Depression in pediatric care: is the WHO-Five Well-Being Index a valid screening instrument for children and adolescents?

Objective: This study investigated the criterion validity of the WHO-Five Well-Being Index (WHO-5) in screening for depression in pediatric care. Method: A total of 446 children aged 9 to 12 and 324 adolescents aged 13 to 16, recruited from pediatric hospitals, completed the WHO-5 and a structured diagnostic interview serving as the gold standard. Diagnoses of depressive disorder included major depression and minor depression. Criterion validity was analyzed using the area under the receiver operating curve (AUC). Sensitivity and specificity were computed for optimal cutoffs. Additionally, unaided clinical diagnoses of depression made by the attending pediatricians were assessed. Results: Diagnoses of depressive disorder were established for 3.6% of children and 11.7% of adolescents. AUCs were .88 for the child and .87 for the adolescent sample. A cutoff score of 10 for children maximized sensitivity (.75) and specificity (.92). For the adolescent sample, decreasing the cutoff score to 9 yielded optimal sensitivity (.74) and specificity (.89). Sensitivity of the unaided clinical diagnosis of depression was .09, while specificity was .96. Conclusions: The WHO-5 demonstrated good diagnostic accuracy for both age groups. Further evidence is needed to support the feasibility of the WHO-5 as a depression screening instrument used in pediatric care.