Pregnancy can often be complicated by reduced well-being and depressive episodes, which, if not addressed, may lead to severe adverse outcomes for both the mother and the infant. A recent study aimed to evaluate the psychometric validity of the 5-item World Health Organization Well-Being Index (WHO-5) and explore its potential as a proxy for core depressive symptoms, as identified in the Major Depression Inventory (MDI). Additionally, the research sought to assess overall well-being and identify risk factors for reduced well-being in pregnant women.
Study Overview and Methodology
The study involved analyzing the psychological well-being of 37,129 women in their first trimester of pregnancy, using the WHO-5 index. Psychometric validity was assessed through confirmatory factor analysis and item response theory. Furthermore, the study evaluated the sensitivity, specificity, and predictive values of two cut-off scores on the WHO-5 index (≤50 and ≤28), which have previously been associated with mental distress. These scores were compared with the MDI-2, a key tool for identifying depressive symptoms, in a subsample of 1,001 women.
Key Findings
The study found that certain demographics were more likely to report lower scores on the WHO-5 index, indicating reduced well-being. These factors included being aged 25 or younger, having lower educational attainment, unemployment, being nulliparous, not understanding the Danish language, living without a partner, smoking, and lack of physical activity prior to pregnancy. The results suggest that these social and behavioral factors play a role in a woman’s psychological health during pregnancy.
In terms of psychometric validity, the WHO-5 index proved to be a reliable tool for assessing mental well-being. However, the study highlighted that scores could not be directly compared between women who understood Danish and those who did not, suggesting that language barriers may impact the interpretation of results.
Predictive Power of WHO-5 Index
The study also explored the ability of the WHO-5 index to predict depressive symptoms based on the MDI-2. When using a cut-off score of ≤50 on the WHO-5 index, the sensitivity for detecting one core symptom of depression from the MDI-2 was 0.81, and specificity was 0.82, demonstrating strong predictive accuracy. However, using a more stringent cut-off score of ≤28 showed a sensitivity of only 0.32, though it exhibited a high specificity of 0.98, indicating its effectiveness in ruling out depressive symptoms in this group.
Conclusion
The WHO-5 index has proven to be a valid tool for assessing psychological well-being in pregnant women, with clear implications for identifying those at risk of mental distress. However, the study emphasizes the need for caution when comparing results across different linguistic groups. The findings suggest that the WHO-5 can serve as an effective screening tool for depressive symptoms in pregnant women, although further research is needed to optimize its use in diverse populations. Identifying key risk factors for reduced well-being can help guide more tailored interventions for expectant mothers, improving both maternal and infant health outcomes.
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