The 5-Item Who Well-Being Index as a Screening Tool for Depression in a Population of Doctors and Nurses in Nigeria during the COVID-19 Pandemic

Abstract

Background: Undetected depression can result in a significant decline in productivity among the workforce in every system, the healthcare sector inclusive. It is vital to utilize brief screening tools to detect populations at risk of depression. The 5-item WHO Well-being Index (WHO-5) has been used as a screening measure for depression, but research on this is scarce in sub-Saharan Africa. This study aimed to determine the utility and validity of the WHO-5 in screening for depression in a population of doctors and nurses in Nigeria during the COVID-19 pandemic. Methods: A representative sample of medical doctors and nurses across Nigeria (n = 464), completed the 5-item World Health Organization Well-Being Index (WHO-5) and the 9-item Patient Health Questionnaire (PHQ-9). Results: The pattern of factors associated with cases of a positive depression screening was considerably similar for the WHO-5 and the PHQ-9. At a cut-off score of 50 for the WHO-5, the sensitivity and specificity values obtained were 0.857 and 0.851 respectively. Positive and negative predictive values were 0.404 and 0.981 respectively. ROC analysis of the WHO-5 against the PHQ-9 revealed that, at a cut-off of 50, the sensitivity of the WHO-5 was 0.857, 1-specificity was 0.152. The AUC was 0.918 (95% CI 0.884-0.953). Also, there was a strong, negative correlation between the WHO and the PHQ-9 scores (r = -0.590, p ≤ 0.0001). Conclusion: The WHO-5 well-being index has satisfactory validity as a screening tool for the detection of depression. It is also feasible for use in very busy settings, because of its brevity and ease of administration.