Validation of the World Health Organization Well-Being Index (WHO-5) among medical educators in Hong Kong: a confirmatory factor analysis

Ability and utility of the Physician Well-Being Index to identify distress among Chinese physicians

BACKGROUND

Despite the high prevalence of mental stress among physicians, reliable screening tools are scarce. This study aimed to evaluate the capability of the Physician Well-Being Index (PWBI) in identifying distress and adverse consequences among Chinese physicians.

METHODS

This cross-sectional online survey recruited 2803 physicians from Southern Mainland China via snowball sampling between October and December 2020. Data on socio-demographic characteristics, the PWBI, mental distress (including quality of life [QOL], burnout, sleepiness, fatigue and suicidal ideation) and adverse outcomes (medical errors and turnover intention) were collected. Chi-square tests and logistic regression were used for data analysis.

RESULTS

Seven items of the PWBI (emotional exhaustion, depression, stress, poor mental and physical QOL, low work meaning and dissatisfaction with work-life integration) were independently associated with low QOL (all p < 0.05). Physicians with lower QOL were more likely to endorse each item (OR: 1.76-5.86) and less likely to have favourable index scores (all p < 0.001). Assuming a prevalence of 29.2% for low QOL, the PWBI could reduce the post-test probability to 6.9% or increase it to 70.8%. Physicians scoring ≥4 on the PWBI were at increased risk (likelihood ratio >1) for experiencing various mental distress, with sensitivity exceeding 80% in detecting burnout, depression, high stress and anxiety. Additionally, the PWBI score helped stratify physicians' likelihood of reporting medical errors and turnover intention.

CONCLUSIONS

This study provides preliminary insights into the validity and utility of the 9-item PWBI as a screening tool for assessing distress and well-being among Chinese physicians, helping identify those at higher risk of medical errors or turnover. However, these findings should be interpreted with caution due to the limited sample size.

Four scales measuring mental wellbeing in the Nordic countries: do they tell the same story?

BACKGROUND

Mental wellbeing is an important focus in surveys among adolescents. Several relevant instruments are available. In the Nordic part of the Health Behaviour in School-aged Children (HBSC) study 2022, four different scales for the measurement of wellbeing, were employed: Cantril's Ladder, the WHO-5 Wellbeing Index, the seven-item Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS), and the HBSC Health Complaints Scale. This study aims to examine statistically to what extent these scales overlap or measure distinctly different aspects of mental wellbeing.

METHODS

Data stem from the Nordic part of the HBSC 2022 study (n = 28 189). In all statistical analyses, data are weighted to ensure equal representation of genders, age groups (ages 11, 13, and 15 years), and countries (Denmark, Finland, Iceland, Norway, Sweden). Adjustments were made for cluster effects (school classes). The statistical analyses included factor analysis, general linear modeling, variants of latent variable analysis, and structural equation modeling including bifactor modeling.

RESULTS

Exploratory factor analysis produced three factors corresponding well to the three multi-item instruments, with the single item Cantril's ladder loading on the factor defined by the WHO-5 Wellbeing Index. Confirmatory factor analysis produced good fit for a model with one factor consisting of the three positively worded scales and a separate factor for health complaints, but with a high negative correlation between the two factors. Analyses of each of the four scales against gender, age, and 16 other covariates, showed strikingly similar patterns of associations. In an analysis based on a hierarchical model, adjustments for the general mental wellbeing (second-order) factor reduced associations between the first-order factors (one for each scale) and covariates substantially. Latent variable and bifactor modeling confirmed that most of the covariance among all items from all scales combined was captured by one general dimension. Information curve analysis showed that for all scales, the most reliable scores were obtained for participants with below average latent scores.

CONCLUSION

The study indicates that the four scales essentially reflect one underlying dimension. In studies such as HBSC, efforts should be made to use instruments that cover distinctly different aspects of mental health and wellbeing.

Study and personal resources of university students' academic resilience and the relationship with positive psychological outcomes

Introduction

Embarking on university-level studies is a period of new challenges for young people as they meet new academic demands, environments, and teaching systems. Academic resilience, defined as students' capacity to endure challenges while sustaining optimism, positive thinking, and emotional stability, is crucial in enabling individuals to navigate academic difficulties and foster future success. In this context, developing the role of contextual and personal factors in university students' academic resilience and its role in predicting positive psychological outcomes is crucial. This study, grounded in the Study Demands-Resources framework, sought to examine study-related characteristics and self-efficacy as resources that support students' academic resilience. Additionally, it aimed to explore the connections between academic resilience and positive psychological outcomes, such as student engagement and well-being.

Method

The convenience study sample included 350 students from Lithuanian universities: 79.14% were female, the mean age was 23.8 years (SD = 5.7). Students were in varying bachelor's and master's study programs. Data were collected using a self-administered online survey. Descriptive statistics, correlation, regression analyses, and structural equation modelling were applied for data analysis.

Results and conclusion

The study found that students' academic resilience was positively influenced by the characteristics of their study environment and self-efficacy. Furthermore, academic resilience was positively associated with student engagement and well-being. Our findings highlight the role of academic resilience in mediating the interplay between study-related resources, student engagement, and well-being. This research study features practical implications for enhancing university students' academic resilience, engagement, and well-being by strengthening both study-related and personal resources.

Cross-sectional analysis of the association between information and communication technology and mental health among Korean workers

BACKGROUND

The adoption of information and communication technology (ICT) has been the fastest and most widespread in the South Korean workplace. While ICT has several advantages, it can also cause stress among workers. However, the relationship between the introduction of ICT in the workplace and mental health problems among Korean workers remains unclear.

METHODS

We conducted a cross-sectional analysis of data obtained from the sixth Korean Working Conditions Survey (KWCS). In total, 40,019 participants answered a question about whether ICT had been introduced in their workplace. Among these, we compared the rate of complaints of mental health disorders between those who answered "yes" (n = 3,250) and those who answered "no" (n = 36,769). We analyzed the data using the SAS statistical software and calculated the odds ratios (ORs) and 95% confidence intervals (95% CIs) for anxiety, insomnia, and depression using multiple logistic regression models. We also stratified the data on Korean workers to assess the impact of ICT on subgroups.

RESULTS

In our nationally representative cohort, on experiencing ICT incorporation at work, 384 participants (11.8%) reported anxiety, 138 (4.2%) reported insomnia, and 296 (9.1%) reported depression. In contrast, among participants who did not have access to ICT, 1,929 (5.2%) reported anxiety, 702 (1.9%) reported insomnia, and 4,404 (12.0%) reported depression. The ORs (95% CIs) for anxiety and insomnia complaint rates were 2.47 (2.19-2.79) and 2.55 (2.10-3.10), respectively, among workers who experienced new ICT adaptations in comparison with those who did not. However, no significant relationship was observed between ICT adoption and depression.

CONCLUSIONS

The causes of mental health problems in the workplace should be identified and addressed. We found that the introduction of ICT in the workplace was significantly related to anxiety and insomnia symptoms among Korean workers, after controlling for the selected covariates. This information can be used to identify subgroups in the workplace that are vulnerable to ICT changes and tailor interventions to their social and demographic profiles.

Assessing the psychometric properties of the World Health Organization -five well-being index (WHO-5) in Filipino samples amid the COVID-19 pandemic

BACKGROUND

The WHO-5 well-being index is a brief rating scale extensively used to evaluate well-being symptoms. Despite the increasing number of studies validating this instrument across different samples from different countries, its psychometric properties remain unexplored in the Philippine context. Bridging this gap, the present study assessed the psychometric properties of the WHO-5 in Filipinos amid the pandemic.

METHODS

In study one, exploratory structural equation modeling (ESEM) was conducted using a sample of Filipinos (N = 2,521) from the general population and a unidimensional model of well-being was extracted. In study two, confirmatory factor analysis (CFA) was employed to examine the one-factor model in 1,289 Filipino government workers. In study three, nomological validity was examined by performing a mediation analysis using 407 Filipino left-behind emerging adult children with dysfunctionality as mediator, pandemic-related adversities as independent variable, and well-being as the dependent variable.

RESULTS

The results of ESEM and CFA provided support for the WHO-5 one-factor model. Moreover, the negative relationship of well-being to anxiety, depression, and distress lend evidence to the scale's criterion validity. The results of the mediation analysis performed in study three implied that those who experienced pandemic-related adversities tended to have greater dysfunctionality, and in turn, had lower levels of well-being.

CONCLUSIONS

Overall, the findings suggest that the WHO-5 well-being index is a psychometrically sound tool for measuring Filipinos' well-being.

Measurement Properties and Optimal Cutoff Point of the WHO-5 Among Chinese Healthcare Students

Purpose

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.

Psychometric Properties of the WHO-5 Well-Being Index among Nurses during the COVID-19 Pandemic: A Cross-Sectional Study in Three Countries

Nurses' well-being has been increasingly recognised due to the ongoing pandemic. However, no validation scales measuring nurses' well-being currently exist. Thus, we aimed to validate the WHO-5 Well-Being Index (WHO-5) in a sample of nurses. A cross-sectional multinational study was conducted, and a total of 678 nurses who worked during the COVID-19 pandemic in Spain (36.9%), Chile (40.0%) and Norway (23.1%) participated in this study. The nurses completed the WHO-5, the Patient Health Questionnaire-2 (PHQ-2), the Generalized Anxiety Disorder-2 (GAD-2) and three questions about the quality of life (QoL). The WHO-5 demonstrated good reliability and validity in the three countries. Cronbach's alphas ranged from 0.81 to 0.90. High correlations were found between the WHO-5 and the psychological well-being dimension of QoL, and negative correlations between the WHO-5 and PHQ-2. The unidimensional scale structure was confirmed in all the countries, explaining more than 68% of the variance. The item response theory likelihood ratio model did not show discernible differences in the WHO-5 across the countries. To conclude, the WHO-5 is a psychometrically sound scale for measuring nurses' well-being during a pandemic. The scale showed strong construct validity for cross-cultural comparisons; however, more research is required with larger sample sizes.