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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 [1], Jennifer Halliday [2] 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 [3].

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 [3]. Diabetes Research and Clinical Practice, 2017; 132: 27-35.