General Health Questionnaire 12-item Version Research Articles

Measurement Invariance of the General Health Questionnaire GHQ 12-Item Version (GHQ-12)

Abstract: Understanding how levels, patterns, predictors, and outcomes of mental health issues differs in students relative to non-students can inform more effective and better tailored prevention and intervention for mental health in higher education contexts. However, comparisons of mental health in student and non-student groups depend on the critical but seldom-tested assumption of measurement invariance. In this study, we use data from the UK household longitudinal study (UKLS) to evaluate the measurement invariance of the scores from a commonly used mental health measure: the General Health Questionnaire 12-item version (GHQ-12) across students and non-students. Using a bifactor model to take account of wording factors we found measurement invariance up to the scalar level for students and non-student groups. This provides support for the use of instruments for comparing mental health issue levels and candidate risk factors and outcomes across students and non-students.

Trajectories of musculoskeletal pain among midlife employees

Abstract Background We examined the developmental trajectories of multisite musculoskeletal pain to acquire the developmental patterns of musculoskeletal pain among midlife municipal employees and whether pain trajectories associate with common mental disorders or behaviors. Methods Middle-aged (44 to 67 years) municipal employees from the city of Helsinki were studied. The baseline survey was conducted in 2000-02 (N = 8960) and two follow-up surveys in 2007 (N = 7332) and 2012 (N = 6809). Repeated measurement of musculoskeletal pain in four anatomical sites was obtained. Trajectories of number of pain sites (0-4) were modeled using latent class growth analysis (n = 6527). Common mental disorders were measured using the General Health Questionnaire 12-item version (GHQ-12). Information on behavior factors, morbidity, and the socioeconomic position was obtained from the questionnaire survey. Associations of baseline factors with pain trajectories were assessed by multinomial logistic regression. Results We found four distinct trajectories of the number of pain sites: high (15%), increasing (24%), decreasing (20%) and low (41%). In multivariable multinomial regression model high, increasing and decreasing trajectories were strongly associated with higher odds with both medium and high common mental disorders. However, the magnitude of the association was much higher for high vs. low trajectory group due to medium (OR 3.70, 95% CI 2.81-4.89) and high (OR 5.37, 95% 4.36-6.61) common mental disorders. Mean score of common mental disorders was also highest for high trajectory group. High, increasing and decreasing trajectory group were also associated with poor behavior, having one or more musculoskeletal comorbidities and low socioeconomic position. Conclusions Multisite musculoskeletal pain remain persistent among midlife employees and those high trajectories of musculoskeletal pain are associated with common mental disorders, behavior, and musculoskeletal comorbidities. Key messages Four distinct trajectories of number of pain sites was identified among midlife municipal employees. High common mental disorders and poor behavior, as well as low socioeconomic position and musculoskeletal comorbidities were strongly associated with pain trajectories.

Dopamine Augmented Rehabilitation in Stroke (DARS): a multicentre double-blind, randomised controlled trial of co-careldopa compared with placebo, in addition to routine NHS occupational and physical therapy, delivered early after stroke on functional recovery

Background Dopamine is a key modulator of striatal function and learning, and may improve motor recovery after stroke. Seven small trials of dopamine agonists after stroke have provided equivocal evidence of the clinical effectiveness of dopamine agonists in improving motor recovery. Design Dopamine Augmented Rehabilitation in Stroke was a multicentre, randomised, double-blind, placebo-controlled trial with stroke patients randomised to receive 6 weeks of co-careldopa (Sinemet®, Merck Sharp & Dohme Ltd) or placebo in combination with occupational and physical rehabilitation. Methods The primary outcome measure was the proportion of patients walking independently at 8 weeks [Rivermead Mobility Index (RMI) score of ≥ 7 points and ‘yes’ to item 7 on the RMI]. Secondary outcome measures assessed physical functioning, pain, cognition, mood, fatigue and carer burden at 8 weeks, 6 months and 12 months. Results Between May 2011 and March 2014, 593 patients (mean age 68.5 years) and 165 carers (mean age 59.7 years) were recruited from stroke rehabilitation units; 308 patients were randomised to co-careldopa and 285 to placebo at a median of 15 days following stroke onset. The study drug was to be taken 45–60 minutes before therapy, which included motor activities (mean 23.2 and 24.8 sessions in the co-careldopa and placebo groups, respectively). The mean number of investigational medicinal product doses taken was 20.6 in the co-careldopa group and 22.4 in the placebo group. Ability to walk independently was not improved at 8 weeks [40.6% (co-careldopa) vs. 44.6% (placebo); odds ratio 0.78, 95% confidence interval (CI) 0.53 to 1.15], 6 months [51.6% (co-careldopa) vs. 53.3% (placebo)] or 12 months [51.6% (co-careldopa) vs. 56.8% (placebo)]. There were no significant differences for Barthel Index, Nottingham Extended Activities of Daily Living, ABILHAND Manual Ability Measure or Modified Rankin Scale, pain or fatigue at any time point. Montreal Cognitive Assessment scores did not significantly differ; the majority of participants had cognitive impairment at baseline, which improved during 12 months’ follow-up. No difference was observed in General Health Questionnaire 12-item version scores between groups at 8 weeks and 12 months but, at 6 months, those in the co-careldopa group reported significantly better general health [mean difference (MD) –1.33, 95% CI –2.57 to –0.10]. Mortality at 12 months was not significantly different. Carers in the placebo group reported significantly greater burden at 6 months (MD 5.05, 95% CI 0.10 to 10.01) and 12 months (MD 7.52, 95% CI 1.87 to 13.18). Conclusion Co-careldopa in addition to routine NHS occupational and physical therapy is not clinically effective or cost-effective in improving walking, physical functioning, mood or cognition following stroke. We recommend further research to develop imaging and clinical markers that would allow identification of promising drug therapies that would enhance motor therapy in improving walking ability and arm function. Further research is needed to compare strategies of giving drug therapy intermittently immediately prior to therapy sessions or as continuous background daily administration. Limitations In total, 10.3% of patients were lost to follow-up at 8 weeks and < 10% of patients met the strict per-protocol definition. Despite this, the findings are robust and generalisable to patients with limited mobility in the first few weeks after stroke. Trial registration Current Controlled Trials ISRCTN99643613. Funding This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research partnership.

Effects of Music Therapy in Frail Elderlies: Controlled Crossover Study

Background: Music therapy (MT) may exert beneficial preventive effects in frail elderly individuals in psychophysiological health. Objectives: One hundred and fifteen frail elderly individuals (65–89 years old) participated. Methods: Subjects were randomly divided into 2 groups for a controlled crossover trial. The MT-first group participated in group sessions of 45–50 min conducted by a certified music therapist for 12 weeks, followed by a 12-week waiting period. The waiting-first group participated in the reverse order. Cognitive function was assessed by the Verbal Fluency Test (VFT) and Yamaguchi Kanji Symbol Substitution Test (YKSST). Physical function was assessed by the Timed Up and Go test (TUG). Psychophysical health was assessed by the Geriatric Depression Scale 15-item version (GDS-15), General Health Questionnaire 12-item version (GHQ-12), Instrumental Activity of Daily Living (IADL) scale, and Life Space Assessment (LSA) scale. We also evaluated the outcome of MT using the Clinical Global Impressions of Improvement (CGI-I) scale. Results: After 12 weeks of MT, significant improvements were observed in TUG, GDS-15, and GHQ-12 scores. However, no improvements were noted in other scores. CGI-I scores revealed the significant benefits of MT. Conclusions: MT may improve physical function, depressive mood, and quality of life in frail elderly individuals.

Mental symptoms and cause-specific mortality among midlife employees.

BackgroundMental symptoms are prevalent among populations, but their associations with premature mortality are inadequately understood. We examined whether mental symptoms contribute to cause-specific mortality among midlife employees, while considering key covariates.MethodsBaseline mail survey data from 2000–02 included employees, aged 40–60, of the City of Helsinki, Finland (n = 8960, 80 % women, response rate 67 %). Mental symptoms were measured by the General Health Questionnaire 12-item version (GHQ-12) and the Short Form 36 mental component summary (MCS). Covariates included sex, marital status, social support, health behaviours, occupational social class and limiting long-standing illness. Causes of death by the end of 2013 were obtained from Statistics Finland (n = 242) and linked individually to survey data pending consent (n = 6605). Hazard ratios (HR) and 95 % confidence intervals (95 % CI) were calculated using Cox regression analysis.ResultsFor all-cause mortality, only MCS showed a weak association before adjustments. For natural mortality, no associations were found. For unnatural mortality (n = 21), there was a sex adjusted association with GHQ (HR = 1.96, 95 % CI = 1.45–2.64) and MCS (2.30, 95 % CI = 1.72–3.08). Among unnatural causes of death suicidal mortality (n = 11) was associated with both GHQ (2.20, 95 % CI = 1.47–3.29) and MCS (2.68, 95 % CI = 1.80–3.99). Of the covariates limiting long-standing illness modestly attenuated the associations.ConclusionsTwo established measures of mental symptoms, i.e. GHQ-12 and SF-36 MCS, were both associated with subsequent unnatural, i.e. accidental and violent, as well as suicidal mortality. No associations were found for natural mortality due to diseases. These findings need to be corroborated in further populations. Supporting mental health through workplace measures may help counteract subsequent suicidal and other unnatural mortality among midlife employees.

‘Living with Aphasia the Best Way I Can': A Feasibility Study Exploring Solution-Focused Brief Therapy for People with Aphasia

Objective: Post-stroke aphasia can profoundly affect a person's social and emotional well-being. This study explored the feasibility of solution-focused brief therapy as an accessible intervention and investigated its impact on participants' psychosocial well-being. Participants and Methods: This is a small-scale repeated-measures feasibility study. Participants received between 3 and 5 therapy sessions. They were assessed on psychosocial outcome measures before and after therapy and took part in post-therapy in-depth qualitative interviews. Three men and 2 women with chronic aphasia took part (age range: 40s-70s). Results: Participants found the therapy acceptable, and it was possible to adapt the approach so as to be communicatively accessible. Quantitative assessments showed encouraging trends in improved mood [pre-therapy General Health Questionnaire 12-item version (GHQ-12): mean (SD): 4.80 (4.60), median: 6; post-therapy GHQ-12: mean (SD): 2.00 (2.55), median: 1] and improved communicative participation [pre-therapy Communicative Participation Item Bank (CPIB): mean (SD): 7.80 (5.76), median: 7; post-therapy CPIB: mean (SD): 12.20 (4.44), median: 14]. Measures of social network and connectedness, however, remained stable. Themes emerging from the qualitative analysis included changes to mood, communicative participation, mobility, and everyday activities. Conclusions: This small-scale study suggests that solution-focused brief therapy is a promising approach to helping people with aphasia build positive change in their lives.

Glucose intolerance and General Health Questionnaire 12-item version scores of male two-shift workers stratified by precariousness of work

AimsThis study examined the relationship between precariousness of work, glucose intolerance and psychological wellbeing for male workers, stratified by age. Materials and MethodsI recruited 2542 manufacturing two-shift workers, aged from 35 to 54 years. Glucose intolerance was defined as fasting plasma glucose of ≥100mg/dL or current medication of diabetes mellitus. The rating scale of General Health Questionnaire 12-item version (GHQ-12) was used for evaluating psychological well-being. ResultsThere was a significant increase in the prevalence of glucose intolerance by aging in permanent workers. In addition, the prevalence of glucose intolerance except 30s and the prevalence of positive GHQ-12 scores except 50s of permanent workers were both significantly higher than that of temporary workers in each age class. ConclusionTemporary workers in this study sign contracts for 3 years, and heather worker's effect, compared with permanent workers, would be reflected in this study.

Parental Psychopathology and Somatic Presentation in Children: A Comparative Study

Introduction: Many of the psychological problems present with pure somatic symptoms, especially among children and adolescents. The long term impact of somatisation is poor and results in compromised outcome in various areas. Children of parents having psychopathology are more prone to develop psychological problems. Thus, the present study was done to assess the relation between parental psychopathology and somatic presentation in children. Aim and objective: To assess the parental psychopathology and its relationship with somatic presentation in children. Research design and methods: It was a cross-sectional, case-control study design. The children of age between 9-14 years who presented with psychological and emotional problems attending Paediatrics OPD from July 2013 to December 2013 were referred to Department of Psychiatry in Pt. B.D. Sharma, PGIMS, Rohtak, a tertiary care centre in northern India. Thirty children who presented with somatic symptoms constituted group-I and thirty children who presented with other psychological non somatic symptoms constituted the group-II. Their socio-demographic profile was taken on a specially designed proforma. Psychopathology among parents of both the groups was assessed by General Health Questionnaire-12 item version. The collected data was analysed statistically.

Common mental disorders and cause-specific disability retirement

ObjectivesCommon mental disorders are prevalent among employees and may cause work disability. We aimed to examine the association between common mental disorders and disability retirement, with an emphasis on the...

Validation of short screening tools for common mental disorders in Nigerian general practices

ObjectiveThe objective was to examine the psychometric properties of two brief screening questionnaires for common mental disorders in general practices in areas speaking the three main Nigerian languages. MethodConsecutives attendees of selected general practices in Ibadan, Enugu and Kaduna were screened with the General Health Questionnaire 12-item version (GHQ12) and K6. We selected all cases and 50% of noncases for second-stage interview with the Composite International Diagnostic Interview. The receiver operating characteristic curves were generated for both questionnaires, and optimal cutoffs were determined. Exploratory factor analysis was done for both questionnaires. ResultsThe K6 had an area under the curve (AUC) of 0.62 for depression and 0.58 for anxiety disorder. The GHQ12 had an AUC of 0.74 for depression, while that for generalized anxiety disorder was 0.6. The GHQ12 was able to correctly classify 75% of the subjects with or without depression, while the K6 was able to correctly classify 56% of the subjects with or without depression. The optimal cutoff for both questionnaires was 4, selecting the point of best balance of sensitivity and specificity. ConclusionThe findings suggest that the GHQ12 will be a useful tool in screening for common mental disorders in general practice in Nigeria.

The effect of mental ill health on absence from work in different occupational classifications: analysis of routine data in the British Household Panel Survey.

To investigate relationship of mental ill health to absence from work in different occupational classifications. Examined sickness absence, mental health (GHQ-12), physical health, job characteristics, and personal characteristics in 18 waves of the British Household Panel Survey. Overall sickness absence rate was 1.68%. Increased absence was associated with age greater than 45 years, female gender, lower occupational classification, and public-sector employers. Decreased absence was associated with part-time working. Scoring 4 or more on the General Health Questionnaire 12-item version (GHQ-12 caseness) was strongly associated with sickness absence. Public-sector employers had highest rates of sickness absence. GHQ-12 caseness had largest impact on absence in the public and nonprofit sectors, whereas physical health problems impacted more in the private sector. GHQ-12 caseness is strongly associated with increased absence in all classifications of occupations. Differences between sectors require further investigation.

Relationship among lifestyles, aging and psychological wellbeing using the General Health Questionnaire 12-items in Japanese working men

Introduction. The relationship among lifestyle, aging and psychological wellbeing was evaluated in Japanese working men.Methods. Self-administered questionnaire on six lifestyle factors and the General Health Questionnaire 12-item version (GHQ12) were administered to 3306 male workers. Health practice index (HPI) was calculated as a desirable lifestyle score by summing up each binary lifestyle score (0, 1), ranging from 0 to 6. To check validity of the study outcome, the authors repeated twice with 1 year interval. HPI was categorised into three groups by the score of 0–2, 3–4 and 5–6.Results. The number of subjects categorised by HPI was 532, 1967 and 807, respectively. The mean value of GHQ12 significantly decreased as the HPI increased by adjusting age. Multiple regression analysis was conducted to predict GHQ12 by six lifestyle scores, and age, sleep, night snacking and exercise were significantly related to GHQ12. Multiple logistic regression analysis was conducted and age in 50s, two-shift work, sleep, night snacking and exercise were significantly associated with GHQ12.Conclusion. Although cause–effect relationship cannot make clear, some of desirable health practices and aging were closely related to psychological wellbeing judged by GHQ12.

Help-seeking preferences for psychological distress in primary care:

There is much debate over when it is appropriate to intervene medically for psychological distress, and limited evidence on patients' perspectives about a broad range of possible treatment options. It is currently unclear whether preferences may differ for those patients with milder symptoms compared to those experiencing more severe distress. To determine patient preferences for professional, informal, and alternative help for psychological distress in primary care, and the impact of their current mental state on these. Cross-sectional survey in seven general practices across suburban/urban London. Participants were 1357 consecutive general practice attenders aged 18 years and over. The main outcome measure was the General Health Questionnaire 12-item version and a questionnaire on help-seeking preferences. Overall, only 47% of participants reported wanting 'some help' if feeling stressed, worried, or low and it was affecting their daily life. Those currently experiencing mild-to-moderate distress preferred informal sources of help such as friends/family support, relaxation/yoga, exercise/sport, or massage along with general advice from their GP and talking therapies. Self-help (books/leaflets or computer/internet) was not popular at any level of distress, and less favoured by those with mild-to-moderate distress (odds ratio [OR] = 0.50; 95% confidence interval [CI] = 0.35 to 0.70). Those experiencing severe distress were much more likely to want talking therapies (OR = 3.43, 95% CI = 2.85 to 4.14), tablets (OR = 3.07, 95% CI = 2.00 to 4.71), and support groups (OR = 3.07, 95% CI = 1.72 to 5.47). People with mild-to-moderate distress appear to prefer informal sources of help and those involving human contact, compared to medication or self-help. This has implications for the implementation of potential interventions for psychological distress in primary care.

Burden and coping strategies in mothers of patients with schizophrenia in Japan

The present study was conducted to identify factors contributing to burden of care in 57 mothers caring for patients with schizophrenia. Members of the Federation of Families of People with Mental Illness in Nagasaki Prefecture were evaluated using well-validated scales to evaluate burden of care (eight-item short version of the Japanese version of the Zarit Caregiver Burden Interview), general health status (General Health Questionnaire 12-item version), difficulty in life, coping strategies, emotional support, and understanding of mental illness and disorders. Burden of care was significantly associated with general health status and difficulty in life. On multiple regression it was found that 'social interests' and 'resignation', both of which are the subscales of coping strategies, exerted significant and independent effects with respect to burden of care.

Residential program for long‐term hospitalized persons with mental illness in Japan: Randomized controlled trial

Research on the merits of long-term group residences is inconclusive. The purpose of the present paper was to investigate the effects of supported group residence on the symptoms, social function, quality of life, general health quality, and the medical/psychiatric cost in Japan of a large number of psychiatric beds and long average length of stay. Patients were assessed every 6 months for 2 years using Positive and Negative Syndrome Scale, Katz Adjustment Scale, World Health Organization Quality of Life (WHO-QOL) and General Health Questionnaire 12-item version. Patients discharged to the supported group residence (SGR) significantly improved with regard to positive symptoms, the level of socially expected activities and free-time activities. The QOL physical domain of the inpatients was significantly more deteriorated compared to the SGR group. The total psychiatric/medical cost of the SGR group was approximately one-third that of the inpatient group, while the cost of the SGR to treat physical comorbidity was much higher. The present findings indicate that SGR has advantages for mental and social function but not for physical health. A major limitation of the present study was the high mean age (>60 years) of the subjects who had been hospitalized for a long period (mean, 24 years).

The effects of caregiving resources on the incidence of depression over one year in family caregivers of disabled elderly.

The purpose of the study was to investigate the over-time effects of physical, psychological and social resources on the incidence of depression in family caregivers of the disabled elderly. Data were collected twice at a one-year interval from 1,141 primary caregivers of a disabled older person in an urban area of Japan using a self-reported questionnaire survey. The questionnaire included physical health as an indicator of physical resources, caregiving satisfaction and intention to care as indicators of psychological resources, and instrumental and emotional support network and formal home care service utilization as indicators of social resources. The mental health outcome measure was the General Health Questionnaire 12-item version (GHQ-12). Complete data on 235 non-depressed female caregivers were separated into 3 groups according to the relationship type (wife, daughter and daughter-in-law) and analyzed separately. Multivariate logistic regression models controlling for duration of caregiving, care-recipient's gender, ADL dependency and behavioral problems demonstrated that significant predictors of depression were caregiving satisfaction and intention to care in wives, caregiving satisfaction in daughters, and physical health and emotional support network in daughters-in-law. Noteworthy, intention to care increased the risk of depression in wives, while decreasing the risk of depression in daughters-in-law. The findings indicate that the effects of caregivers' resources on mental health may differ by relationship type.

Associations of benzodiazepine craving with other clinical variables in a population of general practice patients

Background The aim of this study was to (1) describe the characteristics of patients reporting craving for benzodiazepines (BZs) and (2) to search for associations between BZ craving and other clinical variables in a population of general practice (GP) patients who have made an attempt to discontinue their long-term BZ use. Methods The Benzodiazepine Craving Questionnaire (BCQ) and other self-report questionnaires were administered once to a population of 113 long-term and 80 former long-term GP BZ users participating in a large BZ reduction trial in GP. Cross-sectional data were gathered on self-reported BZ craving (BCQ), self-reported BZ dependence severity (Bendep-SRQ), psychopathology (General Health Questionnaire 12-item version), mood state (Profile of Mood States), personality (Dutch shortened MMPI), and lifestyle characteristics. Differences between patients who reported craving and patients who did not were analyzed univariately. Multivariate analyses were performed on variables significantly associated with craving, controlling for current use status. Results (1) Patients reporting craving differed significantly from patients not reporting craving on aspects of BZ dependence severity, psychopathology, negative mood state, and personality. (2) Negative mood and somatization were positively associated with BZ craving, although only the contribution of negative mood to craving was statistically significant for the total group of (former) BZ users ( P = .002). Conclusions Self-reported negative mood and somatization are positively associated with BZ craving. In future BZ craving research, personality factors should be further explored.

Identification of somatic and anxiety symptoms which contribute to the detection of depression in primary health care

Somatic symptoms and anxiety symptoms are often disregarded in the detection of depression in primary care. The present investigation examined to what extent somatic and anxiety symptoms recorded with the Composite International Diagnostic Interview–Primary Health Care Version (CIDI–PHC) can improve the detection of depression as compared to the General Health Questionnaire—12-item version alone. Data from the World Health Organization study on Psychological Problems in General Health Care were used. The study sample consisted of primary care attenders from 15 centres from all over the world who underwent a psychiatric examination with the CIDI–PHC. Medically unexplained somatic symptoms (back pain, feelings of heaviness/lightness in parts of the body, periods of bodily weakness, seizures/convulsions, permanent tiredness, exhaustion after a minimum of effort) and—to a smaller extent—diverse anxiety symptoms (e.g. feelings of anxiousness/nervousness, feelings of tension, difficulties relaxing) significantly contributed to the detection of depression in a logistic regression analysis. The results confirm the observation that in primary care somatic symptoms play an important role in the manifestation of depressive disorders. The items investigated herein could prove beneficial for future depression screening instruments to improve the detection of depressive disorders in primary care.

Mental health and food habits among employed women and men

The aim of this study was to examine the association between mental health and recommended food habits among employed middle-aged women and men. A mail survey including data on mental health and intake of food items was collected from 40 to 60-year-old women ( n=4991) and men ( n=1252), employed by the City of Helsinki. The participants' current mental health status was assessed by the General Health Questionnaire 12-item version and categorised into ‘poor’ (score 3–12) and ‘normal’ mental health (score 0–2). Multivariable logistic regression analyses were conducted using this categorisation as an independent variable to predict recommended food habits among women and men. All analyses first adjusted for age and lifetime mental diagnosis, secondly socio-economic status variables, and thirdly health behaviours. Women having poor mental health were less likely than their healthier counterparts to report consuming fresh vegetables, fresh fruits, low-fat milk and low-fat cheese on a daily basis, and cereals or porridge at least five times a week. Men having poor mental health reported consuming less frequently fresh fruits and dark bread. Except for cereals and dark bread, these results remained statistically significant in the fully adjusted model. The results suggest that poor mental health is associated with unhealthy food habits.

Screening for depression in adult acne vulgaris patients: tools for the dermatologist

Adult dermatological out patients have a 40% prevalence of psychiatric co-morbidity. If psychiatric co-morbidity is unrecognized, undetected and untreated, the consequences may be fatal. Acne is the most common skin disorder of the second and third decades of life. Acne and its treatments may cause depression. To identify a screening tool to identify depression in adult acne patients. The literature was reviewed to identify validated screening instruments for depressive disorders. Questionnaires studied included the Hospital Anxiety and Depression Scale (HAD), the Brief Patient Health Questionnaire (B-PHQ), the General Health Questionnaire-12 item version (GHQ-12), and the World Health Organization-5 Well Being Index (WHO-5). WHO-5 performed best in terms of sensitivity (0.93 for a cut-off score of 13) as well as taking least time to complete (2-5 min) and evaluate (0.5-2 min). WHO-5 can be recommended as part of a two-step screening process for depression in acne patients. Step 1 is the WHO-5. In the case of a positive score, step 2 is a detailed psychosocial assessment.