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

¹ Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
² EMGO Institute, VU University Medical Center, Amsterdam, the Netherlands
³ Department of Pediatrics, VU University Medical Center, Amsterdam, the Netherlands
⁴ Institute of Clinical and Experimental Neurosciences, VU University Medical Center, Amsterdam, the Netherlands

Address correspondence and reprint requests to M. de Wit, MSc, Department of Medical Psychology, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands. E-mail: m.dewit{at}vumc.nl

OBJECTIVE—It is recommended that the psychological status of adolescents with diabetes be assessed periodically as part of ongoing care. The World Health Organization-Five Well-Being 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 = –0.67), with the mental health (r = 0.60) and self-esteem (r = 0.43) subscales of the CHQ-CF87, and with the DFCS (r = –0.34), confirming concurrent validity. ROC curve analysis confirmed the WHO-5 cutoff point of <50 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.

Abbreviations: CES-D, Center for Epidemiologic Studies Depression Scale • CFA, confirmatory factor analysis • CFI, comparative fit index • CHQ-CF87, Child Health Questionnaire-Child Form 87 items • DFCS, Diabetes Family Conflict Scale • RMSEA, root mean square error of approximation • ROC, receiver operating characteristic • WHO-5, World Health Organization-Five Well-Being Index

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				M. de Wit and F. J. Snoek Routine Psychological Screening in Youth With Type 1 Diabetes and Their Parents: a Notion Whose Time Has Come?: Response to Cameron et al. Diabetes Care, March 1, 2008; 31(3): e14 - e14. [Full Text] [PDF]