Trends in Psychiatry and Psychotherapy
Trends in Psychiatry and Psychotherapy
Original Article

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

Mahboubeh Dadfar; Nahid Momeni Safarabad; Ali Asghar Asgharnejad Farid; Monir Nemati Shirzy; Farzad Ghazie pour Abarghouie

Downloads: 0
Views: 415


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.


Psychological well-being, validity, reliability, factorial structure, WHO-5, psychiatric outpatients, 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.


Bem-estar psicológico, validade, confiabilidade, estrutura fatorial, WHO-5, pacientes psiquiátricos ambulatoriais, Irã


Linton MJ, Dieppe P, Medina-Lara A. Review of 99 self-report measures for assessing well-being in adults: exploring dimensions of well-being and developments over time. BMJ Open. 2016;6:010641.

Bech P. Measuring the dimensions of psychological general well-being by the WHO-5. QoL Newsletter. 2004;32:15-6.

Bech P, Olsen LR, Kjoller M, Rasmussen N. Measuring well-being rather than the absence of distress symptoms: A comparison of the SF-36 mental health subscale and the WHO-Five well-being scale. Int J Methods Psychiatr Res. 2003;12:85-91.

Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol. 1989;57:1069-81.

Winefield HR, Gill TK, Taylor AW, Pilkington RM. Psychological well-being and psychological distress: Is it necessary to measure both?. Psychol Well-Being Theo Res Pract.. 2012;2:1-16.

Fernandes T, Sanyal N, Dhupar S. Perceived social support, affect and psychological well-being in married and widowed older adults. Int J Indian Psychol. 2016;3:48-60.

Ashkanasy NM, Dorris AD. Emotion in workplace. Ann Rev Org Psychol Org Behav. 2017;4:67-90.

Şimşek ÖF. An intentional model of emotional well-being: The development and initial validation of a measure of subjective well-being. J Happiness Stud. 2011;12:421-2.

Social and emotional wellbeing: development of a Children's Headline Indicator. 2012.

Ryff C, Keyes C. The structure of psychological well-being revisited. J Pers Soc Psychol. 1995;69:719-27.

Schütte S, Chastang JF, Malard L, Parent-Thirion A, Vermeylen G, Niedhammer I. Psychosocial working conditions and psychological well-being among employees in 34 European countries. Int Arch Occup Environ Health. 2014;87:897-907.

Schneider CB, Pilhatsch M, Rifati M, Jost WH, Wodarz F, Ebersbach G. Utility of the WHO-Five Well-being Index as a screening tool for depression in Parkinson's disease. Mov Disord. 2010;25:777-83.

Papanas N, Tsapas A, Papatheodorou K, Papazoglou D, Bekiari E, Sariganni M. Glycaemic control is correlated with wellbeing index (WHO-5) in subjects with type 2 diabetes. Exp Clin Endocrinol Diabetes. 2010;118:364-7.

Lucas-Carrasco R, Allerup P, Bech P. The validity of the WHO-5 as an early screening for apathy in an elderly population. Cur Gerontol Geriatr Res. 2012;2012:171857.

Furuya M, Hayashino Y, Tsujii S, Ishii H, Fukuhara S. Comparative validity of the WHO-5 Well-Being Index and two-question instrument for screening depressive symptoms in patients with type 2 diabetes. Acta Diabetol. 2013;50:117-21.

Allgaier AK, Kramer D, Saravo B, Mergl R, Fejtkova S, Hegerl U. Beside the Geriatric Depression Scale: the WHO-Five Well-being Index as a valid screening tool for depression in nursing homes. Int J Geriatr Psychiatry. 2013;28:1197-204.

Krieger T, Zimmermann J, Huffziger S, Ubl B, Diener C, Kuehner C. Measuring depression with a well-being index: further evidence for the validity of the WHO Well-Being Index (WHO-5) as a measure of the severity of depression. J Affect Disord. 2014;156:240-4.

Sisask M, Värnik A, Kõlves K, Konstabel K, Wasserman D. Subjective psychological well-being (WHO-5) in assessment of the severity of suicide attempt. Nord J Psychiatry. 2008;62:431-5.

Awata S, Bech P, Yoshida S, Hirai M, Suzuki S, Yamashita M. Reliability and validity of the Japanese version of the World Health Organization-Five Well-Being Index in the context of detecting depression in diabetic patients. Psychiatry Clin Neurosci. 2007;61:112-9.

Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 WellBeing Index: a systematic review of the literature. Psychother Psychosom. 2015;84:167-76.

Wu SFV. Rapid screening of psychological well-being of patients with chronic illness: Reliability and validity test on WHO-5 and PHQ-9 scales. Dep Res Treat. 2014;2014:239490.

de Wit M, Pouwer F, Gemke RJ, Delemarre-van de Waal HA, Snoek FJ. Validation of the WHO-5 well-being index in adolescents with type 1 diabetes. Diabetes Care. 2007;30:2003-6.

Hajos TR, Pouwer F, Skovlund SE, Den Oudsten BL, Geelhoed-Duijvestijn PH, Tack CJ. Psychometric and screening properties of the WHO-5 well-being index in adult outpatients with type 1 or type 2 diabetes mellitus. Diabet Med. 2013;30:63-9.

Saipanish R, Lotrakul M, Sumrithe S. Reliability and validity of the Thai version of the WHO-Five Well-Being Index in primary care patients. Psychiatry Clin Neurosci. 2009;63:141-6.

Khosravi A, Mousavi SA, Chaman R, Sepidar Kish M, Ashrafi E, Khalili M. Reliability and validity of the Persian version of the World Health Organization-Five well-being index. Int J Health Stud. 2015;1:17-9.

Mortazavi F, Mousavi SA, Chaman R, Khosravi A. Validation of the World Health Organization-5 well-being index; assessment of maternal well-being and its associated factors. Turk Psikiyatri Derg. 2015;26:48-55.

Dadfar M, Lester D. Psychometric characteristics of Patient Health Questionnaire-2 (PHQ-2) in Iranian psychiatric outpatients. Austin J Psychiatry Behav Sci. 2017;4:1059.

The WHO-5-Region Hovedstadend Psykiatri. 2017.

Johnson JG, Harris ES, Spitzer RL, Williams JBW. The Patient Health Questionnaire for Adolescents: Validation of an instrument for the assessment of mental disorders among adolescent primary care patients. J Adolesc Health. 2013;30:196-204.

Neves I, Sales C, Carlota R, Brinquete C, Magalhães A, Falcão C. Relevance of individualized measures: Listening the patient means capturing the story?. Psicol Saude Doencas.. 2016;17:39-44.

Torres A, Monteiro S, Pereira A, Albuquerque E. Reliability and validity of the PHQ-9 in Portuguese women with breast cancer. EpSBS. 2016;7:411-23.

Inagaki M, Ohtsuki T, Yonemoto N, Kawashima Y, Saitoh A, Oikawa Y. Validity of the Patient Health Questionnaire (PHQ)-9 and PHQ-2 in general internal medicine primary care at a Japanese rural hospital: a cross-sectional study. Gen Hosp Psychiatry. 2013;35:592-7.

Santos I, Tavares BF, Munhoz TN, Almeida LSPD, Silva NTBD, Tams BD. Sensitivity and specificity of the Patient Health Questionnaire-9 (PHQ-9) among adults from the general population. Cad Saude Publica. 2013;29:1533-43.

Rathore JS, Jehi LE, Fan Y, Patel SI, Foldvary-Schaefer N, Ramirez MJ. Validation of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy. Epilepsy Behav. 2014;37:215-20.

Zhong Q, Gelaye B, Fann JR, Sanchez SE, Williams MA. Crosscultural validity of the Spanish version of PHQ-9 among pregnant Peruvian women: a Rasch item response theory analysis. J Affect Disord. 2014;158:148-53.

Hanwella R, Ekanayake S, De Silva VA. The validity and reliability of the Sinhala translation of the Patient Health Questionnaire (PHQ-9) and PHQ-2 screener. Dep Res Treat. 2014;2014:768978.

Xiong N, Fritzsche K, Wei J, Hong X, Leonhart R, Zhao X. Validation of Patient Health Questionnaire (PHQ) for major depression in Chinese outpatients with multiple somatic symptoms: a multicenter cross-sectional study. J Affect Disord. 2015;174:636-43.

Van der Zwaam GL, Van Dijk SE, Adriaanse MC, Van Marwijk HW, Van Tulder MW, Pols AD. Diagnostic accuracy of the Patient Health Questionnaire-9 for assessment of depression in type II diabetes mellitus and/or coronary heart disease in primary care. J Affect Disord. 2016;15:68-74.

Dadfar M, Kalibatseva Z. Psychometric properties of the Persian of the short Beck Depression Inventory (BDI-13) with Iranian psychiatric outpatients. Scientifica. 2016;2016:8196463.

Guðmundsdóttir HB, Olason DP, Guðmundsdóttir DG, Sigurðsson JF. A psychometric evaluation of the Icelandic version of the WHO-5. Scand J Psychol. 2014;55:567-72.

Allgaier AK, Pietsch K, Frühe B, Prast E, Sigl-Glöckner J, Schulte-Körne G. Depression in pediatric care: is the WHO-Five Well-Being Index a valid screening instrument for children and adolescents?. Gen Hosp Psychiatry. 2012;34:234-41.

Sibai AM, Chaaya M, Tohme RA, Mahfoud Z, Al-Amin H. Validation of the Arabic version of the 5-item WHO Well Being Index in elderly population. Int J Geriatr Psychiatry. 2009;24:106-7.

Awata S, Bech P, Koizumi Y, Seki T, Kuriyama S, Hozawa Ohmori K. 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. Int Psychogeriatr. 2007;19:77-88.

Bonsignore M, Barkow K, Jessen F, Heun R. Validity of the Five-Item WHO Well-Being Index (WHO-5) in an elderly population. Eur Arch Psychiatry Clin Neurosci. 2001;251:27-31.

Blom EH, Bech P, Högberg G, Larsson JO, Serlachius E. Screening for depressed mood in an adolescent psychiatric context by brief self-assessment scales--testing psychometric validity of WHO-5 and BDI-6 indices by latent trait analyses. Health Qual Life Outcomes. 2012;10:149.

6169b95fa953954b686be5c4 trends Articles
Links & Downloads

Trends Psychiatry Psychother

Share this page
Page Sections