Validation of the WHO-5 Well-being Index (WHO-5) in Adolescents with Type 1 Diabetes

Abstract

OBJECTIVE It is recommended to assess the psychological status of adolescents with diabetes periodically as part of ongoing care. The WHO-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 (age 13-17) from 4 pediatric clinics completed the WHO-5, along with other psychological measures: Centre for Epidemiology Studies-Depression scale (CES-D), Diabetes Family Conflict Scale (DFCS), Mental health and Self-esteem subscales of the Child Health Questionnaire (CHQ-CF87). Confirmatory and Exploratory Factor Analyses (CFA/EFA) were conducted. Readability, homogeneity, item-total and inter-item correlations were determined. Concurrent validity was examined by calculating correlation coefficients between all measures. Sensitivity and specificity of the WHO-5 were tested against the CES-D using receiver operating characteristics (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), Mental Health (r = 0.60) and Self-esteem (r = 0.43) subscales of the CHQ, and with the DFCS (r = -0.34), confirming concurrent validity. ROC curve analysis confirmed the WHO-5 cut-off point of < 50 for identification of mild to severe depressive affect (sensitivity 89 %, 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.