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The WHO-5 well-being index – validation based on item response theory and the analysis of measurement invariance across 35 countries
Open accessAbstract
The five-item World Health Organization Well-Being Index (WHO-5) is a frequently used brief standard measure in large-scale cross-cultural clinical studies. Despite its frequent use, some psychometric questions remain that concern the choice of an adequate item response theory (IRT) model, the evaluation of reliability at important cutoff points, and most importantly the assessment of measurement invariance across countries. Data from the 6th European Working Condition survey (2015) were used that collected nationally representative samples of employed and self-employed individuals (N = 43,469) via computer-aided personal interviews across 35 European countries. An in-depth IRT analysis was conducted for each country, testing different IRT assumptions (e.g., unidimensionality), comparing different IRT-models, and calculating reliabilities. Furthermore, measurement invariance analysis was conducted with the recently proposed alignment procedure. The graded response model fitted the data best for all countries. Furthermore, IRT assumptions were mostly fulfilled. The WHO-5 showed overall and at critical points high reliability. Measurement invariance analysis revealed metric invariance but discarded scalar invariance across countries. Analysis of the test characteristic curves of the aligned graded response model indicated low levels of differential test functioning at medium levels of the WHO-5, but differential test functioning increased at more extreme levels. The current study has no external criterion (e.g., structured clinical interviews) to assess sensitivity and specificity of the WHO-5 as a depression screening-tool. The WHO-5 is a psychometrically sound measure. However, large-scale cross-cultural studies should employ a latent variable modeling approach that accounts for non-invariant parameters across countries (e.g., alignment).
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Metadata
- Authors
- Sischka, P. E., Costa, A. P., Steffgen, G., & Schmidt, A. F.
- Affiliations
- University of Luxembourg (LU)
- Johannes Gutenberg University Mainz (DE)
- Corresponding author
- Sischka, Philipp E.
- Venue
- Journal of Affective Disorders Reports
- Publisher
- Elsevier BV
- Published
- 2020-12
- Volume
- 1
- Pages
- 100020
- ISSN
- 2666-9153 (ISSN-L)
- OpenAlex
- W3094404984
- Cited by
- 245
- References
- 88
- Citations by year
- 2026: 50 · 2025: 55 · 2024: 61 · 2023: 35 · 2022: 28 · 2021: 13 · 2020: 3
- FWCI
- 12.56
- Type
- journal article
- Language
- en
- Update notices
- erratum (2022-12-01)
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Affective Disorders Reports (publishedVersion, cc-by-nc-nd)
- Open Repository and Bibliography (University of Luxembourg) (submittedVersion, cc-by-nc-sa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- OSF Preprints (OSF Preprints) (submittedVersion)
- Topics
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- WHO-5, well-being index, measurement invariance, graded response model, alignment procedure, differential item functioning, depression screening, psychometric validation, cross-cultural measurement, European Working Conditions Survey, reliability statistics, unidimensionality
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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