TY - JOUR
T1 - Validation of the WHO-5 as a first-step screening instrument for depression in adults with diabetes
T2 - Results from Diabetes MILES – Australia
AU - Halliday, Jennifer A.
AU - Hendrieckx, Christel
AU - Busija, Lucy
AU - Browne, Jessica L.
AU - Nefs, Giesje
AU - Pouwer, François
AU - Speight, Jane
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Aims Screening for depression is recommended internationally. The World Health Organization's 5-item Well-being Index (WHO-5) is used clinically to screen for depression but its empirical suitability for this purpose is not well documented. We investigated the psychometric properties of the WHO-5 and its suitability for identifying likely depression in Australian adults with diabetes. Methods The Diabetes MILES – Australia study dataset provided a sample of N = 3249 who completed the WHO-5 (positively-worded 5-item measure of emotional well-being) and the PHQ-9 (9-item measure of depressive symptoms). Analyses were conducted for the full sample, and separately by diabetes type and treatment (type 1, non-insulin-treated type 2, and insulin-treated type 2 diabetes). Construct (convergent and factorial) validity and reliability of the WHO-5 were examined. ROC analyses were used to examine the sensitivity and specificity of the WHO-5 as a depression screening instrument, comparing two commonly used WHO-5 cut-off values (≤7 and <13) with the PHQ-9. Results For the whole sample, the WHO-5 demonstrated satisfactory internal consistency reliability (α = 0.90) and convergent validity with the PHQ-9 (r = −0.73, p < 0.001). Confirmatory factor analysis partially supported factorial validity: Χ2(5) = 834.94, p < 0.001; RMSEA = 0.23, 90% CI 0.21–0.24; CFI = 0.98, TLI = 0.96; factor loadings = 0.78–0.92. The AUC was 0.87 (95% CI: 0.86–0.89, p < 0.001). The sensitivity/specificity of the WHO-5 for detecting likely depression was 0.44/0.96 for the ≤7 cut-off, and 0.79/0.79 for the <13 cut-off, with similar findings by diabetes type and treatment. Conclusions These findings support use of a WHO-5 cut-point of <13 to identify likely depression in Australian adults with diabetes, regardless of type/treatment.
AB - Aims Screening for depression is recommended internationally. The World Health Organization's 5-item Well-being Index (WHO-5) is used clinically to screen for depression but its empirical suitability for this purpose is not well documented. We investigated the psychometric properties of the WHO-5 and its suitability for identifying likely depression in Australian adults with diabetes. Methods The Diabetes MILES – Australia study dataset provided a sample of N = 3249 who completed the WHO-5 (positively-worded 5-item measure of emotional well-being) and the PHQ-9 (9-item measure of depressive symptoms). Analyses were conducted for the full sample, and separately by diabetes type and treatment (type 1, non-insulin-treated type 2, and insulin-treated type 2 diabetes). Construct (convergent and factorial) validity and reliability of the WHO-5 were examined. ROC analyses were used to examine the sensitivity and specificity of the WHO-5 as a depression screening instrument, comparing two commonly used WHO-5 cut-off values (≤7 and <13) with the PHQ-9. Results For the whole sample, the WHO-5 demonstrated satisfactory internal consistency reliability (α = 0.90) and convergent validity with the PHQ-9 (r = −0.73, p < 0.001). Confirmatory factor analysis partially supported factorial validity: Χ2(5) = 834.94, p < 0.001; RMSEA = 0.23, 90% CI 0.21–0.24; CFI = 0.98, TLI = 0.96; factor loadings = 0.78–0.92. The AUC was 0.87 (95% CI: 0.86–0.89, p < 0.001). The sensitivity/specificity of the WHO-5 for detecting likely depression was 0.44/0.96 for the ≤7 cut-off, and 0.79/0.79 for the <13 cut-off, with similar findings by diabetes type and treatment. Conclusions These findings support use of a WHO-5 cut-point of <13 to identify likely depression in Australian adults with diabetes, regardless of type/treatment.
KW - Depression
KW - Diabetes mellitus
KW - Factor analysis, statistical
KW - Psychometrics
KW - ROC curve
KW - Surveys and questionnaires
UR - http://www.scopus.com/inward/record.url?scp=85026744096&partnerID=8YFLogxK
U2 - 10.1016/j.diabres.2017.07.005
DO - 10.1016/j.diabres.2017.07.005
M3 - Article
C2 - 28783530
SN - 0168-8227
VL - 132
SP - 27
EP - 35
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
ER -