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Open Access Research

Screening for depressed mood in an adolescent psychiatric context by brief self-assessment scales – testing psychometric validity of WHO-5 and BDI-6 indices by latent trait analyses

Eva Henje Blom12*, Per Bech3, Göran Högberg1, Jan Olov Larsson4 and Eva Serlachius1

Author Affiliations

1 Department of Clinical Neuroscience, Karolinska Institutet, Retzius väg 8, A2:3, Stockholm, 17177, Sweden

2 Psychiatric Research Unit Mental Health Centre North Zealand, Dyrehavevej 48, DK 3400, Hillerød, Denmark

3 Department of Women’s and Children’s Health, Building H2:00 Karolinska University Hospital, 171 76, Stockholm, Sweden

4 Department of Women’s and Children’s Health, Karolinska Institutet, Retzius väg 8, A2:3, Stockholm, 17177, Sweden

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Health and Quality of Life Outcomes 2012, 10:149  doi:10.1186/1477-7525-10-149

Published: 11 December 2012



Major depressive disorder is prevalent in the adolescent psychiatric clinical setting and often comorbid with other primary psychiatric diagnoses such as ADHD or social anxiety disorder. Systematic manual-based diagnostic procedures are recommended to identify such comorbidity but they are time-consuming and often not fully implemented in clinical practice. Screening for depressive symptoms in the child psychiatric context using brief, user-friendly and easily managed self-assessment scales may be of clinical value and utility. The aim of the study is to test the psychometric validity of two such scales, which may be used in a two-step screening procedure, the WHO-Five Well-being Index (WHO-5) and the six-item version of Beck’s Depression Inventory (BDI-6).


66 adolescent psychiatric patients with a clinical diagnosis of major depressive disorder (MDD), 60 girls and 6 boys, aged 14–18 years, mean age 16.8 years, completed the WHO-5 scale as well as the BDI-6. Statistical validity was tested by Mokken and Rasch analyses.


The correlation between WHO-5 and BDI-6 was −0.49 (p=0.0001). Mokken analyses showed a coefficient of homogeneity for the WHO-5 of 0.52 and for the BDI-6 of 0.46. Rasch analysis also accepted unidimensionality when testing males versus females (p > 0.05).


The WHO-5 is psychometrically valid in an adolescent psychiatric context including both genders to assess the wellness dimension and applicable as a first step in screening for MDD. The BDI-6 may be recommended as a second step in the screening procedure, since it is statistically valid and has the ability to unidimensionally capture the severity of depressed mood.

Well-being; Adolescent major depressive disorder; Rasch analyses; Mokken analyses; Brief self-assessment scales; BDI-6; WHO-5