The 12-item Chinese Health Questionnaire (CHQ-12) has been widely used for screening mental disorders. This study aims to examine the internal consistency and factor structure of CHQ-12 and its suitability for use in the elderly Chinese population. This is a cross-sectional study. A total of 8526 elderly people aged ≥60 years from 11 cities in Shanxi Province were selected for participation in this study by stratified random cluster sampling. Cronbach's alpha was employed to assess internal consistency. An exploratory factor analysis (EFA) was performed to explore the underlying factor structure of the CHQ-12 in the elderly. A confirmatory factor analysis (CFA) was then conducted to test and compare the goodness-of-fit between possible factor structure obtained from the EFA and the unidimensional structure, which was originally recommended. The Cronbach's alpha for CHQ-12 was 0.838. The EFA extracted three factors, which explained 55.985% of the total variance of the data. The CFA of the three-factor model resulted in an acceptable model fit (Comparative Fit Index = 0.98, Tucker-Lewis Index = 0.97, Normed Fit Index = 0.98, Expected Cross-Validation Index = 0.28, Root-Mean-Square Error of Approximation = 0.071). The item loadings ranged from 0.58 to 0.82. Correlation coefficients among the three factors ranged from 0.40 to 0.75. The CHQ-12 presented satisfactory internal consistency and structural validity in the Chinese elderly population. The CFA of the three-factor structure expressed a preferred model fit in comparison to the unidimensional model. The three-factor structure of the CHQ-12 interpreted three different aspects of mental health: somatic symptoms, anxiety and worry, and depression/poor family relationship. Copyright © 2020 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.