Home The WHO-5 well-being questionnaire in type 1 diabetes: screening for depression in pediatric and young adult subjects
Article
Licensed
Unlicensed Requires Authentication

The WHO-5 well-being questionnaire in type 1 diabetes: screening for depression in pediatric and young adult subjects

  • Sascha René Tittel EMAIL logo , Bernhard Kulzer , Petra Warschburger , Ulrich Merz , Angela Galler , Christian Wagner , Maike Plaumann , Erhard Siegel and Reinhard Walter Holl
Published/Copyright: February 22, 2023
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 36 Issue 4

Abstract

Objectives

To evaluate the WHO-5 tool in pediatric and young adult subjects with type 1 diabetes, and to analyse associations with demographic/psychological characteristics.

Methods

We included 944 patients with type 1 diabetes 9–25 years of age, documented in the Diabetes Patient Follow-up Registry between 2018 and 2021. We used ROC curve analysis to determine optimal cut-off values for the WHO-5 scores to predict psychiatric comorbidity (ICD-10-diagnoses) and analysed associations with obesity, HbA1c, therapy regimen, and lifestyle via logistic regression. All models were adjusted for age, sex, and diabetes duration.

Results

In the total cohort (54.8% male), the median score was 17 [Q1-Q3: 13–20]. Adjusted for age, sex, and diabetes duration, the WHO-5 scores<13 were associated with psychiatric comorbidity, especially depression and ADHD, poor metabolic control, obesity, smoking, and less physical activity. There were no significant associations with therapy regimen, hypertension, dyslipidemia, or social deprivation. In subjects with any diagnosed psychiatric disorder (prevalence 12.2%), the odds ratio for conspicuous scores was 3.28 [2.16–4.97] compared to patients without mental disorders. Using ROC analysis, the optimal cut-off to anticipate any psychiatric comorbidity in our cohort was 15, and 14 for depression.

Conclusions

The WHO-5 questionnaire is a useful tool to predict depression in adolescents with type 1 diabetes. ROC analysis suggests a slightly higher cut-off for conspicuous questionnaire results compared to previous reports. Due to the high rate of deviant results, adolescents and young adults with type-1 diabetes should be screened regularly for signs of psychiatric comorbidity.

Keywords: injection therapy; metabolic control; multicentre registry; psychiatric comorbidity; pump therapy
Corresponding author: Sascha René Tittel, MS, Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, D-89081 Ulm, Germany; and German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany, Phone: 0731-50-25483, Fax: 0731-50-25309, E-mail:

Funding source: German Diabetes Association (DDG)

Funding source: Robert Koch Institute (RKI)

Funding source: German Center for Diabetes Research (DZD)

Award Identifier / Grant number: 82DZD14E03

Acknowledgments

Special thanks to A. Hungele and R. Ranz for development of the DPV documentation software (clinical data managers, Ulm University). We further wish to thank all centers contributing to this analysis: Augsburg Uni-Kinderklinik, Bad Mergentheim - Kinderdiabetologische Praxis, Bocholt Kinderklinik, Bonn Uni-Kinderklinik, Bremen - Kinderklinik Nord, Bremen Zentralkrankenhaus Kinderklinik, Bruchweiler Edelsteinklinik Kinder-Reha, Dortmund Knappschaftskrankenhaus Innere, Duisburg Homberg Helios Rhein-Ruhr Kliniken GmbH, Duisburg St. Anna Innere Helios Rhein-Ruhr Kliniken GmbH, Filderstadt Kinderklinik, Gießen Uni-Kinderklinik, Gummersbach Oberbergklinikum, Hameln Kinderklinik, Heidelberg Uni-Kinderklinik, Jena Uni-Kinderklinik, Landau Innere, Ludwigshafen Kinderklinik St.Anna-Stift, Meissen Kinderklinik Elblandklinikum, Neuss Lukas-Krankenhaus Kinderklinik, Nürnberg Cnopfsche Kinderklinik, Rosenheim Kinderklinik, Schleswig Heliosklinik Kinderklinik, Schweinfurt Kinderklinik, Stolberg Kinderklinik, Traunstein Kinderklinik, Ulm Endokrinologikum Amedes, Wesel Marienhospital Kinderklinik, Wiesbaden Helios Horst-Schmidt-Kinderkliniken, Winnenden Rems-Murr Kinderklinik.

  1. Research funding: The DPV is supported through the German Federal Ministry for Education and Research within the German Center for Diabetes Research (DZD, grant no. 82DZD14E03). Further financial support was received from the Robert Koch Institute (RKI) and the German Diabetes Association (DDG). The funding organisation had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review and approval of the manuscript; and the decision to submit the manuscript for publication.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The protocol of DPV was approved by the ethics committee of Ulm University (confirmation no. 314/21), and data collection was approved by local review boards at the participating centres.

References

1. Steffen, A, Thom, J, Jacobi, F, Holstiege, J, Bätzing, J. Trends in prevalence of depression in Germany between 2009 and 2017 based on nationwide ambulatory claims data. J Affect Disord 2020;271:239–47. https://doi.org/10.1016/j.jad.2020.03.082.Search in Google Scholar PubMed

2. Delamater, AM, de Wit, M, McDarby, V, Malik, JA, Hilliard, ME, Northam, E, et al.. ISPAD clinical practice consensus guidelines 2018: psychological care of children and adolescents with type 1 diabetes. Pediatr Diabetes 2018;19:237–49. https://doi.org/10.1111/pedi.12736.Search in Google Scholar PubMed

3. Plener, PL, Molz, E, Berger, G, Schober, E, Mönkemöller, K, Denzer, C, et al.. Depression, metabolic control, and antidepressant medication in young patients with type 1 diabetes. Pediatr Diabetes 2015;16:58–66. https://doi.org/10.1111/pedi.12130.Search in Google Scholar PubMed

4. Buchberger, B, Huppertz, H, Krabbe, L, Lux, B, Mattivi, JT, Siafarikas, A. Symptoms of depression and anxiety in youth with type 1 diabetes: a systematic review and meta-analysis. Psychoneuroendocrinology 2016;70:70–84. https://doi.org/10.1016/j.psyneuen.2016.04.019.Search in Google Scholar PubMed

5. Roy, T, Lloyd, CE. Epidemiology of depression and diabetes: a systematic review. J Affect Disord 2012;142:8. https://doi.org/10.1016/S0165-0327(12)70004-6.Search in Google Scholar PubMed

6. Qiu, W, Cai, X, Zheng, C, Qiu, S, Ke, H, Huang, Y. Update on the relationship between depression and neuroendocrine metabolism. Front Neurosci 2021;15:728810. https://doi.org/10.3389/fnins.2021.728810.Search in Google Scholar PubMed PubMed Central

7. Musselman, DL, Nemeroff, CB. Depression and endocrine disorders: focus on the thyroid and adrenal system. Br J Psychiatr 1996;168:123–8. https://doi.org/10.1192/S0007125000298504.Search in Google Scholar

8. Köstner, K, Geirhos, A, Ranz, R, Galler, A, Schöttler, H, Klose, D, et al.. Angst und Depression bei Typ-1-Diabetes – Erste Ergebnisse des Screenings auf psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen im Rahmen des COACH-Konsortiums. Stuttgart, Germany: Georg Thieme Verlag KG; 2021.10.1055/a-1589-7922Search in Google Scholar

9. Tittel, SR, Dunstheimer, D, Hilgard, D, Knauth, B, Fröhlich-Reiterer, E, Galler, A, et al.. Coeliac disease is associated with depression in children and young adults with type 1 diabetes: results from a multicentre diabetes registry. Acta Diabetol 2021;58:623–31. https://doi.org/10.1007/s00592-020-01649-8.Search in Google Scholar PubMed PubMed Central

10. Prinz, N, Ebner, S, Grünerbel, A, Henkelüdecke, U, Hermanns, N, Hummel, M, et al.. Female sex, young age, northern German residence, hypoglycemia and disabling diabetes complications are associated with depressed mood in the WHO-5 questionnaire - a multicenter DPV study among 17,563 adult patients with type 2 diabetes. J Affect Disord 2017;208:384–91. https://doi.org/10.1016/j.jad.2016.08.077.Search in Google Scholar PubMed

11. Stahl-Pehe, A, Selinski, S, Bächle, C, Castillo, K, Lange, K, Holl, RW, et al.. Overestimation and underestimation of youths’ health-related quality of life are associated with youth and caregiver positive screens for depression: results of a population-based study among youths with longstanding type 1 diabetes. Diabetol Metab Syndrome 2022;14:40. https://doi.org/10.1186/s13098-022-00809-w.Search in Google Scholar PubMed PubMed Central

12. American Diabetes Association. 13. Children and adolescents: standards of medical care in diabetes-2020. Diabetes Care 2020;43:S163–82. https://doi.org/10.2337/dc20-S013.Search in Google Scholar PubMed

13. Topp, CW, Østergaard, SD, Søndergaard, S, Bech, P. The WHO-5 well-being index. Psychother Psychosom 2015;84:167–76. https://doi.org/10.1159/000376585.Search in Google Scholar PubMed

14. The World Health Organisation-Five Well-Being Index (WHO-5). Available from: https://www.corc.uk.net/outcome-experience-measures/the-world-health-organisation-five-well-being-index-who-5/ [Accessed 17 Nov 2021].Search in Google Scholar

15. S3-Leitlinie/Nationale Versorgungsleitlinie Unipolare Depression. Available from: https://www.leitlinien.de/themen/depression/2-auflage [Accessed 7 Feb 2022].Search in Google Scholar

16. WHO-5 questionnaires. Available from: https://www.psykiatri-regionh.dk/who-5/who-5-questionnaires/Pages/default.aspx [Accessed 7 Jun 2022].Search in Google Scholar

17. Nicolucci, A, Rossi, MC, Pellegrini, F, Lucisano, G, Pintaudi, B, Gentile, S, et al.. Benchmarking network for clinical and humanistic outcomes in diabetes (BENCH-D) study: protocol, tools, and population. SpringerPlus 2014;3:83. https://doi.org/10.1186/2193-1801-3-83.Search in Google Scholar PubMed PubMed Central

18. Kulzer, B, Lüthgens, B, Landgraf, R, Hermanns, N. Diabetesbezogene Belastungen, Wohlbefinden und Einstellung von Menschen mit Diabetes. Diabetologe 2015;11:211–8. https://doi.org/10.1007/s11428-015-1335-8.Search in Google Scholar

19. Brähler, E, Mühlan, H, Albani, C, Schmidt, S. Teststatistische Prüfung und Normierung der deutschen Versionen des EUROHIS-QOL Lebensqualität-Index und des WHO-5 Wohlbefindens-Index. Diagnostica 2007;53:83–96. https://doi.org/10.1026/0012-1924.53.2.83.Search in Google Scholar

20. Nagy, B, Laczkóné Majer, R. Specific quality of life factors in patients with inflammatory bowel disease. Orv Hetil 2012;153:1511–9. https://doi.org/10.1556/OH.2012.29369.Search in Google Scholar PubMed

21. Tadele, H, Ahmed, H, Mintesnot, H, Gedlu, E, Guteta, S, Yadeta, D. Subjective wellbeing among rheumatic heart disease patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: observational cross-sectional study. BMC Health Serv Res 2021;21:1354. https://doi.org/10.1186/s12913-021-07378-0.Search in Google Scholar PubMed PubMed Central

22. Balázs, J, Miklósi, M, Keresztény, A, Hoven, CW, Carli, V, Wasserman, C, et al.. Comorbidity of physical and anxiety symptoms in adolescent: functional impairment, self-rated health and subjective well-being. Int J Environ Res Publ Health 2018;15. https://doi.org/10.3390/ijerph15081698.Search in Google Scholar PubMed PubMed Central

23. Craig, ME, Prinz, N, Boyle, CT, Campbell, FM, Jones, TW, Hofer, SE, et al.. Prevalence of celiac disease in 52,721 youth with type 1 diabetes: international comparison across three continents. Diabetes Care 2017;40:1034–40. https://doi.org/10.2337/dc16-2508.Search in Google Scholar PubMed PubMed Central

24. Schaffrath Rosario, A, Kurth, BM, Stolzenberg, H, Ellert, U, Neuhauser, H. Body mass index percentiles for children and adolescents in Germany based on a nationally representative sample (KiGGS 2003–2006). Eur J Clin Nutr 2010;64:341–9. https://doi.org/10.1038/ejcn.2010.8.Search in Google Scholar PubMed

25. Donaghue, KC, Marcovecchio, ML, Wadwa, RP, Chew, EY, Wong, TY, Calliari, LE, et al.. ISPAD clinical practice consensus guidelines 2018: microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes 2018;19:262–74. https://doi.org/10.1111/pedi.12742.Search in Google Scholar PubMed PubMed Central

26. Kroll, LE, Schumann, M, Hoebel, J, Lampert, T. Regional health differences – developing a socioeconomic deprivation index for Germany. Berlin, Germany: Robert Koch-Institut, Epidemiologie und Gesundheitsberichterstattung; 2017.Search in Google Scholar

27. Zweig, MH, Campbell, G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 1993;39:561–77. https://doi.org/10.1093/clinchem/39.4.561.Search in Google Scholar

28. Lins, S, Koch, R, Aquino, S, de Freitas Melo, C, Costa, IM. Anxiety, depression, and stress: can mental health variables predict panic buying? J Psychiatr Res 2021;144:434–40. https://doi.org/10.1016/j.jpsychires.2021.11.008.Search in Google Scholar PubMed

29. Bansal, P, Chaudhary, A, Soni, RK, Sharma, S, Gupta, VK, Kaushal, P. Depression and anxiety among middle-aged women: a community-based study. J Fam Med Prim Care 2015;4:576–81. https://doi.org/10.4103/2249-4863.174297.Search in Google Scholar PubMed PubMed Central

30. Noble, RE. Depression in women. Metabolism 2005;54:49–52. https://doi.org/10.1016/j.metabol.2005.01.014.Search in Google Scholar PubMed

31. Hyde, JS, Mezulis, AH. Gender differences in depression: biological, affective, cognitive, and sociocultural factors. Harv Rev Psychiatr 2020;28:4–13. https://doi.org/10.1097/HRP.0000000000000230.Search in Google Scholar PubMed

32. Pinquart, M, Shen, Y. Depressive symptoms in children and adolescents with chronic physical illness: an updated meta-analysis. J Pediatr Psychol 2011;36:375–84. https://doi.org/10.1093/jpepsy/jsq104.Search in Google Scholar PubMed

33. Warschburger, P. Chronisch kranke Kinder und Jugendliche - Psychosoziale Belastungen und Bewältigungsanforderungen. Göttingen: Hogrefe; 2000, vol 3.Search in Google Scholar

34. World Health Organization. Growth reference charts 2-5 and 5-19 years. Available from: www.who.int/growthref/who2007_bmi_for_age/en/ [Accessed 27 Oct 2021].Search in Google Scholar

35. Depression and other common mental disorders: global health estimates. Geneva: World Health Organization; 2017.Search in Google Scholar

36. Luppino, FS, de Wit, LM, Bouvy, PF, Stijnen, T, Cuijpers, P, Penninx, BWJH, et al.. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatr 2010;67:220–9. https://doi.org/10.1001/archgenpsychiatry.2010.2.Search in Google Scholar PubMed

37. de Wit, LM, van Straten, A, van Herten, M, Penninx, BWJH, Cuijpers, P. Depression and body mass index, a u-shaped association. BMC Publ Health 2009;9:14. https://doi.org/10.1186/1471-2458-9-14.Search in Google Scholar PubMed PubMed Central

38. McClintock, JM, Blackmore, T, Chepulis, LM, Fraser, S, Paul, RG. The psychological profile of youth and young adults with type 1 diabetes in New Zealand. Pediatr Diabetes 2022;23:150–6. https://doi.org/10.1111/pedi.13289.Search in Google Scholar PubMed

39. Galler, A, Tittel, SR, Baumeister, H, Reinauer, C, Brosig, B, Becker, M, et al.. Worse glycemic control, higher rates of diabetic ketoacidosis, and more hospitalizations in children, adolescents, and young adults with type 1 diabetes and anxiety disorders. Pediatr Diabetes 2021;22:519–28. https://doi.org/10.1111/pedi.13177.Search in Google Scholar PubMed

40. Harrington, KR, Shapira, A, Volkening, LK, Butler, DA, Anderson, BJ, Wasserman, RM, et al.. Associations of diabetes self-management characteristics, HbA1c, and psychosocial outcomes with depressive symptoms in a contemporary sample of adolescents with type 1 diabetes. J Diabet Complicat 2021;35:107838. https://doi.org/10.1016/j.jdiacomp.2020.107838.Search in Google Scholar PubMed PubMed Central

41. Grant, P, Dworakowska, D, DeZoysa, N, Barnes, D. The impact of anxiety and depression on patients within a large type 1 diabetes insulin pump population. An observational study. Diabetes Metab 2013;39:439–44. https://doi.org/10.1016/j.diabet.2013.06.003.Search in Google Scholar PubMed

42. Grunberger, G, Abelseth, JM, Bailey, TS, Bode, BW, Handelsman, Y, Hellman, R, et al.. Consensus statement by the American association of clinical Endocrinologists/American College of Endocrinology insulin pump management task force. Endocr Pract 2014;20:463–89. https://doi.org/10.4158/EP14145.PS.Search in Google Scholar PubMed

43. Verbiest, I, Blechert, J, Debeuf, T, Verbeken, S, Klosowska, JC, Michels, N, et al.. Is there stress eating in children and adolescents? A first validation of the Dutch version of the Salzburg Stress Eating Scale. Appetite 2021;167:105657. https://doi.org/10.1016/j.appet.2021.105657.Search in Google Scholar PubMed

44. Sharma, A, Madaan, V, Petty, FD. Exercise for mental health. Prim Care Companion J Clin Psychiatry 2006;8:106. https://doi.org/10.4088/pcc.v08n0208a.Search in Google Scholar PubMed PubMed Central

45. Long, D. Smoking as a coping strategy. Nurs Times 2003;99:53.Search in Google Scholar

46. Slabšinskienė, E, Gorelik, A, Kavaliauskienė, A, Zaborskis, A. Burnout, lifestyle and relaxation among dentists in Lithuania: a cross-sectional study. BMC Health Serv Res 2021;21:1098. https://doi.org/10.1186/s12913-021-07074-z.Search in Google Scholar PubMed PubMed Central

47. Chen, X. Relative deprivation and individual well-being: low status and a feeling of relative deprivation are detrimental to health and happiness. Bonn, Germany: IZA World Labor; 2015.10.15185/izawol.140Search in Google Scholar PubMed PubMed Central

48. Greitemeyer, T, Sagioglou, C. The impact of personal relative deprivation on aggression over time. J Soc Psychol 2019;159:664–75. https://doi.org/10.1080/00224545.2018.1549013.Search in Google Scholar PubMed PubMed Central

49. Auzanneau, M, Rosenbauer, J, Maier, W, von Sengbusch, S, Hamann, J, Kapellen, T, et al.. Heterogeneity of access to diabetes technology depending on area deprivation and demographics between 2016 and 2019 in Germany. J Diabetes Sci Technol 2021;15:1059–68. https://doi.org/10.1177/19322968211028608.Search in Google Scholar PubMed PubMed Central

50. Poethko-Müller, C, Kuntz, B, Lampert, T, Neuhauser, H. The general health of children and adolescents in Germany. Results of the cross-sectional KiGGS wave 2 study and trends. J Health Monit 2018;3:8–14. https://doi.org/10.17886/RKI-GBE-2018-021.Search in Google Scholar PubMed PubMed Central

Received: 2023-01-10
Accepted: 2023-02-01
Published Online: 2023-02-22
Published in Print: 2023-04-25

© 2023 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. Approach to nutritional rickets
  4. Subclinical hyperthyroidism in children
  5. Original Articles
  6. Can thyroid elastography with ultrasound be used to stage children with Hashimoto’s thyroiditis?
  7. Congenital hypothyroidism in children with eutopic gland or thyroid hemiagenesis: prognostic factors for transient vs. permanent hypothyroidism
  8. Comparison of developmental outcomes in children with permanent and transient congenital hypothyroidism
  9. Impact of overweight and obesity on epicardial adipose tissue in children with type 1 diabetes
  10. Peripheral arterial disease among children with type 1 diabetes mellitus in a Nigerian teaching hospital
  11. The WHO-5 well-being questionnaire in type 1 diabetes: screening for depression in pediatric and young adult subjects
  12. Clinical correlation of 2D shear wave elastography findings in children with type 1 diabetes mellitus without autoimmune thyroiditis
  13. Molecular analysis of MKRN3 gene in Turkish girls with sporadic and familial idiopathic central precocious puberty
  14. Case Reports
  15. ALG11-CDG: novel variant and review of the literature
  16. Betamethasone cream to treat diapers rash causing Cushing syndrome
  17. Rapid-onset obesity, hypothalamic dysfunction, hypoventilation, and autonomic dysregulation syndrome – neuro-endocrine tumours (ROHHAD-NET): case series and learning points
  18. Lathosterolosis: a rare cholesterol metabolism disorder with a wide range of clinical variability
  19. Urea as safe treatment for hyponatremia due to syndrome of inappropriate antidiuretic hormone in infant with solitary central incisor and neurofibromatosis-1
https://doi.org/10.1515/jpem-2023-0013
Keywords for this article
injection therapy; metabolic control; multicentre registry; psychiatric comorbidity; pump therapy

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. Approach to nutritional rickets
  4. Subclinical hyperthyroidism in children
  5. Original Articles
  6. Can thyroid elastography with ultrasound be used to stage children with Hashimoto’s thyroiditis?
  7. Congenital hypothyroidism in children with eutopic gland or thyroid hemiagenesis: prognostic factors for transient vs. permanent hypothyroidism
  8. Comparison of developmental outcomes in children with permanent and transient congenital hypothyroidism
  9. Impact of overweight and obesity on epicardial adipose tissue in children with type 1 diabetes
  10. Peripheral arterial disease among children with type 1 diabetes mellitus in a Nigerian teaching hospital
  11. The WHO-5 well-being questionnaire in type 1 diabetes: screening for depression in pediatric and young adult subjects
  12. Clinical correlation of 2D shear wave elastography findings in children with type 1 diabetes mellitus without autoimmune thyroiditis
  13. Molecular analysis of MKRN3 gene in Turkish girls with sporadic and familial idiopathic central precocious puberty
  14. Case Reports
  15. ALG11-CDG: novel variant and review of the literature
  16. Betamethasone cream to treat diapers rash causing Cushing syndrome
  17. Rapid-onset obesity, hypothalamic dysfunction, hypoventilation, and autonomic dysregulation syndrome – neuro-endocrine tumours (ROHHAD-NET): case series and learning points
  18. Lathosterolosis: a rare cholesterol metabolism disorder with a wide range of clinical variability
  19. Urea as safe treatment for hyponatremia due to syndrome of inappropriate antidiuretic hormone in infant with solitary central incisor and neurofibromatosis-1
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 12.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/jpem-2023-0013/html
Scroll to top button