Can a brief, positively-worded questionnaire be used to screen for depression in people with diabetes?

New ACBRD research published in Diabetes Research and Clinical Practice describes the validation of the WHO-5 as a first-step screening tool.

by Jennifer Halliday

Screening for depression is recommended in Australia and internationally as a part of holistic diabetes care. The World Health Organization’s 5-item Well-being Index (WHO-5) is used clinically to screen for likely depression as it is brief and positively-worded – but the evidence of its suitability for this purpose is not well documented.

Using data from Diabetes MILES-Australia, Jennifer Halliday and colleagues investigated the suitability of the WHO-5 for identifying likely depression in Australian adults with diabetes. The WHO-5 provides a score ranging 0 to 25, with lower scores indicating impaired emotional well-being. Scores £7 and <13 have both been proposed as clinically relevant cut-off points. Halliday and colleagues used statistical analyses to demonstrate that the WHO-5 is both reliable and valid, and to examine the sensitivity and specificity of the cut-off scores against a validated measure of depressive symptoms (PHQ-9). Sensitivity refers to the true positive rate (i.e. the ability of the WHO-5 to correctly identify people with likely depression); specificity refers to the true negative rate (i.e. the ability of the WHO-5 to correctly identify people without likely depression). The sensitivity/specificity of the WHO-5 for detecting likely depression was unsatisfactory for the £7 cut-off (0.44/0.96). However, for the <13 cut-off, the sensitivity/specificity were satisfactory (0.79/0.79) for the whole sample, with similar results found when they examined the data by diabetes type and treatment. The findings support use of a WHO-5 cut-point of <13 as a first-step screener for likely depression in Australian adults with type 1 or type 2 diabetes, regardless of treatment type.

While these findings demonstrate that the WHO-5 can be used as a screener, it is important to recognise that this is just a first step. Positive screening results (<13 on the WHO-5) should be followed-up with a diagnostic interview by a trained professional who can confirm or refute a diagnosis of depression. The article is free to access until 24 September 2017 here.

Halliday JA, Hendrieckx C, Busija L, Browne JL, Nefs G, Pouwer F, Speight J. Validation of the WHO-5 as a first-step screening instrument for depression in adults with diabetes: Results from Diabetes MILES-Australia. Diabetes Research and Clinical Practice, 2017; 132: 27-35.

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