Validation of the WHO-5 as a first-step screening instrument for depression in adults with diabetes: Results from Diabetes MILES - Australia

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 (

Results: 

For the whole sample, the WHO-5 demonstrated satisfactory internal consistency reliability (a = 0.90) and convergent validity with the PHQ-9 (r = -0.73, p <0.001). Confirmatory factor analysis partially supported factorial validity:.2(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

Conclusions: 

These findings support use of a WHO-5 cut-point of