A psychometric evaluation of the Icelandic version of the WHO-5

Dynamic greenspace exposure, individual mental health status and momentary stress level: A study using multiple greenspace measurements

Previous research on the relationship between greenspace exposure and mental health has largely taken a residence-based approach to exposure assessment, ignoring the dynamic nature of people's daily movements. Moreover, most studies evaluated greenspace from an overhead perspective, whereas an eye-level perspective could potentially offer a more comprehensive understanding of individuals' encounters with greenspaces. Based on our survey in two communities in Hong Kong (Sham Shui Po and Tin Shui Wai), we captured people's eye-level greenspace exposure based on their travel routes and visited places using GPS trajectories, streetscape images, and deep learning methods. We then compared the results with those obtained with an overhead greenness exposure measure (the normalized difference vegetation index [NDVI]). The results indicate that these two greenspace measurements are not associated with each other, implying that they encompass distinct facets of greenspace, which may have different effects on mental health. Further, we examined the associations between various greenspace exposure measures and mental health using GPS trajectories and ecological momentary assessment data. The results reveal a negative association between eye-level greenspace exposure and momentary stress, while no similar association was observed when using the top-down NDVI as an indicator of greenspace exposure. Moreover, compared to the total volume of greenspace exposure, the distance-weighted average of greenspace exposure based on dynamic mobility contexts has a stronger association with individual overall mental health. Lastly, the relationship between greenspace exposure and mental health varies between the two communities with different socio-economic attributes. The study indicates that policymakers should focus not only on residential neighborhoods and overhead greenspace but also consider the dynamic environments and socio-economic contexts that people are embedded in.

Utilization and engagement with an employer-provided digital mental health platform: An international perspective

Objective

This retrospective study (2020-2022) compared the usage patterns across international regions of an employer-provided digital mental health platform, which is available in native languages and offers both self-guided digital activities and one-on-one sessions.

Methods

Routine data from the platform were analyzed by describing the demographic profile of 178,119 users from different geographical regions, their baseline mental health status and burnout levels, as well as patterns of engagement. Statistical analyses were conducted using logistic and ordered logit models to examine the association between cumulative engagement with the platform over time and baseline characteristics.

Results

The platform had high engagement and satisfaction levels across regions and age groups. Female users were more engaged than males in both self-guided digital activities and one-on-one sessions. Older users and those from non-US regions were more engaged in self-guided digital activities, while younger users and those from the US were more engaged in one-on-one sessions. Symptoms of anxiety were also associated with engagement with one-on-one sessions.

Conclusions

The study's findings provide valuable insights into the benefits of digital platforms in addressing mental health needs of employers from different regions. Future research should focus on exploring the specific factors that influence engagement with digital mental health platforms and how these platforms can be optimized and tailored to better serve diverse populations.

Measurement Properties and Optimal Cutoff Point of the WHO-5 Among Chinese Healthcare Students

Purpose

The World Health Organization-Five Well-Being Index (WHO-5) is widely used to assess subjective well-being. Nevertheless, measurement invariance and optimal cutoff point of the WHO-5 have not been examined in Chinese samples. We aimed to assess measurement properties of the Chinese version of the WHO-5 (WHO-5-C) among healthcare students.

Patients and Methods

A two-wave longitudinal assessment was conducted among 343 Chinese healthcare students from September to November 2022. Measurement properties of the WHO-5-C were assessed through structural validity using confirmatory factor analysis (CFA), measurement invariance using multigroup CFA (MGCFA) and longitudinal CFA (LCFA), convergent validity using correlation analysis with the Self-Rated Health Questionnaire (SRHQ) and Patient Health Questionnaire-4 (PHQ-4), reliability using internal consistency and test-retest reliability, and optimal cutoff point using receiver operating characteristic (ROC) analysis.

Results

The WHO-5-C demonstrated satisfactory structural validity with comparative fit index (CFI) of 0.968 at baseline and 0.980 at follow-up, and adequate measurement invariance in different sociodemographic variables at baseline (gender, age, major, home location, being only child, monthly household income, part-time job, physical exercise, hobby, frequency of visiting home, and stress coping strategy) (CFI changes [ΔCFI] = -0.009-0.003) and over a week (ΔCFI = -0.006-0.000). The WHO-5-C also had good internal consistency (Cronbach's α = 0.907-0.934; McDonald's ω = 0.908-0.935) and test-retest reliability (intraclass correlation coefficient [ICC] = 0.803). Convergent validity was supported by moderate correlations of the WHO-5-C with the SRHQ and PHQ-4. The optimal cutoff point of the WHO-5-C was found to be 50, with an area under the ROC curve of 0.882 at baseline data, with sensitivity of 0.803 and specificity of 0.762 at follow-up.

Conclusion

The WHO-5-C demonstrated adequate measurement properties, especially concerning cross-sectional and longitudinal measurement invariance, with a recommended optimal cutoff point of ≥ 50 for assessing adequate level of psychological well-being in healthcare students.

Can Waist-to-Height Ratio and Health Literacy Be Used in Primary Care for Prioritizing Further Assessment of People at T2DM Risk?

BACKGROUND

To identify people at risk of type 2 diabetes. Primary health care needs efficient and noninvasive screening tools to detect individuals in need of follow-up to promote health and well-being. Previous research has shown people with lower levels of health literacy and/or well-being scores are vulnerable but may benefit from intervention and follow-up care.

AIMS

This cross-sectional study, aimed to identify people at risk for type 2 diabetes by comparing the Finnish Diabetes Risk instrument with the waist-to-height ratio. Further, the difference was examined in health literacy and well-being scale scores in the countryside versus town areas, respectively.

RESULTS

In total, 220, aged 18-75 years, participated. Thereof, 13.2% displayed biomarkers at prediabetes level of HbA1c (39-47 mmol/mol); none had undiagnosed diabetes. Of the participants, 73% were overweight or obese. Waist-to-height ratio demonstrated 93.1% of the prediabetes group at moderate to high health risk and 64.4% of the normal group, with an area under the curve of 0.759, sensitivity of 93.3%, and specificity of 63.1%. Residency did not influence prediabetes prevalence, health literacy, or well-being.

CONCLUSION

Waist-to-height ratio and the Finnish Diabetes Risk instrument may be suitable for identifying who need further tests and follow-up care for health promotion in primary care.

Maternal Well-Being and Stage of Behaviour Change during Pregnancy: A Secondary Analysis of the PEARS Randomised Controlled Trial

We aimed to determine whether early pregnancy well-being was associated with the stage of behaviour change during an antenatal lifestyle intervention using a secondary analysis of data from the Pregnancy Exercise and Nutrition Research Study (PEARS). Pregnant women (n = 277) with well-being data in early pregnancy were included. Maternal well-being was measured using the World Health Organisation Five-Item Well-Being Index. The intervention consisted of a mobile health (mHealth) phone application, supported by antenatal education and exercise, to prevent gestational diabetes in a population with overweight. Stage of behaviour change was measured in late pregnancy using a five-stage classification. Ordinal logistic regression was used to examine if well-being, the study group, or their interaction, were related to behaviour change. Maternal well-being (OR 1.03, 95% CI 1.01, 1.04, p < 0.01) and the study group (OR 2.25, 95% CI 1.44, 3.51, p < 0.01) both significantly influenced the positive stage of behaviour change. The probability of being at stage 5 increased from 43 to 92% as well-being increased from 0 to 100% and was higher in the intervention (53%) compared to the control (34%) group (p ≤ 0.01 (8.65, 29.27). This study demonstrates the potential importance of well-being in enabling women to engage with a healthy lifestyle, and the role that mHealth technology has in facilitating beneficial behaviour change.

Validity and Psychometric Evaluation of the Chinese Version of the 5-Item WHO Well-Being Index

Aims

This article evaluates the psychometric properties of the Chinese version of the 5-item WHO Well-Being Index (WHO-5) in mainland China.

Methods

Two cross-sectional studies with 1,414 participants from a university in China were conducted. The Chinese version of the WHO-5 was assessed to determine its internal consistency, concurrent validity, factorial validity, and construct validity.

Results

The results indicate that the WHO-5 is unidimensional and has good internal consistency, with Cronbach's a = 0.85 and 0.81 in Study 1 (n = 903) and Study 2 (n = 511), respectively. The findings also demonstrate that the WHO-5 has good concurrent validity with other well-established measures of wellbeing, self-efficacy, self-esteem, and mental wellbeing. The results of confirmatory factor analysis also suggest that the scale has a good model fit.

Conclusions

This study provides empirical data demonstrating that the Chinese version of the WHO-5 has good psychometric properties. The scale can be a useful measure in epistemological studies and clinical research related to wellbeing in Chinese populations.

Assessing individual environmental exposure derived from the spatiotemporal behavior context and its impacts on mental health

Research on the associations between environmental exposures and mental health has attracted considerable attention. Most studies to date have mainly estimated environmental health effects based on static geographic contexts (e.g., residential neighborhoods, administrative units), ignoring the dynamic nature of individual spatiotemporal behavior, which may lead to unreliable results. To address this limitation, this study collects survey data from 1003 adults in Guangzhou, China. Then, it delineates dynamic geographic context to capture individual daily activity and travel and assesses individual exposure to environmental factors derived from the home buffer (HB) and the time-weighted activity and travel buffer (TATB). Finally, multiple linear regression models are used in this paper to examine and compare the relationships between individual environmental exposure and mental health based on the HB and TATB. The results of this study indicate that there are great differences in individual environmental exposure levels based on the HB and TATB. The explanatory power of the environmental factors obtained from the TATB on mental health is greater than that derived from the HB. Specifically, exposures to some environmental factors (i.e., green space coverage, blue space coverage, fitness facility density, and recreational facility density) derived from the TATB have mental health-promoting effects, while exposures to the other environmental factors (i.e., public transit station density) have mental health-constraining effects. These findings enrich our knowledge of spatiotemporal behavior and the effects of the dynamic contextual environment on mental health, as well as provide valuable implications for urban planning and public health service.

Validity, Reliability, and Optimal Cut-off Scores of the WHO-5, PHQ-9, and PHQ-2 to Screen Depression Among University Students in Iran

This study aimed to investigate the validity, reliability, and optimal cut-off points for the Patient Health Questionnaire-2 (PHQ-2), Patient Health Questionnaire-9 (PHQ-9), and Well-being Index (WHO-5) to screen mild depression among 400 Iranian students who completed these tools and Beck Depression Inventory (BDI-13). Further, a psychiatrist diagnosed the depression by using the "Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders." The validity and internal consistency of tools assessed and the accuracy were computed using the receiver operating characteristic (ROC) and area under the curve (AUC). The internal consistency values of PHQ-2, PHQ-9, and WHO-5 were .73, .88, and .94, respectively. The PHQ-2 (.53), PHQ-9 (.60), and WHO-5 (.54) were significantly associated with the BDI. The PHQ-2, PHQ-9, and WHO-5 had optimal cut-off points of 2, 5, and 9 with an AUC of .809, .851, and .823, respectively. Based on these findings, it is recommended to use the PHQ-9 for mild depression screening among medical university students in Iran because of its high sensitivity and specificity.

Assessing mental well-being in a Sinhala speaking Sri Lankan population: validation of the WHO-5 well-being index

Purpose

The WHO-5 well-being index is a widely used, short rating scale that measures subjective well-being. We translated the WHO-5 index into Sinhala and tested its psychometric properties including measurement invariance among diverse groups in a community sample in Sri Lanka.

Methods

The sample of 267 persons aged between 16 and 75 years was recruited from a semi-urban area. 219 completed a paper-based questionnaire and 48 responded to an online survey. Construct validity was tested for factorial validity (Confirmatory Factor Analysis -CFA), convergent validity and known group validity. Composite reliability for congeneric measures and test-retest reliability were also tested. Multi-group CFA (MG-CFA) was used to test measurement invariance.

Results

The translated Sinhala version demonstrated good content and face validity. Internal consistency reliability of the five items had a Cronbach’s alpha of 0.85 and test-retest reliability over 2 weeks was satisfactory (Pearson r = 0.72, p < 0.001, ICC = 0.82). Confirmatory factor analysis supported factorial validity with a \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\chi}_5^2 $$\end{document}χ52 =4.99 (p = 0.28), a RMSEA of 0.03 (90% C.I. =0.00–0.10), a SRMR of 0.02, a TLI of 0.99 and a CFI of 0.99; factor loadings were between 0.55 and 0.89. Measurement invariance was acceptable for configural, metric and scalar invariance for gender.

WHO-5 scores were significantly negatively correlated with the Patient Health Questionnaire (PHQ-9) (Pearson’s r = − 0.45, p < 0.001) scores and the Kessler Psychological Distress Scale (K10) scores (Pearson’s r = − 0.56, p < 0.001).

Conclusion

The Sinhala translation of WHO-5 well-being index has shown acceptable psychometric properties and can be used for assessing mental well-being in the community in Sri Lanka. Further testing of the measure with larger and diverse (including different ethnic/cultural) groups are indicated to test measurement invariance of the measure.

Patient-reported well-being: psychometric properties of the world health organization well-being index in specialised community mental health settings

The Five-item World Health Organization Well-being Index (WHO-5) is an increasingly used measure of generic well-being, but there is no evidence to support whether outpatients consider the questionnaire valuable. As the WHO-5 has not yet been psychometrically evaluated in specialised community mental health settings, an evaluation of its validity seems warranted. The aim of this cross-sectional study was to examine the psychometric properties of the WHO-5 in this type of setting. Data was collected from an outpatient center (N = 191 adults). Results indicate that the questionnaire was feasible to administer (n = 57 patients), it reported low mean Burden-scores and high Positive-Value scores, and had excellent internal consistency. No evidence of floor or ceiling effects was found. Results supported the unidimensional structure of the questionnaire. Significant differences were found concerning patients' diagnoses, with patients with schizophrenia diagnoses reporting higher scores and patients with depression and personality disorders reporting lower ones. When comparing the WHO-5 total score and patients' attitudes toward medication, negative correlations were observed with psychological reactance, as well as positive aspects of psychiatric medication. The present study demonstrates that the WHO-5 is feasible to administer and has robust psychometric properties in specialised community mental health centres.

The large majority of coeliacs have a high degree of perceived dietary competence

Purpose: The treatment for coeliac disease (CD) is a gluten-free diet (GFD), which impacts the health-related quality of life (HRQoL). The aim of the study was to develop the Gluten-Free Diet Perceived Competence Scale (GFD-PCS): a short and precise CD-specific patient-reported outcome measure.Methods: The GFD-PCS was developed from the scales 'Perceived Competence (Maintaining a Healthy Diet)' and 'Perceived Competence for Diabetes'. The scale was then programmed into a web-based questionnaire and distributed together with generic quality of life (WHO-5) and CD-specific HRQoL (CDQL) questionnaires.Results: There were 931 respondents. The 831 who reported 'diagnosed CD' were retained. The average age was 37.6 years (SD = 16.5). There was no statistically significant difference between males (M = 5.9, SD = 1.6) and females (M = 6.2, SD = 1.4) in GFD-PCS score. Respondents younger than 18 years (n = 104) scored lower (M = 5.8, SD = 1.4) than adults (M = 6.2, SD = 1.4). The psychometric properties of the GFD-PCS showed excellent internal reliability (α = .96) and satisfied construct and criterion validity.Conclusion: The GFD-PCS measures patient-perceived dietary competence for maintaining a GFD. The scale is psychometrically robust and provides a useful tool in assessing patients' difficulties with a GFD.

Reliability and validity of the Turkish version of the WHO-5, in adults and older adults for its use in primary care settings

Background:

This study aims to determine the psychometric properties of the World Health Organization Well-Being Index (WHO-5) Turkish version in Turkish adults and older adults.

Methods:

This is a multicenter cultural adaptation study carried out with 1752 participants. Internal consistency (by Cronbach’s alpha); Construct validity (by known groups and confirmatory factor analysis-CFI) and discriminant validity are evaluated stratified by adults and older adults. Cohen’s Effect Size is used in known groups and discriminant validity analyses.

Results:

Distribution properties of the WHO-5 Turkish version are in acceptable limits. Alpha values are 0.81 for adults and 0.86 for older adults. The variances of the 58.5% of the adults sample and 63.9% of the older adults sample are explained in Exploratory FA. Model fits (CFI) are satisfactory ( > 0.95) in both samples; but RMSEA is poor in the older adults sample (0.166) whereas it is acceptable (0.073) in the adults sample. Known groups validity and discriminant analyses are satisfactory in both adults and older adults.

Conclusion:

The WHO-5 Turkish version has a good measurement capacity, internal consistency and good model fits in both samples. The error values in the older adults group suggest that the results when testing older adults should be interpreted with caution.

Reliability, validity, and factorial structure of the World Health Organization-5 Well-Being Index (WHO-5) in Iranian psychiatric outpatients

INTRODUCTION

The association between psychological well-being and physical and mental health has been shown in the literature. Psychological well-being is a multifaceted concept. The World Health Organization-5 Well-Being Index (WHO-5) is a 5-item instrument used to screen for depression. However, the validity of the WHO-5 has not been investigated in Iranian psychiatric or psychological settings.

OBJECTIVE

To investigate the validation of the Farsi version of the WHO-5 in a sample of Iranian psychiatric outpatients.

METHODS

A cross-sectional study was conducted with a convenience sample of 116 Iranian volunteer psychiatric outpatients selected from the psychiatric and psychological clinics at the School of Behavioral Sciences and Mental Health - Tehran Institute of Psychiatry, Iran University of Medical Sciences. Patients completed the WHO-5, the Patient Health Questionnaire-9 (PHQ-9), the Patient Health Questionnaire-15 (PHQ-15), and the short form of the Beck Depression Inventory-13 (BDI-13).

RESULTS

The mean score of the WHO-5 was 8.95 (standard deviation [SD] = 5.49). Cronbach's α for the WHO-5 was 0.91. The WHO-5 negatively correlated with PHQ-9 (-0.358), PHQ-15 (-0.328), and BDI-13 (-0.475), indicating good validity. Factor analysis of the WHO-5 items identified one factor labeled psychological well-being.

CONCLUSIONS

The WHO-5 has a single dimensional structure and acceptable psychometric parameters. The results of this study suggest that WHO-5 can be used in a clinical context in Iran.

Test-retest reliability and measurement error of the Danish WHO-5 Well-being Index in outpatients with epilepsy

Background

The generic questionnaire WHO-5 Well-being Index (WHO-5), which measures the construct of mental well-being has been widely used in several populations across countries. The questionnaire has demonstrated sufficient psychometric properties; however, the test- retest reliability of the WHO-5 scale has yet to be determined. The aim of this study was to evaluate the test-retest reliability and measurement error of the Danish WHO-5 Well-being Index for outpatients with epilepsy. A further aim was to evaluate whether the method of administration (web, paper, or a mixture of the two modalities) influenced the results.

Methods

Epilepsy outpatients aged ≥15 years from three outpatient clinics in Central Denmark Region were included from August 2016 to April 2017. The participants were randomly divided into four test-retest groups: web-web, paper-paper, web-paper, and paper-web. Test-retest reliability was assessed by intraclass correlation coefficients (ICC) and measurement error by calculating minimal detectable change (MDC) on the basis of the standard error of the measurement.

Results

A total of 554 patients completed the questionnaire at two time points. The median duration between test-retest was 22 days. The pooled test-retest reliability estimate was ICC 0.81 (95% CI 0.78; 0.84). The estimated MDC was 23.60 points (95% CI 22.27; 25.10). These estimates showed little variation across administration methods.

Conclusions

WHO-5 showed acceptable test-retest reliability in a Danish epilepsy outpatient population across different method of administration; however, the relatively large measurement error should be taken into account when evaluating changes in WHO-5 scores over time. Further research should be done to explore these findings.

Depression screening in HIV-positive Tanzanian adults: comparing the PHQ-2, PHQ-9 and WHO-5 questionnaires

BACKGROUND

HIV-positive individuals are at significantly increased risk of depression. In low- and middle-income countries, depression is frequently under-detected, hampered by a lack of data regarding available screening tools. The 5-item World Health Organization Well-Being Index (WHO-5) is widely used to screen for depression, yet its validity in African adults with HIV has yet to be examined.

METHODS

In this cross-sectional study, we enrolled HIV-positive adults presenting to an outpatient HIV clinic in Mwanza, Tanzania. Patients were administered the Patient Health Questionnaires (PHQ)-2/9 and WHO-5 questionnaires. The rate of positive screens was calculated. Fisher's exact test and Pearson's correlation coefficients between PHQ-2/9 and WHO-5 scores were calculated.

RESULTS

We enrolled 72 HIV-positive adults: rates of positive depression screen were 62.5%, 77.8%, and 47.2% according to PHQ-2, PHQ-9, and WHO-5, respectively. PHQ and WHO results for depression were significantly associated (Fisher's exact test: PHQ-2 v. WHO-5, p = 0.028; PHQ-9 v. WHO-5, p = 0.002). The level of correlation between PHQ and WHO results for depression was moderate (Pearson's correlation coefficient: PHQ-2 v. WHO-5 -0.3289; PHQ-9 v. WHO-5 -0.4463).Per Mantel-Haenszel analysis, screening results were significantly more concordant among patients in the following strata: men, age >40, Sukuma ethnicity, Christian, unmarried, self-employed, at least primary school education completed, and higher than the median income level.

CONCLUSIONS

WHO-5 scores correlated well with those of the PHQ-9, suggesting that the WHO-5 represents a valid screening tool. The concordance of PHQ-9 and WHO-5 results was poorer in marginalized socioeconomic groups. Positive depression screens were exceedingly common among HIV-positive Tanzanian adults according to all three questionnaires.