Reliability, validity, and factorial structure of the World Health Organization-5 Well-Being Index (WHO-5) in Iranian psychiatric outpatients / Confiabilidade, validade e estrutura fatorial do World Health Organization-5 Well-Being Index (WHO-5) em pacientes psiquiátricos ambulatoriais iranianos

Abstract 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.

Resumo Introdução: A associação entre bem-estar psicológico e saúde física e mental tem sido demonstrada na literatura. Bem-estar psicológico é um conceito multifacetado. O World Health Organization-5 Well-Being Index (WHO-5) é um instrumento composto por 5 itens utilizado para avaliar depressão. No entanto, a validade do WHO-5 não foi investigada em contextos psiquiátricos ou psicológicos iranianos. Objetivo: Investigar a validade da versão persa do WHO-5 em uma amostra de pacientes psiquiátricos ambulatoriais iranianos. Métodos: Um estudo transversal foi conduzido com uma amostra de conveniência composta por 116 pacientes psiquiátricos ambulatoriais iranianos voluntários selecionados nas clínicas psiquiátrica e psicológica da School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences. Os pacientes completaram o WHO-5, o Patient Health Questionnaire-9 (PHQ-9), o Patient Health Questionnaire-15 (PHQ-15) e a versão abreviada do Beck Depression Inventory-13 (BDI-13). Resultados: O escore médio obtido no WHO-5 foi de 8,95 (desvio padrão = 5,49). O alfa de Cronbach para o WHO-5 foi 0,91. O WHO-5 se correlacionaram negativamente com o PHQ-9 (-0,358), o PHQ-15 (-0,328) e o BDI-13 (-0,475), indicando validade adequada. A análise fatorial dos itens do WHO-5 identificaram um único fator, a saber, bem-estar psicológico. Conclusão: O WHO-5 tem uma estrutura dimensional única e parâmetros psicométricos aceitáveis. Os resultados deste estudo sugerem que o WHO-5 pode ser usado em contextos clínicos no Irã.

Reproducibilidad del Índice de Bienestar General (WHO-5 WBI) en estudiantes adolescentes / Reproducibility of the Weil-Being Index (WHO-5 WBI) among adolescent students

Objetivo: Conocer la reproducibilidad del Índice de Bienestar General (WHO-5 WBI) en estudiantes adolescentes de noveno grado de Cartagena (Colombia). Método: Participaron en el estudio 157 estudiantes adolescentes, con una media para la edad de 15,1 años (DE = 1,1), el 56,1 % eran varones. WHO-5 WBI se compone de cinco ítems que cuantifican estado de ánimo triste, reducción del interés por las actividades relevantes y nivel de energía durante las dos últimas semanas. Se calcularon los coeficientes de alfa de Cronbach y omega de McDonald como indicadores de consistencia interna, y la correlación de Pearson (r) y el coeficiente de correlación intraclase(CCI) como estimadores de la estabilidad. Resultados: WHO-5 WBI mostró aceptable consistencia interna en la primera y segunda aplicación, con valores de alfa de Cronbach de 0,668 y 0,697 y omega de McDonald de 0,671 y 0,686, respectivamente. Igualmente, WHO-5 WBI presentó alta estabilidad a cuatro semanas con coeficiente de Pearson (r = 0,612; p<0,001) y el CCI 0,613 (IC95 % 0,505-0,702). Conclusiones: WHO-5 WBI presenta aceptable reproducibilidad, estabilidad, a cuatro semanas en estudiantes adolescentes. Se necesita conocer el desempeño de esta escala frente al mejor criterio de referencia, una entrevista clínica estructurada.

Objective: To know the reproducibility of results of the WHO-5 WBI among nine-grade adolescent students in Cartagena (Colombia). Method: A total of 157 students participated in the research with mean age of 15.1 (SD = 1.1), 56.1 % were boys. WHO-5 WBI consists of five items that quantify depressed mood, decreased interest in activities and energy lost during the last two weeks. It was calculated Cronbach alpha and omega McDonald coefficients as indicators of internal consistency; and Pearson correlation coefficient (r) and intraclass correlation coefficient (ICC) as estimators of the stability. Results: WHO-5 WBI showed acceptable internal consistency in the first and second application, Cronbach's alpha of 0.668 and 0.697, respectively, and omega of McDonald and 0.686 0.671, respectively. Similarly, WHO-5 WBI showed high stability over four weeks with Pearson coefficient (r = 0.612, P <0.001) and ICC 0.613 (95% CI 0.505-0.702). Conclusions: The WHO-5 WBI presents acceptable reproducibility over four-weeks among adolescent students. It is needed to know the psychometric performance of the WHO-5 WBI using the best gold standard.