Psychology Research and Behavior Management (Dec 2023)
Measurement Properties and Optimal Cutoff Point of the WHO-5 Among Chinese Healthcare Students
Abstract
Nongnong Yang,1,* Haiyan Ma,1,2 Mengyi Huang,1,* Esther Yuet Ying Lau,3– 5 Daniel Yee Tak Fong,6 Meng Wang,7 Pengqiao Wang,1 Siyi Xu,8 Jiale Xu,1 Chen Jiang,1 Yi Luo,9 Runtang Meng1,2,* 1School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, People’s Republic of China; 2Engineering Research Center of Mobile Health Management System, Ministry of Education, Hangzhou, Zhejiang, People’s Republic of China; 3Sleep Laboratory, Department of Psychology, The Education University of Hong Kong, Hong Kong, People’s Republic of China; 4Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong, People’s Republic of China; 5Centre for Religious and Spirituality Education, The Education University of Hong Kong, Hong Kong, People’s Republic of China; 6School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People’s Republic of China; 7Ophthalmology Center, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang, People’s Republic of China; 8School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, People’s Republic of China; 9School of Nursing, Ningbo College of Health Sciences, Ningbo, Zhejiang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Runtang Meng; Haiyan Ma, School of Public Health, Hangzhou Normal University, No. 2318, Yuhangtang Road, Yuhang District, Hangzhou, Zhejiang, 311121, People’s Republic of China, Email [email protected]; [email protected]: The World Health Organization-Five Well-Being Index (WHO-5) is widely used to assess subjective well-being. Nevertheless, measurement invariance and optimal cutoff point of the WHO-5 have not been examined in Chinese samples. We aimed to assess measurement properties of the Chinese version of the WHO-5 (WHO-5-C) among healthcare students.Patients and Methods: A two-wave longitudinal assessment was conducted among 343 Chinese healthcare students from September to November 2022. Measurement properties of the WHO-5-C were assessed through structural validity using confirmatory factor analysis (CFA), measurement invariance using multigroup CFA (MGCFA) and longitudinal CFA (LCFA), convergent validity using correlation analysis with the Self-Rated Health Questionnaire (SRHQ) and Patient Health Questionnaire-4 (PHQ-4), reliability using internal consistency and test–retest reliability, and optimal cutoff point using receiver operating characteristic (ROC) analysis.Results: The WHO-5-C demonstrated satisfactory structural validity with comparative fit index (CFI) of 0.968 at baseline and 0.980 at follow-up, and adequate measurement invariance in different sociodemographic variables at baseline (gender, age, major, home location, being only child, monthly household income, part-time job, physical exercise, hobby, frequency of visiting home, and stress coping strategy) (CFI changes [ΔCFI] = − 0.009– 0.003) and over a week (ΔCFI = − 0.006– 0.000). The WHO-5-C also had good internal consistency (Cronbach’s α = 0.907– 0.934; McDonald’s ω = 0.908– 0.935) and test–retest reliability (intraclass correlation coefficient [ICC] = 0.803). Convergent validity was supported by moderate correlations of the WHO-5-C with the SRHQ and PHQ-4. The optimal cutoff point of the WHO-5-C was found to be 50, with an area under the ROC curve of 0.882 at baseline data, with sensitivity of 0.803 and specificity of 0.762 at follow-up.Conclusion: The WHO-5-C demonstrated adequate measurement properties, especially concerning cross-sectional and longitudinal measurement invariance, with a recommended optimal cutoff point of ≥ 50 for assessing adequate level of psychological well-being in healthcare students.Keywords: WHO-5 Well-Being Index, subjective well-being, measurement properties, diagnostic performance, observational longitudinal design, healthcare students
