Validity of the five-item WHO Well-Being Index (WHO-5) in an elderly population

Background Depression has a high prevalence in the elderly population; however it often remains undetected. The WHO 5-item Well-Being Index (WHO-5) is a short screening instrument for the detection of depression in the general population, which has not yet been evaluated. The goals of the present study were: 1) to assess the internal and external validity of WHO-5 and 2) to compare the two recent versions of WHO-5.Study population and methods 367 subjects above 50 years of age were examined with the WHO-5. ICD-10 diagnoses were made using a structured interview (CIDI). The internal validity of the well-being index was evaluated by calculating Loevinger’s and Mokken’s homogeneity coefficients. External validity for detection of depression was evaluated by ROC analysis.Results The scale was sufficiently homogeneous (Loevinger’s coefficient: version 1=0.38, version 2=0.47; Mokken coefficient τ; 0.3 in nearly all items). ROC analysis showed that both versions adequately detected depression. Version 1 additionally detected anxiety disorders, version 2 being more specific for detection of depression.Conclusion The WHO-5 showed a good internal and external validity. The second version is a stronger scale and was more specific for the detection of depression. The WHO-5 is an useful instrument for identifying elderly subjects with depression.

     

Validity and utility of the Japanese version of the WHO-Five Well-Being Index in the context of detecting suicidal ideation in elderly community residents

OBJECTIVE: The aim of this study is to evaluate the validity and the utility of the Japanese version of the WHO-Five Well-Being Index (WHO-5-J) in the context of detecting suicidal ideation in elderly community residents. METHODS: A sample of 696 subjects aged 70 years or over who completed a set of questionnaires was examined. RESULTS: Cronbach's alpha was 0.87 and Loevinger's coefficient was 0.64. The total score was significantly correlated with the number of cohabitants, the number of physical illnesses, physical functioning, instrumental activities of daily living, and depressive symptoms. Subjects with suicidal ideation had significantly lower scores on the WHO-5-J. The receiver-operating characteristic curve analysis indicated that the scale significantly discriminated the subjects with suicidal ideation. When combined with the assessment of a lack of perceived social support (PSS), a standard cut-off criterion of "a total score < or = 12 or answering 0 or 1 to any of the five items" more appropriately identified elderly subjects with suicidal ideation: sensitivity = 87%, specificity = 75%, negative predictive value = 99%, and positive predictive value = 10%. CONCLUSIONS: In combination with PSS, the scale has predictive utility to detect suicidal ideation in elderly community residents.     

Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition

Recent studies emphasize the negative impact of comorbidity on the course of depression. If undiagnosed, depression and comorbidity contribute to high medical utilization. We aimed to assess (1) prevalences of depression alone and with comorbidity (anxiety/somatoform disorders) in primary care, (2) coexistence of anxiety/somatoform disorders in depressive patients, and (3) diagnostic validity of two screeners regarding depression with versus without comorbidity. We examined 394 primary care outpatients using the Composite International Diagnostic Interview (CIDI), the General Health Questionnaire (GHQ-12), and the Well-Being Index (WHO-5). We conducted configurational frequency analyses to identify nonrandom configurations of the disorders and receiver operating characteristic (ROC)-analyses to assess diagnostic validity of the screeners. Point prevalence of any depressive disorder was 22.8%; with at least one comorbid disorder, 15%; and with two comorbid conditions, 6.1%, which significantly exceeded expected percentage (0.9%, P< or =.0001). Depression without comorbidity occurred significantly less often than expected by chance (P< or =.0007). Comorbidity of depressive and anxiety or somatoform disorders was associated with a high odds ratio (6.25). The screeners were comparable regarding their diagnostic validity for depression with [GHQ-12: area under the curve (AUC)=0.86; WHO-5: AUC=0.88] and without comorbidity (GHQ-12: AUC=0.84; WHO-5: AUC=0.86). It can be concluded that comorbidity between depression and anxiety/somatoform disorders in primary care may occur much more frequently than expected. These results confirm assumptions that the current division between depression and anxiety might be debatable. Validity of screeners tested in our study was not affected by comorbid conditions (e.g., anxiety or somatoform disorders).     

Assessing perceived change in the well-being of family caregivers: psychometric properties of the Perceived Change Index and response patterns

The purpose of this study was to evaluate the psychometric properties of the Perceived Change Index (PCI), a 13-item scale that measures caregiver appraisals of self-improvement or decline in distinct areas of well-being, and to examine demographic differences in responses. The scale was administered to 255 care-givers participating at the Philadelphia site of the National Institute of Aging-funded Resources for Enhancing Alzheimer's Caregiver Health initiative. Principal axis analysis with one half of the sample was used to evaluate factor structure. Evidence of convergent and divergent validity was examined using the second half of the sample. Differential response patterns by caregiver characteristics were also examined using regression analysis. Using one half of the sample, 3 underlying factors were found (affect, alpha = .85; somatic, alpha = .80; management, alpha = .76), accounting for 63% of the variance. The overall index was internally consistent (Cronbach's alpha = .90). Using the second half of the sample, Pearson correlational analyses of the overall index and its subscales revealed that perceived improvement was significantly associated with fewer depressive symptoms, higher scores on perceived positive aspects of caregiving, and more participation in social activities. As expected, it was not associated with the care recipient's Mini-Mental Status Examination scores or functional status. Perceived improvement scores for specific areas of well-being were associated with being African American, male, and a spouse. The PCI is a brief, easily administered, and valid self-report measure that can serve as an indicator of caregiver appraisal of well-being in research and clinical practice.     

World Health Organization 5-item well-being index: validation of the Brazilian Portuguese version

The psychological well-being dimension and depressive symptoms are both important variables in an individual’s health. In this study, we evaluated the World Health Organization 5-item well-being index (WHO-Five) internal and external validities, and accuracy in detecting depression. A total of 1,128 individuals between 18 and 65 years old from a rural Brazilian population were included. Cronbach’s alpha and factor analysis were performed for internal validation. Demographic variables means were compared, receiver operating characteristic (ROC) curve was constructed, and sensitivity, specificity and positive and negative predictive values for different cutoff points were calculated for external validation and accuracy in detecting depression. Cronbach’s alpha was 0.83, and only one factor was responsible for 59% of common variances, with an eigenvalue of 2.96. Higher WHO-Five scores were associated with being man, from oldest age category and retired. It was also related to better general health self-perception and negative screening in the Beck Depression Inventory (BDI). Based on BDI, the area under the curve was 67.37. A sensitivity of 66/75% and a negative predictive value of 91/92% for cutoffs <19/20 were detected. WHO-Five showed internal and external validities when used to measure the well-being dimension and to be a useful tool for depression screening.     

Reliability, validity and factor structure of the GHQ-28 used among elderly Iranians

BACKGROUND: The object of this study was to develop an Iranian version of the General Health Questionnaire-28 (GHQ-28) for use with elderly subjects. METHODS: The GHQ-28 Farsi version was evaluated for face validity among 204 elderly subjects aged 59 years or older, chosen randomly from residents of Tehran. The Composite International Diagnostic Interview (CIDI) was used to establish a gold standard diagnosis of mental disorders. RESULTS: The GHQ-28 was an internally consistent measure. Cronbach's alpha, split-half coefficients and test-retest reliability were 0.9, 0.89 and 0.58 respectively. Four factors were extracted using factor analysis: "depression," "psychosocial activity," "anxiety," and "somatic." Using receiver operating curve (ROC) analysis, the optimum cutoff score for the GHQ-28 in this group was 19/20 (sensitivity 0.83, specificity 0.76). Using a loading of 0.6 or greater, a short form of the instrument (GHQ-15) (alpha=0.9) was derived and correlated well with the longer form of the scale (r=0.97). Using ROC analysis, the optimum cutoff score was 10/11 (sensitivity 0.83, specificity 0.69). CONCLUSIONS: The short and long forms of the GHQ-28 are suitable screening instruments for elderly Iranian residents, particularly those living in urban areas.     

Validation of the Quality of Life Inventory for patients with anxiety and depression

BACKGROUND: In 1992, Frisch et al (Psychol Assess. 1992;4:92-101) developed the Quality of Life Inventory (QOLI) to measure the concept of quality of life (QOL) because it has long been thought to be related to both physical and emotional well-being. However, the psychometric properties of the QOLI in clinical populations are still in debate. The present study examined the factor structure of QOLI and reported its validity and reliability in a clinical sample. METHOD: Two hundred seventeen patients with anxiety and depressive disorders completed the QOLI, and additional questionnaires measuring symptoms (Zung Self-rating Depression Scale, Beck Anxiety Inventory, Fear Questionnaire, Depression Anxiety Stress Scale-Stress) and subjective well-being (Satisfaction With Life Scale) were also used. RESULTS: Exploratory factor analysis via the principal components method, with oblique rotation, revealed a 2-factor structure that accounted for 42.73% of the total variance, and a subsequent confirmatory factor analysis suggested a moderate fit of the data to this model. The 2 factors appeared to describe self-oriented QOL and externally oriented QOL. The Cronbach alpha coefficients were 0.85 for the overall QOLI score, 0.81 for the first factor, and 0.75 for the second factor. CONCLUSION: Consistent evidence was also found to support the concurrent, discriminant, predictive, and criterion-related validity of the QOLI.     

Reliability and validity of the Thai version of the WHO-Five Well-Being Index in primary care patients

Aims:  Because of the high patient load in Thailand, we need a practical measurement to help primary physicians detect depression. This study aimed to examine the reliability and validity of the Thai version of the World Health Organization-Five Well-Being Index (WHO-5-T), which is short and easy to use as a screening tool for major depression in primary care patients.
Methods:  The English version of the WHO-Five Well-Being Index was translated into Thai. Back-translations, cross-cultural adaptation and field testing of the pre-final version with final adjustments were performed accordingly. The WHO-5-T was administered randomly to 300 patients in our primary care clinic. Then the patients were further assessed using the Mini International Neuropsychiatric Interview and the Hamilton Rating Scale for Depression as the gold standard of diagnosis and symptom severity, respectively.
Results:  Completed data were obtained from 274 respondents. Their mean age was 44.6 years [standard deviation (SD) = 14.7] and 73.7% of them were female. The mean WHO-5-T score was 14.32 (SD = 5.26). The WHO-5-T had a satisfactory internal consistency (Cronbach's alpha = 0.87) and showed moderate convergent validity with the Hamilton Rating Scale for Depression (r = −0.54; P  < 0.001). The optimal cut-off score of the WHO-5-T <12 revealed a sensitivity of 0.89 and a specificity of 0.71 in detecting depression. The area under the curve in this study was 0.86 (SD = 0.03, 95% confidence interval 0.81 to 0.89).
Conclusions:  The Thai version of the WHO-Five Well-Being Index was found to be a reliable and valid self-assessment to screen for major depression in primary care setting at a cut-off point of <12.     

Psychometric evaluation of a measure of Beck's negative cognitive triad for youth: applications for African-American and Caucasian adolescents

A measure of Beck's negative cognitive triad, the Cognitive Triad for Children (CTI-C), was evaluated for its psychometric properties and utility with a community sample of 880 African-American and Caucasian adolescents. High-school students ranging from 14 to 17 years of age completed the CTI-C, the Children's Depression Inventory (CDI) and the Children's Attributional Style Questionnaire-Revised (CASQ-R) on two occasions 4 months apart. The CTI-C was found to be internally consistent, Cronbach's alpha=.90, to have acceptable test-retest reliability, r=.70, and concurrent validity as demonstrated by a significant correlation with the CASQ-R, r=.53. A principal factor analysis with promax rotation did not yield support for Beck's tripartite model of negative cognitions about the self, world, and future but rather yielded three factors with a combination of cognitions from all three domains. African American adolescents who reported more maladaptive cognitions on the CTI-C reported fewer depressive symptoms on the CDI 4 months later compared to their Caucasian counterparts, suggesting some limitation to using the CTI-C to predict depressive symptoms in African-American youth; however, Factor 1 derived from a factor analysis with the sample was more consistent in predicting future symptoms among both African-American and Caucasian adolescents. This factor consisted largely of positively worded items, offering some support for low positive affect as a predictor of depressive symptoms in adolescents.     

Migraine in women. Epidemiological,clinical, genetic,and experimental aspects

Objective: To estimate the validity of the Hamilton Depression Scale (HDS) in a population of patients with chronic obstructive pulmonary disease (COPD). Methods: Forty-nine patients with moderate to severe COPD were examined using the ICD-10 criteria for depression. The mean age of the patients was 71 years and 33 (64%) were women. Forty-six (94%) of the patients were also evaluated using the 17-item HDS including the six-item Hamilton Depression subscale (HDSS). Internal and external validity were measured using factor analysis, Cronbach Coefficient alpha, Loevinger coefficient of homogeneity, correlation analysis and ROC-curves. Results: Twenty-three (47%) of the patients were depressed according to the ICD-10 criteria for depression. The HDSS but not the HDS showed a good internal validity. An acceptable external validity was furthermore shown for the HDSS. Conclusion: The HDSS can be recommended as a suitable depression rating scale for COPD patients.