Ananda Lakshmy K N, Shajahan M A
Dept. of Kriya Sareera, Govt. Ayurveda College, Pariyaram, Kannur, India.
Dept. of Dravyagunavijnanam Govt, Ayurveda College, Thiruvananthapuram, India.
J Ayurveda Integr Med. 2025 Aug 6;16(5):101175. doi: 10.1016/j.jaim.2025.101175.
As the bio-regulatory principles (Dosha) are the essential components of the body, the three attributes (Triguna)-Satva, Raja, and Tamas are the crucial components of the mind that determine an individual's mental status. Though Triguna-based psychological assessment tools are available, there are no standardized tools to evaluate mental health using this unique Ayurvedic approach.So this research was undertaken to create a simple, self-administering instrument for screening mental health based on Ayurvedic concept-Triguna.
To develop a simple, reliable, and valid self-administering instrument based on Triguna concept of Ayurvedic classics for screening mental health.
Standard steps to develop the instrument -Conceptualization, item generation, item selection, item wording, Translation-back translation, pre-test, pilot study, Test-retest were done before the final administration of the draft instrument. Reliability and validity testing were carried out. Reliability assessment included Test-retest and internal consistency. Face, content, construct, criterion and convergent validity were done as part of the validity assessment. Exploratory factor analysis using Principal Component Analysis with Varimax rotation was employed for construct validation and item reduction. A cross-sectional study employing a stratified, multi-stage cluster sampling technique was conducted among 400 participants aged 20-40 years, representing rural, urban and coastal areas of Thiruvananthapuram, Kerala, India. The criterion validity of the newly developed tool was assessed against the WHO Subjective Well-being Inventory(SUBI).The reference standard, evaluated for its diagnostic properties including sensitivity, specificity, predictive values, and likelihood ratios, was administered alongside the draft instrument. After appropriate analyses, a 38-item self-administering instrument was developed and named as Mental Health Assessment Scale with Triguna (MHAS-TG). Hypothesis validation and construct validity were assessed using diverse community samples, comprising 100 individuals from various geographical areas of Kannur District, 100 students from NIT Calicut (Kozhikode) and 50 ex-convicts from Kannur District.
The newly developed 38-item Mental Health self-Assessment Scale with Triguna (MHAS-TG) is presented as a discriminating tool that showed high Test-retest (Intra Class Correlation coefficient - 0.8) and Internal consistency reliability (Cronbach's alpha = 0.9). The tool had adequate face validity and content validity (Content validity index- 0.84). Construct validity by Exploratory factor analysis yielded 38 items of 9-factor solution with a cumulative variance of 58.06 %. The self-administering tool with a score range of 0-114 derived a cut-off score of 40 and 80 based on sensitivity and specificity. The scores below 40 were designated as poor mental health, 41-80 were assigned with moderate mental health, and score above 81 were designated with good mental health. Receiver operating characteristic curve analysis showed a Sensitivity of 75.36 % and a Specificity of 78.18. The average administration time of the tool was 10 min. Mental health screening of 400 individuals in Thiruvananthapuram district, Kerala, India yielded the following results: 28.25 % exhibited good mental health, 63.5 % had moderate mental health and 8.5 % had poor mental health. Re-validations at Kannur district showed 17 % with good mental health, 75 % with moderate mental health and 8 % with poor mental health. In Kozhikode, 16 % had good mental health, 74 % had moderate mental health and 10 % had poor mental health. In ex-convicts, 8 % had good mental health, 67 % had moderate mental health and 25 % had poor mental health. Independent t-test showed that there was a significant difference (p < 0.05) between the two score values. On analysis a weak positive correlation (p < 0.01) was seen between Satva and Rajo Guna scores, a strong negative correlation (p < 0.01) between Satva and Tamo Guna and a moderate positive correlation (p < 0.01) between Rajo and Tamo Guna.
MHAS-TG is a 38-item tool, valid and reliable self-administering instrument based on Triguna concept. The proposed tool with risk and protective factors affecting mental health is a quick and easy screening tool for assessing mental health.Administration of the tool to 400 participants in Thiruvananthapuram district revealed its ability to identify individuals with poor mental health. The results also showed a weak positive correlation between Satva-Rajo scores, a strong negative correlation between Satva-Tamo scores and a moderate positive correlation between Rajo-Tamo scores.
由于生物调节原则（Dosha）是身体的基本组成部分，三种属性（Triguna）——萨埵、罗阇和答摩是决定个体心理状态的关键心理组成部分。虽然有基于Triguna的心理评估工具，但尚无使用这种独特的阿育吠陀方法评估心理健康的标准化工具。因此，本研究旨在创建一种基于阿育吠陀概念——Triguna的简单、可自行填写的心理健康筛查工具。
基于阿育吠陀经典的Triguna概念，开发一种简单、可靠且有效的可自行填写的心理健康筛查工具。
在最终使用该工具草案之前，按照开发工具的标准步骤进行了概念化、项目生成、项目选择、项目措辞、回译、预测试、试点研究、重测。进行了信度和效度测试。信度评估包括重测和内部一致性。作为效度评估的一部分，进行了表面效度、内容效度、结构效度、效标效度和收敛效度评估。采用主成分分析和方差最大化旋转的探索性因素分析进行结构验证和项目精简。采用分层、多阶段整群抽样技术，对印度喀拉拉邦特里凡得琅农村、城市和沿海地区400名年龄在20 - 40岁的参与者进行了横断面研究。以世界卫生组织主观幸福感量表（SUBI）为对照，评估新开发工具的效标效度。将评估其诊断特性（包括敏感性、特异性、预测值和似然比）的参考标准与工具草案一起使用。经过适当分析，开发了一个38项的可自行填写工具，命名为基于Triguna的心理健康评估量表（MHAS - TG）。使用来自卡努尔区不同地理区域的100人、科泽科德国家理工学院的100名学生和卡努尔区的50名刑满释放人员等不同社区样本，评估假设验证和结构效度。
新开发的38项基于Triguna的心理健康自我评估量表（MHAS - TG）是一种具有鉴别力的工具，显示出高重测信度（组内相关系数 - 0.8）和内部一致性信度（克朗巴哈系数 = 0.9）。该工具具有足够的表面效度和内容效度（内容效度指数 - 0.84）。探索性因素分析的结构效度产生了一个9因素解的38个项目，累积方差为58.06%。该可自行填写工具的得分范围为0 - 114，根据敏感性和特异性得出的临界值为40和80。得分低于40被指定为心理健康差，41 - 80被指定为心理健康中等，得分高于81被指定为心理健康良好。受试者工作特征曲线分析显示敏感性为75.36%，特异性为78.18%。该工具的平均使用时间为10分钟。对印度喀拉拉邦特里凡得琅区400人的心理健康筛查结果如下：28.25%表现为心理健康良好，63.5%为心理健康中等，8.5%为心理健康差。在卡努尔区的重新验证显示，17%心理健康良好，75%心理健康中等，8%心理健康差。在科泽科德，16%心理健康良好，74%心理健康中等，10%心理健康差。在刑满释放人员中，8%心理健康良好，67%心理健康中等，25%心理健康差。独立t检验显示两个得分值之间存在显著差异（p < ）。分析发现萨埵和罗阇属性得分之间存在弱正相关（p < 0.01），萨埵和答摩属性之间存在强负相关（p < 0.01），罗阇和答摩属性之间存在中等正相关（p < 0.01）。
MHAS - TG是一个38项的工具，是基于Triguna概念的有效且可靠的可自行填写工具。该提议的工具包含影响心理健康的风险和保护因素，是一种用于评估心理健康的快速简便的筛查工具。对特里凡得琅区400名参与者使用该工具表明其能够识别心理健康差的个体。结果还显示萨埵 - 罗阇得分之间存在弱正相关，萨埵 - 答摩得分之间存在强负相关，罗阇 - 答摩得分之间存在中等正相关。
