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

  1. Maartie de Wit, MSC12,
  2. Frans Pouwer, PHD12,
  3. Reinoud J.B.J. Gemke, MD, PHD3,
  4. Henriette A. Delemarre-van de Waal, MD, PHD34 and
  5. Frank J. Snoek, PHD12
  1. 1Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
  2. 2EMGO Institute, VU University Medical Center, Amsterdam, the Netherlands
  3. 3Department of Pediatrics, VU University Medical Center, Amsterdam, the Netherlands
  4. 4Institute of Clinical and Experimental Neurosciences, VU University Medical Center, Amsterdam, the Netherlands
  1. 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

Abstract

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 α 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.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 2 May 2007. DOI: 10.2337/dc07-0447.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted April 25, 2007.
    • Received March 6, 2007.
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  1. Published online before print May 2, 2007, doi: 10.2337/dc07-0447 Diabetes Care August 2007 vol. 30 no. 8 2003-2006
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