Halliday Jennifer A, Hendrieckx Christel, Busija Lucy, Browne Jessica L, Nefs Giesje, Pouwer François, Speight Jane
School of Psychology, Deakin University, 1 Geringhap Street, Geelong 3220, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia.
School of Psychology, Deakin University, 1 Geringhap Street, Geelong 3220, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia.
Diabetes Res Clin Pract. 2017 Oct;132:27-35. doi: 10.1016/j.diabres.2017.07.005. Epub 2017 Jul 8.
Screening for depression is recommended internationally. The World Health Organization's 5-item Well-being Index (WHO-5) is used clinically to screen for depression but its empirical suitability for this purpose is not well documented. We investigated the psychometric properties of the WHO-5 and its suitability for identifying likely depression in Australian adults with diabetes.
The Diabetes MILES - Australia study dataset provided a sample of N=3249 who completed the WHO-5 (positively-worded 5-item measure of emotional well-being) and the PHQ-9 (9-item measure of depressive symptoms). Analyses were conducted for the full sample, and separately by diabetes type and treatment (type 1, non-insulin-treated type 2, and insulin-treated type 2 diabetes). Construct (convergent and factorial) validity and reliability of the WHO-5 were examined. ROC analyses were used to examine the sensitivity and specificity of the WHO-5 as a depression screening instrument, comparing two commonly used WHO-5 cut-off values (≤7 and <13) with the PHQ-9.
For the whole sample, the WHO-5 demonstrated satisfactory internal consistency reliability (α=0.90) and convergent validity with the PHQ-9 (r=-0.73, p<0.001). Confirmatory factor analysis partially supported factorial validity: Χ(5)=834.94, p<0.001; RMSEA=0.23, 90% CI 0.21-0.24; CFI=0.98, TLI=0.96; factor loadings=0.78-0.92. The AUC was 0.87 (95% CI: 0.86-0.89, p<0.001). The sensitivity/specificity of the WHO-5 for detecting likely depression was 0.44/0.96 for the ≤7 cut-off, and 0.79/0.79 for the <13 cut-off, with similar findings by diabetes type and treatment.
These findings support use of a WHO-5 cut-point of <13 to identify likely depression in Australian adults with diabetes, regardless of type/treatment.
国际上推荐对抑郁症进行筛查。世界卫生组织的5项幸福指数（WHO-5）在临床上用于筛查抑郁症，但其在此目的上的实证适用性记录并不完善。我们调查了WHO-5的心理测量特性及其在识别澳大利亚成年糖尿病患者中可能存在的抑郁症方面的适用性。
澳大利亚糖尿病MILES研究数据集提供了一个N = 3249的样本，这些参与者完成了WHO-5（情绪幸福感的正向5项测量）和PHQ-9（抑郁症状的9项测量）。对整个样本进行了分析，并按糖尿病类型和治疗方式（1型、非胰岛素治疗的2型和胰岛素治疗的2型糖尿病）分别进行分析。检验了WHO-5的结构效度（收敛效度和因子效度）和信度。使用ROC分析来检验WHO-5作为抑郁症筛查工具的敏感性和特异性，将两个常用的WHO-5临界值（≤7和<13）与PHQ-9进行比较。
对于整个样本，WHO-5显示出令人满意的内部一致性信度（α = 0.90）以及与PHQ-9的收敛效度（r = -0.73，p < 0.001）。验证性因子分析部分支持因子效度：Χ(5)=834.94，p < 0.001；RMSEA = 0.23，90% CI 0.21 - 0.24；CFI = 0.98，TLI = 0.96；因子载荷 = 0.78 - 0.92。曲线下面积为0.87（95% CI：0.86 - 0.89，p < 0.001）。对于≤7的临界值，WHO-5检测可能抑郁症的敏感性/特异性为0.44/0.96，对于<13的临界值为0.79/0.79，按糖尿病类型和治疗方式的结果相似。
这些发现支持使用<13的WHO-5切点来识别澳大利亚成年糖尿病患者中可能存在的抑郁症，无论其类型/治疗方式如何。
