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© 2012 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd
Acta Psychiatr Scand 2013: 127: 331–332
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ACTA PSYCHIATRICA SCANDINAVICA
Letter to the editor
Psychometric properties of the Taiwanese version
of the World Health Organization-Five Well-Being
index
DOI: 10.1111/acps.12040
Psychological studies show that early detection in high-risk
groups of mental illness is a critical public health issue (1),
especially in depressive disorder, for such mental illness may
negatively affect their well-being.
Additionally, studies on mental health interventions have
focused on ameliorating suffering, weakness, and anxiety
rather than on increasing happiness and well-being. Chida and
Steptoe indicated that positive psychological well-being has a
favorable effect on survival in both healthy and diseased populations (2). A number of structured interviews and tests have
been developed in Taiwan, all of which are extensive, time consuming, and focus on negative effect. The World Health
Organization-Five Well-Being Index (WHO-5) is a self-administered five-item scale that provides a brief screening tool for
detecting depression (3). We have examined the reliability and
validity of the Taiwanese version of the WHO-5 (WHO-5TW), which is short and easy to use as a brief screening tool
for well-being, and to development the first positive depression
screening tool in Taiwan. The English version of the WHO-5
Well-Being Index was translated into traditional Chinese.
Final adjustments were performed, including back translation,
cross-cultural adaptation and field testing of the pre-final
version. The WHO-5-TW was administered randomly to 242
community samples. Their mean age was 40.3 years, and 64%
of them were female. Significant differences in the WHO-5-TW
total scores were observed between the male and female
subjects [male vs. female (mean SD), 15.93 4.62 vs.
13.50 5.30, t = 3.72, P < 0.001). The females experienced
depression at roughly two or three times the rate of males.
There were significant differences in the Chinese Health Questionnaire 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-5TW (alpha coefficient = 0.94) was excellent. The homogeneity
and unidimensionality were also good, with a Loevinger coefficient of 0.80. The Loevinger coefficient is an analysis of unidimensionality that tests the extent to which an extra item fits
into the structure established by other items of a scale (4). We
determined the convergent validity of the WHO-5-TW in relation to the Chinese Health Questionnaire (CHQ) (5), which is
scored in the opposite direction (r = 0.68; P < 0.001). The
General Health Questionnaire has been shown to be a useful
screening method to detect non-psychotic mental disorders in
general clinical settings (5). Factor analysis identified only one
factor that explained 80.8% of the variance.
Among the limitations to be mentioned, first, the study was
conducted exclusively in a community in Hualien County in
the east of Taiwan. Second, discriminatory validity for the
detection of depression disorders was not examined in the present study because we know that depression disorders may
influence respondents’ subjective well-being. Finally, there was
a possibility that our respondents under- or over-reported their
feelings, which may occur in any subjective study.
The WHO-5-TW was found to be a reliable and valid selfassessment instrument to screen well-being and depression in a
community population in Taiwan.
C.-H. Lin1, S.-M. Lee1,2, B.-J. Wu1,
L.-S. Huang1, H.-J. Sun1 and H.-F. Tsen3,4
1
Department 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 Health
Sciences, Taipei City, Taiwan
E-mail: [email protected]
References
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risk of developing a first psychosis: comparison of two
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2. Chida Y, Steptoe A. Positive psychological well-being and
mortality: a quantitative review of prospective observational studies. Psychosom Med 2008;70:741–756.
3. Bonsignore M, Barkow K, Jessen F, Heun R. Validity of the
five-item WHO Well-Being Index (WHO-5) in an elderly
population. Eur Arch Psychiatry Clin Neurosci 2001;251
(Suppl 2):II27–II31.
4. Mokken RJ. A theory and procedure of scale analysis: with
applications in political research. New York: De Gruyter;
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