The WHO-5 Well-Being Index: A Validation Study in People with Infertility

Overview

Journal Iran J Public Health

Date 2020 Jan 24

PMID 31970105

Citations 34

Authors

Reza Omani-Samani

Saman Maroufizadeh

Amir Almasi-Hashiani

Mahdi Sepidarkish

Payam Amini

Affiliations

Soon will be listed here.

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.

Citing Articles

Assessment of post-traumatic stress disorder and well-being among Sudanese during the ongoing war: a cross-sectional study.

Hussein M, Saleeb M, Tolba B, Mohamed Y, Gebreal A, Mohamed A BMC Psychol. 2025; 13(1):181.

PMID: 40025606 PMC: 11874855. DOI: 10.1186/s40359-025-02542-1.

Assessing Population Well-Being in Saudi Arabia: A Comprehensive National Survey Using the WHO-05 Index and Self-Rated Health Metrics.

Alahmadi A, Almuzaini Y, Alosaimi M, Alahmari A, Alamri F, Sheerah H Healthcare (Basel). 2025; 13(3).

PMID: 39942499 PMC: 11817065. DOI: 10.3390/healthcare13030310.

Measuring psychological well-being in a danish pregnancy cohort using the self-reported WHO-5 index.

Christiansen C, Christensen K, Hogh S, Renault K, Emborg M, Frokjaer V BMC Psychol. 2025; 13(1):41.

PMID: 39815351 PMC: 11737152. DOI: 10.1186/s40359-025-02343-6.

Psychological Well-being Interactively Affected by Long Working Hours and Caregiving Activities.

Park M, Lee J Saf Health Work. 2024; 15(4):458-463.

PMID: 39697316 PMC: 11650789. DOI: 10.1016/j.shaw.2024.10.006.

Psychological wellbeing among carers of children and adolescents with physical disabilities in North-Eastern Tanzania-a cross-sectional survey study.

Swai E, Moshi H, Msuya S, Sorlin A, Sahlen K, Lindkvist M Front Public Health. 2024; 12:1437716.

PMID: 39444961 PMC: 11497636. DOI: 10.3389/fpubh.2024.1437716.

References

Gudmundsdottir H, Olason D, Gudmundsdottir D, Sigurdsson J . A psychometric evaluation of the Icelandic version of the WHO-5. Scand J Psychol. 2014; 55(6):567-72. DOI: 10.1111/sjop.12156. View

Hochberg G, Pucheu S, Kleinebreil L, Halimi S, Fructuoso-Voisin C . WHO-5, a tool focusing on psychological needs in patients with diabetes: the French contribution to the DAWN study. Diabetes Metab. 2012; 38(6):515-22. DOI: 10.1016/j.diabet.2012.06.002. View

Bech P, Gudex C, Johansen K . The WHO (Ten) Well-Being Index: validation in diabetes. Psychother Psychosom. 1996; 65(4):183-90. DOI: 10.1159/000289073. View

Bech P, Olsen L, 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(2):85-91. PMC: 6878541. DOI: 10.1002/mpr.145. View

Maroufizadeh S, Karimi E, Vesali S, Omani Samani R . Anxiety and depression after failure of assisted reproductive treatment among patients experiencing infertility. Int J Gynaecol Obstet. 2015; 130(3):253-6. DOI: 10.1016/j.ijgo.2015.03.044. View

de Wit M, Pouwer F, Gemke R, Delemarre-van de Waal H, Snoek F . Validation of the WHO-5 Well-Being Index in adolescents with type 1 diabetes. Diabetes Care. 2007; 30(8):2003-6. DOI: 10.2337/dc07-0447. View

Kessler R, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J . The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr Soc. 2009; 18(1):23-33. PMC: 3039289. DOI: 10.1017/s1121189x00001421. View

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. 2010; 50(2):117-21. DOI: 10.1007/s00592-010-0219-z. View

Dear B, Titov N, Sunderland M, McMillan D, Anderson T, Lorian C . 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. 2011; 40(3):216-27. DOI: 10.1080/16506073.2011.582138. View

10.

Drosdzol A, Skrzypulec V . Depression and anxiety among Polish infertile couples--an evaluative prevalence study. J Psychosom Obstet Gynaecol. 2009; 30(1):11-20. DOI: 10.1080/01674820902830276. View

11.

Wittchen H, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jonsson B . The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011; 21(9):655-79. DOI: 10.1016/j.euroneuro.2011.07.018. View

12.

Zegers-Hochschild F, Adamson G, Dyer S, Racowsky C, de Mouzon J, Sokol R . The International Glossary on Infertility and Fertility Care, 2017. Hum Reprod. 2017; 32(9):1786-1801. PMC: 5850297. DOI: 10.1093/humrep/dex234. View

13.

Garcia-Campayo J, Zamorano E, Ruiz M, Pardo A, Perez-Paramo M, Lopez-Gomez V . Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool. Health Qual Life Outcomes. 2010; 8:8. PMC: 2831043. DOI: 10.1186/1477-7525-8-8. View

14.

Domar A, Broome A, Zuttermeister P, SEIBEL M, Friedman R . The prevalence and predictability of depression in infertile women. Fertil Steril. 1992; 58(6):1158-63. View

15.

Maroufizadeh S, Ghaheri A, Omani Samani R . Factors associated with poor quality of life among Iranian infertile women undergoing IVF. Psychol Health Med. 2016; 22(2):145-151. DOI: 10.1080/13548506.2016.1153681. View

16.

Boivin J, Bunting L, Collins J, Nygren K . International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod. 2007; 22(6):1506-12. DOI: 10.1093/humrep/dem046. View

17.

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(2):141-6. DOI: 10.1111/j.1440-1819.2009.01933.x. View

18.

Hajos T, Pouwer F, Skovlund S, den Oudsten B, Geelhoed-Duijvestijn P, Tack C . Psychometric and screening properties of the WHO-5 well-being index in adult outpatients with Type 1 or Type 2 diabetes mellitus. Diabet Med. 2012; 30(2):e63-9. DOI: 10.1111/dme.12040. View

19.

Omani Samani R, Maroufizadeh S, Navid B, Amini P . Locus of control, anxiety, and depression in infertile patients. Psychol Health Med. 2016; 22(1):44-50. DOI: 10.1080/13548506.2016.1231923. View

20.

Maroufizadeh S, Ghaheri A, Omani Samani R, Ezabadi Z . Psychometric properties of the satisfaction with life scale (SWLS) in Iranian infertile women. Int J Reprod Biomed. 2016; 14(1):57-62. PMC: 4837918. View