The WHO-5 Well-Being Index: A Validation Study in People with Infertility
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Abstract
Background: Infertility is a public health problem and can lead to depressive symptoms. In recent years, the WHO-five Well-being Index (WHO-5) has been used as a screening measure for depression, but study on psychometric properties in people with infertility is scarce. The objective of this study was to examine the reliability and validity of the Persian version of the WHO-5 in people with infertility.
Methods: Overall, 539 infertile patients from a referral infertility center in Tehran, Iran in the period between May and Aug 2017, completed the WHO-5, along with other psychological measures: the Patient Health Questionnaire-9 (PHQ-9) and the Hospital Anxiety and Depression Scale (HADS). Construct validity and internal consistency of WHO-5 were evaluated using confirmatory factor analysis (CFA) and Cronbach’s alpha, respectively. Convergent validity was examined by relationship with PHQ-9 and HADS.
Results: The prevalence of poor well-being was 44.3% and that of depression was 18.6%. CFA confirmed the unidimensional factor structure of the WHO-5. Internal consistency of the WHO-5 was good (Cronbach’s alpha=0.858). The WHO-5 significantly correlated with the PHQ-9 (r=-0.522), HADS-anxiety (r=-0.524) and HADS-depression (r=-0.630), confirming convergent validity.
Conclusion: The WHO-5 is a short and easy to use questionnaire with satisfactory reliability and validity that appears suitable for use as a screening test for depressive symptom in infertile people. In addition, the prevalence of depression and poor well-being was very high in this population.
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14. Omani Samani R, Maroufizadeh S, Navid B et al (2017). Locus of control, anxiety, and depression in infertile patients. Psychol Health Med, 22(1):44-50.
15. Bech P, Gudex C, Johansen KS (1996). The WHO (Ten) well-being index: validation in diabetes. Psychother Psychosom, 65(4):183-90.
16. Bech P, Olsen LR, Kjoller M et al (2003). Measuring well‐being rather than the ab-sence of distress symptoms: a compari-son of the SF‐36 Mental Health subscale and the WHO‐Five well‐being scale. Int J Methods Psychiatr Res, 12(2):85-91.
17. Guðmundsdóttir HB, Ólason DÞ, Guðmundsdóttir DG et al (2014). A psy-chometric evaluation of the Icelandic ver-sion of the WHO‐5. Scand J Psychol, 55(6):567-72.
18. Lin C, Lee S, Wu B et al (2013). Psychomet-ric properties of the Taiwanese version of the World Health Organization-Five Well-Being index. Acta Psychiatr Scand, 127(4):331-.
19. Hajos TR, Pouwer F, Skovlund S et al (2013). Psychometric and screening properties of the WHO‐5 well‐being in-dex in adult outpatients with Type 1 or Type 2 diabetes mellitus. Diabet Med, 30(2):e63-9.
20. De Wit M, Pouwer F, Gemke RJ et al (2007). Validation of the WHO-5 Well-Being In-dex in adolescents with type 1 diabetes. Diabetes Care, 30(8):2003-6.
21. Furuya M, Hayashino Y, Tsujii S et al (2013). Comparative validity of the WHO-5 Well-Being Index and two-question instrument for screening depressive symptoms in patients with type 2 diabetes. Acta Diabe-tol, 50(2):117-21.
22. Hochberg G, Pucheu S, Kleinebreil L et al (2012). WHO-5, a tool focusing on psy-chological needs in patients with diabetes: The French contribution to the DAWN study. Diabetes Metab, 38(6):515-22.
23. Saipanish R, Lotrakul M, Sumrithe S (2009). Reliability and validity of the Thai version of the WHO‐Five Well‐Being Index in primary care patients. Psychiatry Clin Neuro-sci, 63(2):141-6.
24. Kroenke K, Spitzer RL (2002). The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann, 32(9):509-15.
25. Zigmond AS, Snaith RP (1983). The hospital anxiety and depression scale. Acta Psychi-atr Scand, 67(6):361-70.
26. Amini P, Maroufizadeh S, Omani Samani R (2017). Evaluating the factor structure, item analyses, and internal consistency of hospital anxiety and depression scale in Iranian infertile patients. Int J Reprod Bio-med (Yazd), 15(5):287-96.
27. McDonald RP, Ho M-HR (2002). Principles and practice in reporting structural equa-tion analyses. Psychol Methods, 7(1):64.
28. Kline RB (2015). Principles and practice of struc-tural equation modeling. 4th ed. New York: Guilford Press.
29. Maroufizadeh S, Ghaheri A, Omani Samani R et al (2016). Psychometric properties of the satisfaction with life scale (SWLS) in Iranian infertile women. Int J Reprod Bio-med (Yazd), 14(1):57-62.
30. Thomson H, Snell C, Bouzarovski S (2017). Health, Well-Being and Energy Poverty in Europe: A Comparative Study of 32 Eu-ropean Countries. Int J Environ Res Public Health, 14(6):584.
31. Dear BF, Titov N, Sunderland M et al (2011). Psychometric comparison of the generalized anxiety disorder scale-7 and the Penn State Worry Questionnaire for measuring response during treatment of generalised anxiety disorder. Cogn Behav Ther, 40(3):216-27.
32. Mills SD, Fox RS, Malcarne VL et al (2014). The psychometric properties of the gen-eralized anxiety disorder-7 scale in His-panic Americans with English or Spanish language preference. Cultur Divers Ethnic Minor Psychol, 20(3):463-8.
33. García-Campayo J, Zamorano E, Ruiz MA et al (2010). Cultural adaptation into Spanish of the generalized anxiety disor-der-7 (GAD-7) scale as a screening tool. Health Qual Life Outcomes, 8(1):8.
2. Boivin J, Bunting L, Collins JA et al (2007). International estimates of infertility preva-lence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod, 22(6):1506-12.
3. Direkvand Moghadam A, Delpisheh A, Sayehmiri K (2013). The prevalence of in-fertility in Iran, a systematic review. Iran J Obstet Gynecol Infertil, 16(81):1-7.
4. Maroufizadeh S, Ghaheri A, Omani Samani R (2017). Factors associated with poor quality of life among Iranian infertile women undergoing IVF. Psychol Health Med, 22(2):145-51.
5. Aarts J, van Empel I, Boivin J et al (2011). Relationship between quality of life and distress in infertility: a validation study of the Dutch FertiQoL. Hum Reprod, 26(5):1112-8.
6. Kahyaoglu Sut H, Balkanli Kaplan P (2015). Quality of life in women with infertility via the FertiQoL and the Hospital Anxie-ty and Depression Scales. Nurs Health Sci, 17(1):84-9.
7. Maroufizadeh S, Ghaheri A, Almasi-Hashiani A et al (2018). The prevalence of anxiety and depression among people with infertility referring to Royan Institute in Tehran, Iran: A cross-sectional ques-tionnaire study. Middle East Fertil Soc J, 23(2):103-6.
8. Wittchen H-U, Jacobi F, Rehm J et al (2011). The size and burden of mental disorders and other disorders of the brain in Eu-rope 2010. Eur Neuropsychopharmacol, 21(9):655-79.
9. Kessler RC, Aguilar-Gaxiola S, Alonso J et al (2009). The global burden of mental dis-orders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr Soc, 18(1):23-33.
10. Domar AD, Broome A, Zuttermeister PC et al (1992). The prevalence and predictabil-ity of depression in infertile women. Fertil Steril, 58(6):1158-63.
11. Drosdzol A, Skrzypulec V (2009). Depres-sion and anxiety among Polish infertile couples–an evaluative prevalence study. J Psychosom Obstet Gynaecol, 30(1):11-20.
12. Abbasi S, Kousar R, Sadiq SS (2016). De-pression and anxiety in Pakistani infertile women. J Surg Pakistan, 21(1):13-7.
13. Maroufizadeh S, Karimi E, Vesali S et al (2015). Anxiety and depression after fail-ure of assisted reproductive treatment among patients experiencing infertility. Int J Gynaecol Obstet, 130(3):253-6.
14. Omani Samani R, Maroufizadeh S, Navid B et al (2017). Locus of control, anxiety, and depression in infertile patients. Psychol Health Med, 22(1):44-50.
15. Bech P, Gudex C, Johansen KS (1996). The WHO (Ten) well-being index: validation in diabetes. Psychother Psychosom, 65(4):183-90.
16. Bech P, Olsen LR, Kjoller M et al (2003). Measuring well‐being rather than the ab-sence of distress symptoms: a compari-son of the SF‐36 Mental Health subscale and the WHO‐Five well‐being scale. Int J Methods Psychiatr Res, 12(2):85-91.
17. Guðmundsdóttir HB, Ólason DÞ, Guðmundsdóttir DG et al (2014). A psy-chometric evaluation of the Icelandic ver-sion of the WHO‐5. Scand J Psychol, 55(6):567-72.
18. Lin C, Lee S, Wu B et al (2013). Psychomet-ric properties of the Taiwanese version of the World Health Organization-Five Well-Being index. Acta Psychiatr Scand, 127(4):331-.
19. Hajos TR, Pouwer F, Skovlund S et al (2013). Psychometric and screening properties of the WHO‐5 well‐being in-dex in adult outpatients with Type 1 or Type 2 diabetes mellitus. Diabet Med, 30(2):e63-9.
20. De Wit M, Pouwer F, Gemke RJ et al (2007). Validation of the WHO-5 Well-Being In-dex in adolescents with type 1 diabetes. Diabetes Care, 30(8):2003-6.
21. Furuya M, Hayashino Y, Tsujii S et al (2013). Comparative validity of the WHO-5 Well-Being Index and two-question instrument for screening depressive symptoms in patients with type 2 diabetes. Acta Diabe-tol, 50(2):117-21.
22. Hochberg G, Pucheu S, Kleinebreil L et al (2012). WHO-5, a tool focusing on psy-chological needs in patients with diabetes: The French contribution to the DAWN study. Diabetes Metab, 38(6):515-22.
23. Saipanish R, Lotrakul M, Sumrithe S (2009). Reliability and validity of the Thai version of the WHO‐Five Well‐Being Index in primary care patients. Psychiatry Clin Neuro-sci, 63(2):141-6.
24. Kroenke K, Spitzer RL (2002). The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann, 32(9):509-15.
25. Zigmond AS, Snaith RP (1983). The hospital anxiety and depression scale. Acta Psychi-atr Scand, 67(6):361-70.
26. Amini P, Maroufizadeh S, Omani Samani R (2017). Evaluating the factor structure, item analyses, and internal consistency of hospital anxiety and depression scale in Iranian infertile patients. Int J Reprod Bio-med (Yazd), 15(5):287-96.
27. McDonald RP, Ho M-HR (2002). Principles and practice in reporting structural equa-tion analyses. Psychol Methods, 7(1):64.
28. Kline RB (2015). Principles and practice of struc-tural equation modeling. 4th ed. New York: Guilford Press.
29. Maroufizadeh S, Ghaheri A, Omani Samani R et al (2016). Psychometric properties of the satisfaction with life scale (SWLS) in Iranian infertile women. Int J Reprod Bio-med (Yazd), 14(1):57-62.
30. Thomson H, Snell C, Bouzarovski S (2017). Health, Well-Being and Energy Poverty in Europe: A Comparative Study of 32 Eu-ropean Countries. Int J Environ Res Public Health, 14(6):584.
31. Dear BF, Titov N, Sunderland M et al (2011). Psychometric comparison of the generalized anxiety disorder scale-7 and the Penn State Worry Questionnaire for measuring response during treatment of generalised anxiety disorder. Cogn Behav Ther, 40(3):216-27.
32. Mills SD, Fox RS, Malcarne VL et al (2014). The psychometric properties of the gen-eralized anxiety disorder-7 scale in His-panic Americans with English or Spanish language preference. Cultur Divers Ethnic Minor Psychol, 20(3):463-8.
33. García-Campayo J, Zamorano E, Ruiz MA et al (2010). Cultural adaptation into Spanish of the generalized anxiety disor-der-7 (GAD-7) scale as a screening tool. Health Qual Life Outcomes, 8(1):8.
| Files | ||
| Issue | Vol 48 No 11 (2019) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v48i11.3525 | |
| Keywords | ||
| Infertility WHO-5; Reliability Validity Iran | ||
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How to Cite
1.
OMANI-SAMANI R, MAROUFIZADEH S, ALMASI-HASHIANI A, SEPIDARKISH M, AMINI P. The WHO-5 Well-Being Index: A Validation Study in People with Infertility. Iran J Public Health. 2019;48(11):2058-2064.
