Validation of the World Health Organization-5 Well-Being Index; Assessment of Maternal Well-Being and its Associated Factors

Objective: The aim of this study was to validate the World Health Organization-5 Well-Being Index (WHO-5) in a sample of pregnant Iranian women, to explore the changes in maternal well-being from pregnancy to postpartum, and to determine the factors associated with maternal well-being. Materials and Methods: This study included 341 pregnant women that presented to healthcare centers affiliated with Shahroud University of Medical Sciences, Iran, in 2011. The participants completed the General Health Questionnaire (GHQ-28) and Farsi version of WHO-5 during the third trimester of pregnancy and at 2 months postpartum. Results: Cronbach's alpha coefficient for WHO-5 items was 0.85. The correlation coefficient between WHO-5 and GHQ-28 was -0.64 (P < 0.001). Exploratory factor analysis yielded 1 factor with an eigen value equal to 3.15, which explained 63.1% of the total variance. Confirmatory factor analysis confirmed the 1-factor structure. The area under ROC curve was 0.82. A WHO-5 cut-off score of <50 exhibited optimal sensitivity (0.84) and specificity (0.59) for identifying psychological symptoms (GHQ-28 score 24). There was a significant difference between third trimester (58.4 22) and postpartum (64.1 +/- 22.3) mean WHO-5 scores (P < 0.001). Maternal level of education (OR = 1.130; 95% CI: 1.307, 1.232) was the only predictor of maternal well-being during third trimester. Breastfeeding difficulty (OR = 0.923; 95% CI: 0.882, 0.965) and maternal well-being scores during third trimester (OR = 1.038; 95% CI: 1.019, 1.058) were predictors of maternal well-being during the postpartum period. Conclusions: The Farsi version of WHO-5 was observed to be a reliable and valid instrument for screening psychological symptoms in pregnant Iranian women. The present findings show that maternal well-being improved following childbirth.