Validation of the WHO-5 Well-Being Index in Adolescents With Type 1 Diabetes

Abstract

Index (WHO-5) is a short self-report instrument that appears suitable for this purpose. This study is the first to assess the reliability and validity of the WHO-5 in adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODS -Ninety-one adolescents with type 1 diabetes (aged 13-17 years) from four pediatric clinics completed the WHO-5, along with other psychological measures: the Center for Epidemiologic Studies Depression Scale (CES-D), the Diabetes Family Conflict Scale (DFCS), and the mental health and self-esteem subscales of the Child Health Questionnaire (CHQ-CF87). Confirmatory factor analysis (CFA) and exploratory factor analysis were conducted. Readability, homogeneity, and item-total and inter-item correlations were determined. Concurrent validity was examined by calculating correlation coefficients among all measures. Sensitivity and specificity of the WHO-5 were tested against those for the CES-D using receiver operating characteristic (ROC) curves.RESULTS -CFA confirmed the one-factor structure; Cronbach's ␣ of this 5-item scale was 0.82. The WHO-5 showed a moderate to strong correlation with the CES-D (r ϭ Ϫ0.67), with the mental health (r ϭ 0.60) and self-esteem (r ϭ 0.43) subscales of the CHQ-CF87, and with the DFCS (r ϭ Ϫ0.34), confirming concurrent validity. ROC curve analysis confirmed the WHO-5 cutoff point of Ͻ50 for identification of mild to severe depressive affect (sensitivity 89% and specificity 86%).CONCLUSIONS -The WHO-5 is a brief, patient-friendly measure of positive well-being with good psychometric properties that appears suitable for routine use in adolescents with type 1 diabetes. Diabetes Care 30:2003-2006, 2007D epression appears to be two to three times more prevalent in adolescents with diabetes compared with adolescents in the general population and adversely affects quality of life and diabetes outcomes (1-4). It is therefore recommended that screening for depression be performed routinely in this age-group, but there is no consensus on which measure to use for this purpose (1-3,5). The World Health Organization-Five WellBeing Index (WHO-5) is a short, positively worded instrument designed to assess the level of emotional well-being over a 14-day period. The screening properties of the WHO-5 have been studied in adults with and without diabetes against the Structured Clinical Interview for the Diagnostic and Statistical Manual (DSM)-IV, showing excellent sensitivity (94 -100%) and specificity (78%) (6,7). Given its brevity and focus on positive affect, the WHO-5 may be a suitable instrument to screen for low emotional well-being and depressive affect in adolescents with diabetes. Moreover, as the WHO-5 is a generic measure, it allows for comparison with healthy peers and is available in a multitude of languages. However, only one study so far used the WHO-5 in young men, but no validation data were reported (8). We therefore set out this study to investigate the reliability and validity of the WHO-5 in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS-Partici...

World Health Organization 5-item well-being index: validation of the Brazilian Portuguese version

“…This result was corroborated by the factor analysis, which, as in Dutch [12] and Thai [13] studies, suggested a unidimensional structure of the construct. All of the questions showed high factor loads ([0.6), with the two questions related to ''energy'' presenting the highest factor loads, followed by those related to ''depression'', ''anxiety'' and ''positive well-being''.…”

“…A Cronbach's alpha value of 0.83 for both general and depressed samples means that all of the five questions are related to each other, yet they are not identical, and thus, none of them can be dismissed. Similar internal consistency, ranging from 0.82 to 0.89, was found in previous studies with different populations [11][12][13][14][15].…”

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“…Positive correlations between QoL and the self-esteem of young people with T1DM indicate that these concepts are related (42)(43) . The Brazilian study confirmed this finding through the application of the Quality of Life Instrument for Young People with Diabetes and the Rosenberg Self-Esteem Scale to 124 adolescents (r=0.42 to 0.59; p<0.001) (42) .…”

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“…The score is multiplied by 4 and presented as a total percentage from 0 to 100. A well-being score below 50% indicates depressive affection (sensitivity 89% and specificity 86%), and a score below 28% suggests depression (23).…”