sites
Age 4: All sites

Mnemonic and Version

HOSA

Respondent
Primary maternal caregiver

Rationale
This instrument provides a measure of caregiver's psychological disturbance to
supplement the CES-D.

Results
Descriptive Statistics and Reliability
Table 1 provides the HOS mean scores, standard deviations, and Cronbach’s alpha
coefficients by race and study site based on responses from primary maternal caregivers at the
Age 4 interview. Mean scores on the HOS are quite similar for the White, Black, and Hispanic
racial groups. Total scores also vary little across study sites, with the NW site having a higher
than average mean score, and the SW site having a lower than average mean total score.
Caregiver respondents at the SW sites were more likely to be foster parents, and thus were less

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likely to have symptoms of psychological disturbances than caregivers in other samples. Internal
consistency, measured by Cronbach’s alpha, was acceptable overall as well as by study site and
race.

Table 1 about here

Validity
To assess the content validity of the HOS, a Pearson correlation coefficient was
computed between symptom scores on the HOS (at Age 4) and depression scores on the CES-D.
A correlation coefficient of .66 (n=1127, p < 0.0001) was found, indicating that maternal
caregivers who reported more psychosomatic symptoms tended to report more depressive
symptoms. Primary caregivers who reported use of health or mental health services on the Adult
Mental Health Service Utilization questionnaire also reported a significantly higher (t(-9.3), df =
(277,858), p < 0.001) number of psychosomatic symptoms (M = 30.7, SD = 6.85) on the HOS
than those who reported no service use (M = 26.5, SD = 5.36).

References and Bibliography

Butler, M. C., & Jones, A. P. (1979). The Health Opinion Survey reconsidered:
Dimensionality, reliability, and validity. Journal of Clinical Psychology, 35(3), 554-559.
MacMillan, A. M. (1957). The Health Opinion Survey: Technique for estimating the
prevalence of psychoneurotic and related types of disorder in communities. Psychological
Reports, 3, 325-339.
Murphy, J. M (1990). Depression screening instruments: History and issues. In C. C.
Attkisson, & J. M. Zich (Eds.), Depression in primary care: Screening and detection (pp. 65-83).
New York, NY: Routledge.
Star, S. A. (1950). "The screening of psychoneurotics in the army: Technical
development of tests." In S. A. Stouffer, L. Guttman, E. A. Suchman, P. F. Lazarfield, S. A. Star
and J. A. Clausen (Eds.) Measurement and Prediction (pp. 486-547). Princeton, NJ.: Princeton
University Press.
Tousignant, M. & Denis, G. (1975). Psychiatric patients and the "untreated" cases of
epidemiological surveys: A comparative analysis of the self-concept. Social Science &

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Medicine, 9(1) 39-42.
Tousignant, M., Denis, G., & Lachapelle, R. (1974). Some considerations concerning the
validity and use of the Health Opinion Survey. Journal of Health and Social Behavior,15(3), 241-
252.
Vega, A.W., Kolody, B., & Warheit, G. (1985). Psychoneuroses among Mexican
Americans and other whites: Prevalence and caseness. American Journal of Public Health, 75(5),
323-527.
Vega, W.A., Warheit, G., & Palacio, R. (1985). Psychiatric symptomatology among
Mexican American farmworkers. Social Science and Medicine, 20(1), 39-45.

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Table 1. Mean Scores and Cronbach’s Alpha Coefficients by Race and Study Site
Age 4 Interview

N M (SD) α
Total 1140 27.55 (6.03) .84
Race
White 395 27.79 (6.17) .84
Black 580 27.34 (5.83) .84
Hispanic 81 27.69 (6.72) .87
Multiracial 37 29.05 (5.32) .77
Other 44 26.73 (6.60) .88
Study Site
EA 237 27.31 (5.99) .85
MW 122 27.78 (6.31) .86
SO 218 28.28 (6.19) .84
SW 313 26.05 (5.60) .84
NW 250 28.91 (5.90) .81
Source. Based on data received at the LONGSCAN Coordinating Center by 7/8/97.

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