OBJECTIVES: The ENSEMBLE MDS is a battery of phenotypic patient-reported instruments administered at baseline in clinical studies.  The component measures assess potential predictors (Self-Reported Health Status (SRH), Total Illness Burden Index (TIBI), Patient Health Questionnaire-4, Depression Diagnosis, Perceived Stress Scale) or effect modifying factors of clinical outcomes and/or treatment response (MacArthur Perceived Status Ladder, MacArthur Income, Barratt Simplified Measure of Social Status, Perceived Social Support Scale (SS-5).  This report furthers the initial validation conducted in the United States by evaluating the reproducibility and construct validity outside the United States. METHODS: The ENSEMBLE MDS and other assessments (MOS SF-36, EQ-5D, Life Orientation Test-Revised (LOT-R), items on illness/bed days and doctor visits) were administered to a sample of adults with depression, type 2 diabetes, or rheumatoid arthritis in Germany (n=61), Spain (n=61) and Singapore (n=56, Simplified Chinese). Participants completed the battery on paper and returned one-week later to complete a retest. Test-retest reproducibility was assessed using the intraclass correlation coefficient (ICC); convergent validity by Pearson correlations between MDS instruments and components of the SF-36 and EQ-5D, with hypothesized relationships significant at r>0.30; and known-groups tested using tertiles of the LOT-R, doctor visits and illness days. RESULTS: The mean age of the participants was 55±13 years, 63% were female, 66% were married/living with partner.  Between 85% and 100% completed MDS instruments at the retest (mean 6.7±0.6 days).  The ICCs for the retest of different components ranged from 0.81 to 0.99.  All hypothesized correlations with convergent measures were significant (r>0.40; p<0.01), and the MDS SS-5 discriminated between LOT-R tertiles (F=24.6, p<0.001), SRH between doctor visits (F=8.0 p<0.01) and TIBI between illness days (F=14.9, p<0.001). CONCLUSIONS: Consistent with the results found in the United States, the ENSEMBLE MDS was observed to have adequate reproducibility, appropriate convergent validity and to significantly discriminate between known groups outside the United States.