Letter to the editor

Psychometric properties of the Taiwanese versionof the World Health Organization-Five Well-Beingindex

DOI: 10.1111/acps.12040

Psychological studies show that early detection in high-riskgroups of mental illness is a critical public health issue (1),especially in depressive disorder, for such mental illness maynegatively affect their well-being.

Additionally, studies on mental health interventions havefocused on ameliorating suffering, weakness, and anxietyrather than on increasing happiness and well-being. Chida andSteptoe indicated that positive psychological well-being has afavorable effect on survival in both healthy and diseased popu-lations (2). A number of structured interviews and tests havebeen developed in Taiwan, all of which are extensive, time con-suming, and focus on negative effect. The World HealthOrganization-Five Well-Being Index (WHO-5) is a self-admin-istered five-item scale that provides a brief screening tool fordetecting depression (3). We have examined the reliability andvalidity of the Taiwanese version of the WHO-5 (WHO-5-TW), which is short and easy to use as a brief screening toolfor well-being, and to development the first positive depressionscreening tool in Taiwan. The English version of the WHO-5Well-Being Index was translated into traditional Chinese.Final adjustments were performed, including back translation,cross-cultural adaptation and field testing of the pre-finalversion. The WHO-5-TW was administered randomly to 242community samples. Their mean age was 40.3 years, and 64%of them were female. Significant differences in the WHO-5-TWtotal scores were observed between the male and femalesubjects [male vs. female (mean � SD), 15.93 � 4.62 vs.13.50 � 5.30, t = 3.72, P < 0.001). The females experienceddepression at roughly two or three times the rate of males.There were significant differences in the Chinese Health Ques-tionnaire total scores between the male and female subjects[male vs. female (mean � SD), 1.23 � 2.27 vs. 2.04 � 2.36,t = �2.60, P < 0.01]. The internal consistency of the WHO-5-TW (alpha coefficient = 0.94) was excellent. The homogeneityand unidimensionality were also good, with a Loevinger coeffi-cient of 0.80. The Loevinger coefficient is an analysis of unidi-mensionality that tests the extent to which an extra item fitsinto the structure established by other items of a scale (4). Wedetermined the convergent validity of the WHO-5-TW in rela-tion to the Chinese Health Questionnaire (CHQ) (5), which isscored in the opposite direction (r = �0.68; P < 0.001). TheGeneral Health Questionnaire has been shown to be a usefulscreening method to detect non-psychotic mental disorders ingeneral clinical settings (5). Factor analysis identified only onefactor that explained 80.8% of the variance.

Among the limitations to be mentioned, first, the study wasconducted exclusively in a community in Hualien County inthe east of Taiwan. Second, discriminatory validity for thedetection of depression disorders was not examined in the pres-ent study because we know that depression disorders mayinfluence respondents’ subjective well-being. Finally, there wasa possibility that our respondents under- or over-reported theirfeelings, which may occur in any subjective study.

The WHO-5-TW was found to be a reliable and valid self-assessment instrument to screen well-being and depression in acommunity population in Taiwan.

C.-H. Lin1, S.-M. Lee1,2, B.-J. Wu1,L.-S. Huang1, H.-J. Sun1 and H.-F. Tsen3,4

1Department of Health Executive Yuan, Yuli Hospital,Yuli Township, Hualien County, 2Department of Psychiatry,

National Defense Medical Center, Tri-Service General Hospital,Taipei City, 3Department of Health Taipei City Government,Taipei City and 4Institute of Life and Death Education and

Counseling, National Taipei University of Nursing and HealthSciences, Taipei City, TaiwanE-mail: tcpctpech@gmail.com

References

1. Rietdijk J, Klaassen R, Ising H et al. Detection of people atrisk of developing a first psychosis: comparison of tworecruitment strategies. Acta Psychiatr Scand 2012;126:21–30.

2. Chida Y, Steptoe A. Positive psychological well-being andmortality: a quantitative review of prospective observa-tional studies. Psychosom Med 2008;70:741–756.

3. Bonsignore M, Barkow K, Jessen F, Heun R. Validity of thefive-item WHO Well-Being Index (WHO-5) in an elderlypopulation. Eur Arch Psychiatry Clin Neurosci 2001;251(Suppl 2):II27–II31.

4. Mokken RJ. A theory and procedure of scale analysis: withapplications in political research. New York: De Gruyter;1971.

5. Cheng TA, Williams P. The design and development of ascreening questionnaire (CHQ) for use in community stud-ies of mental disorders in Taiwan. Psychol Med1986;16:415–422.

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Acta Psychiatr Scand 2013: 127: 331–332 © 2012 John Wiley & Sons A/S. Published by Blackwell Publishing LtdAll rights reserved ACTA PSYCHIATRICA SCANDINAVICA