Psychometric validation of an Arabic version of the WHO-5 wellbeing index among Lebanese adolescents

Rita Doumit; Souheil Hallit; Maria-Jose Sanchez-Ruiz; Myriam El Khoury-Malhame

doi:10.1371/journal.pone.0317644

Abstract

Introduction

Wellbeing in adolescence is frequently associated with positive developmental outcomes. The WHO-5 is widely recognized for its brevity, clarity, robust reliability, and cultural validity. In this study, we aimed to assess the psychometric properties of an Arabic version of the WHO-5 scale among Lebanese adolescents.

Methods

This cross-sectional study involved 700 Lebanese school students aged 14−19 years. Participants were assessed using WHO-5 wellbeing index (WHO-5) (wellbeing), PHQ-9 (depression), and GAD-7 (anxiety) Arabic questionnaires at two-time points, 3 months apart.

Results

We found that the 5 items of the WHO-5 converged into a single factor. Internal consistency of scores was adequate in the total sample (ω = .83/ α = .83). The convergent validity for this model was satisfactory. We were able to show the invariance across gender at the configural, metric, and scalar levels, with males showing a higher level of wellbeing compared to females. The pre-posttest assessment for the WHO-5 scale was conducted on 358 participants; the intraclass correlation coefficient was adequate = 0.78 [95% CI .73; .82]. Our analyses also show that wellbeing was negatively correlated with depression (r = −.54; p < .001) and anxiety (r = −.52; p < .001).

Conclusion

The Arabic WHO-5 among Lebanese adolescents displayed highly satisfactory psychometric properties, which are evidence of its validity. It could be used to better track positive mental health in this vulnerable age group and could highlight efficiency in interventions aiming to promote wellbeing in adolescents. It could also potentially identify at risk individuals.

Citation: Doumit R, Hallit S, Sanchez-Ruiz M-J, El Khoury-Malhame M (2025) Psychometric validation of an Arabic version of the WHO-5 wellbeing index among Lebanese adolescents. PLoS One 20(7): e0317644. https://doi.org/10.1371/journal.pone.0317644

Editor: Janna Metzler, Columbia University Mailman School of Public Health, UNITED STATES OF AMERICA

Received: January 29, 2025; Accepted: June 20, 2025; Published: July 17, 2025

Copyright: © 2025 Doumit et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The authors do not have the right to share any data information since the data is owned by a third-party organization, the Lebanese American University. Data can be shared upon a reasonable request from Ms. Perla Zgheib (perla.z.zgheib@gmail.com), Lecturer, Department of Social and Education Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon Other researchers can replicate the results we obtained by following the outlined methods described in the paper. Authors did not have special privileges beyond what was granted by the Lebanese American University. The data used can be accessed by other researchers after obtaining the approval of the Lebanese American University ethics committee.

Funding: This research was funded by Grand Challenges Canada – Global Mental Health – NIHS; R-GMH-POC-2107-47498. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Wellbeing is a multifaceted construct mostly linked to positive mental health, emotional stability, and psychological wellness [1]. The World Health Organization emphasizes its definition as a “state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” [2]. In the absence of unified definitions for wellbeing and with the lack of clear biomarkers, various scales have been validated to measure this construct. The most widely used versions include, yet are not restricted to, the World Health Organization Wellbeing Index (WHO-5) [3], General Wellbeing [4], the Wellbeing Numerical Rating Scales (WB-NRSs) [5] and Psychological Wellbeing Scale (PWB) measuring 6 aspects of wellbeing [6].

Other scales are known to assess conceptually similar constructs such as life satisfaction, positive affect, optimism, and happiness [7]. Among the validated wellbeing-related scales, the WHO-5 stands out for its brevity and ease of use, with only 5 items as opposed for instance to the PWB (42 items) and even its shorter version (18 items). It has strong psychometric properties, minimal overlap with scales measuring mental distress, and has also been translated into over 30 languages. Its adoption has been advocated by the WHO-led recommendations, with the aim of facilitating cross-cultural comparisons of the prevalence of mental wellness and distress [5]. Although this scale has been used in various nations and clinical settings, it has mostly been validated in high-income, western countries and only a few studies have targeted the Middle East [8] or particularly adolescents [9].

Adolescence is a critical developmental stage marked by blatant physical changes, driven by hormonal fluctuation, and often accompanied by emotional lability and interpersonal conflicts [10]. As young adolescents learn to navigate those changes, they become more susceptible to psychological distress and decreased wellbeing [11,12]. In this age group, there is a wealth of evidence linking wellbeing with various developmental benefits, including improved academic performance, reduced risks of mental health problems, stronger social ties, and increased resilience [13,14]. A few studies have investigated some of these benefits in Lebanese youth, especially those related to positive educational outcomes [15].

Measuring wellbeing using WHO-5 in the adolescent population have been conducted in Ghana [16], Europe [17], and ethnic minorities in Norway and Sweden [18]. In those single country studies, the WHO-5 wellbeing index has systematically shown a one factor structure similarly to the original version in adults with adequate convergent and divergent validity. Although a study involving 15 European countries had suggested a better use of the WHO-4; a revisited version of the scale with adolescents [19] yet another very recent cross-national validation of the initial 5-items WHO-5 in adolescents conducted in 43 countries spanning altogether Europe, Central Asia and North America further documented the solid psychometric properties of this scale in more than 250,000 respondents aged 11–15 years [20]. Additionally, the scale has been validated in pediatric care and has shown good enough diagnostic accuracy as a screening tool for depression in adolescents [21]. However, despite its widespread use and promising robustness in the Global North mostly and in adult populations, there is a surprising gap in validation studies within the Arab region, which is known to host one of the most youthful age structures globally [14,22]. From a cultural perspective, adolescents’ distress is particularly prominent in societies marked by collective traumas, often indicating an increased risk of psychiatric disorders as they transition into young adulthood [23]. Lebanon, as a small Middle Eastern country, bears the weight of accumulated national adversities stemming from decades of civil war, including severe socio-political unrest, the most devastating economic collapse of its modern history, and a cataclysmic explosion of the Beirut port. These challenges unfold against the backdrop of ongoing adjustments to the COVID-19 pandemic and the influx of nearly 1.5 million Syrian refugees [24]. Taken together with failing governmental institutions and a lack of mental health public policies, these crises have left the country with staggering psychological distress levels [25,26] and plummeting levels of wellbeing [27]. Recent studies particularly point to alarming levels of anxiety and depression in Lebanese adolescents reaching more than 60% for anxiety and 35% for depression after the Beirut blast [23], while others have focused on protective factors of wellbeing among Lebanese youth during the COVID-19 pandemic, such as trait Emotional Intelligence and meaning-centered coping [28].

In line with global concerns around adolescents’ deteriorating mental health [29] and growing evidence of worsening their distress and isolation [28], determining levels of wellbeing in a vulnerable age group becomes of utmost importance, notably when taken against a backdrop of sociopolitical, healthcare, and financial instabilities. Given the dynamic nature of subjective wellbeing, it would allow the design of targeted interventions aimed at increasing its levels of wellbeing to bolster psychological distress. This study thus aims at validating a culturally-adapted Arabic version of the WHO-5 wellbeing index, a brief reliable instrument for wellbeing in adolescents. It contributes to assessing and subsequently promoting wellbeing in the future life trajectories of the Lebanese population and in the Arab-speaking context in general.

Methods

Procedure

The study was part of a larger project “Yes to Emotions in Youth (YEY): An Emotional Intelligence Training for Vulnerable Youth in Lebanon” funded by Grand Challenges Canada – Global Mental Health. It received administrative approval from the Lebanese Ministry of Education and Higher Education (MEHE) and was approved by the Institutional Review Board (LAU IRB; reference number: LAU.SAS.MJ1.28/Oct/2021), in accordance to the Declaration of Helsinki. The sample consisted of 700 high school students, aged between 14 and 19, who were recruited from four public schools in Lebanon, randomly assigned by MEHE, in September 1^st 2022. Some participants were tested twice for the same scales, within 3 months, on the 15^th of December 2022, to assess test-retest validity and reliability of the scales [30]. At retest, 358 participants opted to complete the survey and their responses were subsequently included. All participants and their parents signed the informed consent before enrolling in the study. Students within the appropriate age range who approved to enroll in the study were approached in class, in person, to fill the validated Arabic version (S1 Table) of the standardized scales for wellbeing (WHO-5), depression (PHQ-9), and anxiety (GAD-7), in that order. All scales are publicly available (S2 Table) and were presented to participants in the same order.

Minimum sample size

We aimed to enroll a minimum of 100 adolescents following the recommendations of Mundfrom et al. of 3–20 times the number of the scale’s variables [31] and those of Giner-Sorolla et al. [32].

Questionnaires

WHO-5 (World Health Organization Wellbeing Index; [33]).

It is a 5-item questionnaire measuring general emotional wellbeing in the past two weeks. Participants answer Likert-scale questions such as “I have felt cheerful and in good spirits” ranging from 0 “At no time” to 5 “All the time”. Higher scores indicate higher states of wellbeing and are transformed to a 100-point basis. It has been shown to hold a reliability greater than (α = .8) and has been validated in adult Arab-speaking population in six-countries [8]. The scale is openly available as per the link.

GAD-7 (The Generalized Anxiety Disorder; [34]).

It is a self-reported questionnaire designed to assess anxiety during the previous 2 weeks. It is based on 7 items “e.g., Feeling nervous, anxious, or on edge”, which are responded to on a 4-point Likert scale ranging from 0 “Not at all” to 3 “Nearly every day”. Higher scores indicate higher severity of symptoms. It has satisfactory internal consistency (α from.79 –.91;) and has been validated among an Arabic Lebanese population [35]. The scale is openly available.

PHQ-9 (Patient health questionnaire-9; [36]).

It is a 9-item questionnaire measuring the frequency of depressive symptoms over the past two weeks, with items such as having “I have little interest or pleasure in doing things” evaluated on a Likert-scale ranging from 0 “Not at all” to 3 “Nearly every day“. Higher scores indicate higher severity of symptoms. It has strong reliability with (α = .82), and was validated in the Lebanese population [35]. The scale is openly available.

Analytic strategy

There were no missing responses in the dataset for the WHO-5 answers. However, some missing data was found in the other variables (age, gender, etc.) and were not replaced. We used data from the entire sample to perform a confirmatory factor analysis (CFA) using RStudio, “lavaan” and “SemTools” programs [37,38]. We used Weighted Least Squares with Mean and Variance (WLSMV) estimation method, which is more appropriate for ordinal data [39]. Parameter estimates were obtained using the maximum likelihood method. Multiple fit indices were calculated: root mean square error of approximation (RMSEA), standardized root mean square residual (SRMR), Tucker-Lewis Index (TLI), and Comparative Fit Index (CFI). Values ≤ .08 for RMSEA, ≤ .05 for SRMR, and ≥.90 for CFI and TLI indicate good fit of the model to the data [40]. The latent variable was scaled in the CFA model by fixing the loading of the first item to 1. Additionally, values of the average variance extracted (AVE) ≥.50 indicated evidence of convergent validity [41]. The assumption of multivariate normality was violated as indicated by Mardia’s skewness = 139.83; p < 0.001 and Mardia’s kurtosis = 3.98; p < 0.001, therefore parameter estimates were obtained using the robust maximum likelihood method. Despite non-normality, this estimator ensures a meaningful model fit evaluation by providing robust standard errors.

To examine gender and age invariance of WHO-5 scores, we conducted multi-group CFA [42] using the total sample. Age was dichotomized into middle adolescence (14−17 years) and late adolescence (18−19 years) [43]. Measurement invariance was assessed at the configural, metric, scalar and strict levels [44]. We accepted ΔCFI ≤ .010 and ΔRMSEA ≤ .015 or ΔSRMR ≤ .010 as evidence of invariance [45]. If measurement invariance was established, we planned on checking for a difference in WHO-5 total scores between males and females using the Mann-Whitney test.

Internal consistency was assessed using McDonald’s ω and Cronbach’s α, with values greater than.70 considered adequate [46,47]. Normality was not verified since the p value of the Shapiro-Wilk test turned out significant (p < 0.001). Spearman were calculated to examine the association between the WHO-5 scores and the other scales, with values of 0.2, 0.5 and 0.8 indicating weak, moderate and strong effect sizes respectively [48]. In order to assess the test-retest reliability of the WHO-5 wellbeing index, we calculated the intraclass correlation coefficient (ICC) using the reliability analysis option in SPSS v.27 to ensure the scale’s stability over time. We used the two-way mixed-effect model ICC. The ICC values vary between 0 and 1, with values >0.75 considered excellent, good between 0.60 and 0.75, moderate between 0.40 and 0.60 and poor if < 0.40 [49].

Results

Participants

Seven hundred adolescents participated in this study. The mean and standard deviation of the scores were as follows: WHO-5 wellbeing index (pre: 41.75 ± 22.61, post: 39.68 ± 21.24), PHQ-9 depression (11.10 ± 6.76), and GAD-7 anxiety (9.62 ± 5.50). The description of the categorization of participants according to their PHQ-9 and GAD-7 scores is summarized in Table 1.

Download:

Table 1. Sociodemographic information and categorization of participants according to their depression and anxiety scores (N = 700).

https://doi.org/10.1371/journal.pone.0317644.t001

Confirmatory factor analysis of the WHO-5 scale.

CFA indicated that fit of the one-factor model of the WHO-5 wellbeing index was excellent: Robust RMSEA = .044 (90% CI.028,.061), SRMR = .028, Robust CFI = .996, Robust TLI = .992. The standardized estimates of factor loadings were all adequate. Internal consistency of scores was adequate in the total sample (ω = .83/ α = .83). The convergent validity for this model was satisfactory, as AVE = .51. To evaluate local fit, we examined the modification indices between residuals; all values, including items 1–2 were below 10; therefore, we did not add a correlation between those two items.

Gender invariance.

We were able to show the invariance across gender at the configural, metric, and scalar levels “S2 Table”. Males showed a higher level of wellbeing compared to females (45.71 ± 23.84 vs 38.85 ± 21.08; t(671) = 3.96; p < .001, Cohen’s d = 0.307). No significant difference was found in terms of age categories (14–17 vs 18–19 years) (41.43 ± 22.50 vs 42.46 ± 23.80; t(652) = 0.39; p = 0.699, Cohen’s d = 0.045) (Table 2).

Download:

Table 2. Measurement invariance of the WHO-5 wellbeing in the total sample.

https://doi.org/10.1371/journal.pone.0317644.t002

Test-retest reliability: Intraclass correlation.

The pre-posttest for the WHO-5 scale was done on 358 participants. The intraclass correlation coefficient was excellent = 0.78 [95% CI .73; .82]. For the item-level test-retest reliability coefficients, the ICC values were as follows: item 1 (0.62 [95% CI .52; .69]), item 2 (0.61 [95% CI .51; .69]), item 3 (.65 [95% CI .57; .72]), item 4 (.63 [95% CI .54; .70]) and item 5 (.61 [95% CI .51; .69]). The correlation between the total scores pre and post was r = 0.64; p < 0.001 (moderate to strong effect).

Concurrent validity.

Higher depression (rho = −.55; p < .001) and anxiety (rho = −.52; p < .001) were significantly associated with lower wellbeing.

Discriminant validity.

Since the square root of the AVE (= 0.71) was higher than the correlations of the WHO-5 and the depression and anxiety ones, discriminant validity was verified.

Discussion

This study investigated the psychometric properties of the Arabic version of the WHO-5 wellbeing index in a group of Arabic-speaking Lebanese high-school students. Findings support a single-factor model, with adequate reliability (McDonald’s ω = .83), as well as good convergent and concurrent validity. Measurement invariance across gender groups was also evidenced at the configural, metric, and scalar levels. Consequently, the WHO-5 could be exploited as a reliable and valid tool, time-effective and easy to use, with cultural sensitivity to evaluate Arab adolescents’ overall wellbeing. Given that this scale has been mostly administered in adults in Western countries, investigating its validity among Lebanese adolescents further endorses its cross-cultural potential and its suitability for measurements of wellbeing in Arabic-speaking adolescents. This could also be particularly relevant for other countries sharing some of the overall settings [24], including vulnerable populations, low-income countries, and those plagued by atrocities of political unrest, ongoing wars, and/or severe monetary depreciation.

The WHO-5 scores in our sample of 681 school students were found to be lower compared to means documented in an international study among European adolescents with comparable age range and gender distribution [17]. Those averages were nonetheless comparable to those of young adults in Lebanon and in other low-middle-income Arab countries such as Morocco, Kuwait, and Jordan [8]. Taken together with values obtained on anxiety (GAD-7) and depression scales (PHQ-9), these results indicate elevated levels of mental distress among Lebanese-educated adolescents, with low levels of wellbeing, and heightened psychological distress in participants; reporting moderate to severe symptoms of anxiety (53%) and depression (47%).

Our findings are in line with recent national prevalence rates of mental distress in adolescents after the Beirut port explosion [23]. This study, conducted a few years post-blast and post-pandemic, illustrates the chronicity and lasting impact of accumulating adversities on adolescents. Although alarming, those findings might be expected in the backdrop of a prolonged collective challenges and traumas altering the quality of life, of the Lebanese people in general and on the most vulnerable youngsters in particular [50]. These crises are aggravated by the absence of governmental policies addressing mental health and the scarcity of school-based mental health interventions promoting wellbeing and interpersonal coping skills. As such, results should inform altogether clinicians, researchers, and policymakers to implement culturally sensitive strategies aiming at addressing wellbeing as well as managing anxious and depressive symptomatology among Lebanese adolescents to prevent potential worsening of mental and physical health.

Per se, the psychometric properties of the WHO-5 construct validity were examined using CFA, an approach systematically supported by validation researchers as an essential step in scale validation [47,51]. Our analyses showed the fit of a one-factor model, replicating the single-factor structure of the original scale version [52]. Similarly, subsequently, psychometric studies across different countries [5] and different age groups including Arab adults and adolescents [16,18] have consistently supported the unidimensional structure. This could infer that the assessment of adolescents’ wellbeing in Lebanon could be accounted for by a single underlying factor, comparably to age-matched participants from other countries. It mostly supports the applicability of the WHO-5 within the Lebanese setting as a unidimensional measure of wellbeing and its recommendation for use in Arab adolescents globally. Future studies could additionally investigate whether current findings within the general population could be replicated in clinical populations of adolescents, whereby a single latent trait would also help evaluate their wellbeing.

Moreover, the unidimensional factor structure of this Arabic version of the WHO-5 was identical for both male and female high schoolers at the three levels of invariance (Configural, Metric, and Scalar). We found no significant gender differences in scores, and as such our results are in support of indiscriminately using the WHO-5 across genders, aligning with findings from previous studies [9]. The WHO-5 items also appeared to be internally consistent, and quite similar to values obtained in a recent validation of the same Arabic version of WHO-5 in a sample of non-clinical Arab adults across six Arab countries including Lebanon [8]. One supplementary distinctive feature of this study was its evaluation of test-retest interclass correlation of wellbeing measures since more than half of the original sample of adolescents were retested at 3 months post-initial assessment. This test across time and across individuals although scarcely used in psychological measures allows to further refine the reliability of the scale by examining consistency and reproducibility [30]. Our results point to statistically adequate values and further evidence of the reliable psychometric properties of WHO-5 in Arab adolescents.

Lastly, the WHO-5 scores showed a strong and negative correlation with depression and anxiety scores. These findings also concur with prior research comparing the correlations between the WHO-5 with various measures of mental distress and related problems worldwide and more precisely in Middle Eastern and neighboring countries [8,53,54].

Implications, limitations and recommendations for future research

Our results suggest that the Arabic version of the WHO-5 wellbeing index can be a valuable tool for researchers and clinicians aiming to assess wellbeing among Arab-speaking adolescents. This scale offers a quick, convenient, and age-appropriate means of assessing wellbeing, with the distinct advantage of being culturally sensitive and easy to understand. In addition, recent studies have highlighted that the WHO-5 could also serve as a proxy measure for clinical depression in the general population [55,56]. As such, psychologists, public health nurses, and educators could use it to assess wellbeing, and, by the same token, depressive symptoms among high schoolers, particularly those living in vulnerable environments.

This study supports the use of the WHO-5 Arabic version in young adolescents in a Middle Eastern country. Although psychometric properties indicate valid and reliable usage of the scale in a culturally sensitive manner, results should be generalized with care to other Arabic-speaking adolescents, especially since the sample included in the study was educated urban youth. Further research should as such target larger sample sizes and non-schooled youth. Additional limitation stems from relying solely on self-report measures that may introduce known biases such as social desirability, memory inaccuracies, and potential misinterpretations of items. Convergent validity was not assessed in this study in the absence of another scale to measure wellbeing in our survey. Nonetheless, the test-retest solid reliability, gender invariance, and religious as well as regional diversity representation within the targeted public schools in Lebanon could mitigate such biases. Future studies should further investigate the potential influence of other demographic factors on wellbeing, incorporate physiological markers, and potentially study clinical samples for a comprehensive understanding.

Conclusion

Findings from this study have demonstrated that the psychometric properties of the Arabic WHO-5 wellbeing index in Lebanese adolescents are scientifically sound, supporting the usage of this easy-to-use, fast assessment tool in research. This scale is highly efficient for assessing wellbeing in adolescents. At the individual level, it would allow an easy, reliable, and valid evaluation of wellbeing, a core construct with strong correlations to improved mental and physical health, increased resilience, better academic performance, and stronger social relationships. On the social versant, it would be relevant to track overall levels of wellbeing in larger samples to prevent and reduce healthcare costs, enhance productivity, and foster a more stable thriving society, especially in times of political instability and ongoing turmoil.

Supporting information

S1 Table. Validated Arabic Scales.

Items for WHO-5, PHQ-9 and GAD-7.

https://doi.org/10.1371/journal.pone.0317644.s001

(DOCX)

S2 Table. Validated Scales.

Items for WHO-5, PHQ-9 and GAD-7.

https://doi.org/10.1371/journal.pone.0317644.s002

(DOCX)

Acknowledgments

The authors wish to acknowledge all those who made the YEY project possible.

References

1. Keyes CLM, Shmotkin D, Ryff CD. Optimizing well-being: the empirical encounter of two traditions. J Pers Soc Psychol. 2002;82(6):1007–22. pmid:12051575
- View Article
- PubMed/NCBI
- Google Scholar
2. World Health Organization. Basic documents. 49th ed. Geneva: The Organization; 2020. pp. 1.
3. Bech P, Lundt I. The WHO-5 reliability and validity in Danish general population surveys. 2004.
4. Dupuy HJ. The General Well-being Schedule. In: McDowell I, Newell C, editors. Measuring Health: A Guide to Rating Scales and Questionnaire. 2nd ed. 1977. p. 206–13.
5. Bonacchi A, Chiesi F, Lau C, Marunic G, Saklofske DH, Marra F, et al. Rapid and sound assessment of well-being within a multi-dimensional approach: The Well-being Numerical Rating Scales (WB-NRSs). PLoS One. 2021;16(6):e0252709. pmid:34125831
- View Article
- PubMed/NCBI
- Google Scholar
6. Ryff CD, Keyes CL. The structure of psychological well-being in older adults: a longitudinal study. J Pers Soc Psychol. 1995;69(4):719–27. pmid:7473027
- View Article
- PubMed/NCBI
- Google Scholar
7. Diener E, Wirtz D, Tov W, Kim-Prieto C, Choi D, Oishi S, et al. New well-being measures: short scales to assess flourishing and positive and negative feelings. Soc Indic Res. 2009;97(2):143–56.
- View Article
- Google Scholar
8. Fekih-Romdhane F, Cherif W, Alhuwailah A, Fawaz M, Shuwiekh HAM, Helmy M, et al. Cross-Country Validation of the Arabic version of the WHO-5 Well-Being Index in non- clinical young adults from six Arab countries. Springer Science and Business Media LLC. 2023. https://doi.org/10.21203/rs.3.rs-2988215/v1
9. Perera BPR, Jayasuriya R, Caldera A, Wickremasinghe AR. Assessing mental well-being in a Sinhala speaking Sri Lankan population: validation of the WHO-5 well-being index. Health Qual Life Outcomes. 2020;18(1):305. pmid:32912245
- View Article
- PubMed/NCBI
- Google Scholar
10. Mendle J, Koch MK. The psychology of puberty: what aren’t we studying that we should? Child Dev Perspectives. 2019;13(3):166–72.
- View Article
- Google Scholar
11. Heim C, Newport DJ, Mletzko T, Miller AH, Nemeroff CB. The link between childhood trauma and depression: insights from HPA axis studies in humans. Psychoneuroendocrinology. 2008;33(6):693–710. pmid:18602762
- View Article
- PubMed/NCBI
- Google Scholar
12. Rapee RM, Oar EL, Johnco CJ, Forbes MK, Fardouly J, Magson NR, et al. Adolescent development and risk for the onset of social-emotional disorders: a review and conceptual model. Behav Res Ther. 2019;123:103501. pmid:31733812
- View Article
- PubMed/NCBI
- Google Scholar
13. Fenwick-Smith A, Dahlberg EE, Thompson SC. Systematic review of resilience-enhancing, universal, primary school-based mental health promotion programs. BMC Psychol. 2018;6(1):30. pmid:29976252
- View Article
- PubMed/NCBI
- Google Scholar
14. Available from: https://www.who.int/health-topics/adolescent-health#tab=tab_1
- View Article
- Google Scholar
15. Ayyash-Abdo H, Sánchez-Ruiz M-J. Subjective wellbeing and its relationship with academic achievement and multilinguality among Lebanese university students. Int J Psychol. 2012;47(3):192–202. pmid:22047001
- View Article
- PubMed/NCBI
- Google Scholar
16. Quansah F, Hagan JE Jr, Ankomah F, Agormedah EK, Nugba RM, Srem-Sai M, et al. Validation of the WHO-5 well-being scale among adolescents in ghana: evidence-based assessment of the internal and external structure of the measure. Children (Basel). 2022;9(7):991. pmid:35883975
- View Article
- PubMed/NCBI
- Google Scholar
17. McMahon EM, Corcoran P, O’Regan G, Keeley H, Cannon M, Carli V, et al. Physical activity in European adolescents and associations with anxiety, depression and well-being. Eur Child Adolesc Psychiatry. 2017;26(1):111–22. pmid:27277894
- View Article
- PubMed/NCBI
- Google Scholar
18. Sirpal MK, Haugen W, Sparle K, Haavet OR. Validation study of HSCL-10, HSCL-6, WHO-5 and 3-key questions in 14-16 year ethnic minority adolescents. BMC Fam Pract. 2016;17:7. pmid:26817851
- View Article
- PubMed/NCBI
- Google Scholar
19. Cosma A, Költő A, Chzhen Y, Kleszczewska D, Kalman M, Martin G. Measurement invariance of the WHO-5 Well-Being Index: evidence from 15 European Countries. Int J Environ Res Public Health. 2022;19(16):9798. pmid:36011429
- View Article
- PubMed/NCBI
- Google Scholar
20. Sischka PE, Martin G, Residori C, Hammami N, Page N, Schnohr C, et al. Cross-National validation of the WHO-5 well-being index within adolescent populations: findings from 43 countries. Assessment. 2025. pmid:39884717
- View Article
- PubMed/NCBI
- Google Scholar
21. Allgaier A-K, Pietsch K, Frühe B, Prast E, Sigl-Glöckner J, Schulte-Körne G. Depression in pediatric care: is the WHO-Five Well-Being Index a valid screening instrument for children and adolescents? Gen Hosp Psychiatry. 2012;34(3):234–41. pmid:22325631
- View Article
- PubMed/NCBI
- Google Scholar
22. Middle East and North Africa: Youth Facts. Available from: https://www.youth-policy.org/mappings/regionalyouthscenes/mena/facts/
- View Article
- Google Scholar
23. Maalouf FT, Haidar R, Mansour F, Elbejjani M, Khoury JE, Khoury B, et al. Anxiety, depression and PTSD in children and adolescents following the Beirut port explosion. J Affect Disord. 2022;302:58–65. pmid:35085669
- View Article
- PubMed/NCBI
- Google Scholar
24. El Khoury-Malhame M, Bou Malhab S, Chaaya R, Sfeir M, El Khoury S. Coping during socio-political uncertainty. Front Psychiatry. 2024;14:1267603. pmid:38318483
- View Article
- PubMed/NCBI
- Google Scholar
25. El Khoury-Malhame M, Rizk R, Joukayem E, Rechdan A, Sawma T. The psychological impact of COVID-19 in a socio-politically unstable environment: protective effects of sleep and gratitude in Lebanese adults. BMC Psychol. 2023;11(1):14. pmid:36658665
- View Article
- PubMed/NCBI
- Google Scholar
26. El Hajj S. Writing (from) the Rubble: Reflections on the August 4, 2020 Explosion in Beirut, Lebanon. Life Writing. 2020;18(1):7–23.
- View Article
- Google Scholar
27. Sfeir M, Akel M, Hallit S, Obeid S. Factors associated with general well-being among Lebanese adults: The role of emotional intelligence, fear of COVID, healthy lifestyle, coping strategies (avoidance and approach). Curr Psychol. 2022:1–10. pmid:35018085
- View Article
- PubMed/NCBI
- Google Scholar
28. Sanchez-Ruiz M-J, Tadros N, Khalaf T, Ego V, Eisenbeck N, Carreno DF, et al. Trait emotional intelligence and wellbeing during the pandemic: the mediating role of meaning-centered coping. Front Psychol. 2021;12:648401. pmid:34054650
- View Article
- PubMed/NCBI
- Google Scholar
29. Bhandari N, Gupta S. Trends in mental wellbeing of US Children, 2019-2022: erosion of mental health continued in 2022. Int J Environ Res Public Health. 2024;21(2):132. pmid:38397623
- View Article
- PubMed/NCBI
- Google Scholar
30. Aldridge VK, Dovey TM, Wade A. Assessing test-retest reliability of psychological measures. Eur Psychol. 2017;22(4):207–18.
- View Article
- Google Scholar
31. Mundfrom DJ, Shaw DG, Ke TL. Minimum sample size recommendations for conducting factor analyses. Int J Testing. 2005;5(2):159–68.
- View Article
- Google Scholar
32. Giner-Sorolla R, Montoya AK, Reifman A, Carpenter T, Lewis NA Jr, Aberson CL, et al. Power to detect what? considerations for planning and evaluating sample size. Pers Soc Psychol Rev. 2024;28(3):276–301. pmid:38345247
- View Article
- PubMed/NCBI
- Google Scholar
33. Johansen SK. The use of well-being measures in primary health care – the Dep-Care project in World Health Organization, Regional Office for Europe. Well-Being Measures in Primary Health Care – the DepCare Project. Geneva: World Health Organization; 1998. pp. E60246.
34. Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008;46(3):266–74. pmid:18388841
- View Article
- PubMed/NCBI
- Google Scholar
35. Sawaya H, Atoui M, Hamadeh A, Zeinoun P, Nahas Z. Adaptation and initial validation of the Patient Health Questionnaire - 9 (PHQ-9) and the Generalized Anxiety Disorder - 7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample. Psychiatry Res. 2016;239:245–52. pmid:27031595
- View Article
- PubMed/NCBI
- Google Scholar
36. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13. pmid:11556941
- View Article
- PubMed/NCBI
- Google Scholar
37. Jorgensen TD, et al. semTools: Useful Tools for Structural Equation Modeling (0.5-6) [Computer software]. 2022; Available from: https://cran.r-project.org/web/packages/semTools/index.html
- View Article
- Google Scholar
38. Rosseel Y, et al. Lavaan: Latent Variable Analysis (0.6-16) [Computer software]. 2023; Available from: https://cran.r-project.org/web/packages/lavaan/index.html
- View Article
- Google Scholar
39. Li C-H. Confirmatory factor analysis with ordinal data: Comparing robust maximum likelihood and diagonally weighted least squares. Behav Res Methods. 2016;48(3):936–49. pmid:26174714
- View Article
- PubMed/NCBI
- Google Scholar
40. Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Model: Mltidiscip J. 1999;6(1):1–55.
- View Article
- Google Scholar
41. Malhotra N, Dash S. Marketing research: An applied orientation. Delhi: Pearson; 2011.
42. Chen FF. Sensitivity of goodness of fit indexes to lack of measurement invariance. Struct Equ Model: Multidiscip J. 2007;14(3):464–504.
- View Article
- Google Scholar
43. Available from: https://www.healthychildren.org/English/ages-stages/teen/Pages/Stages-of-Adolescence.aspx
- View Article
- Google Scholar
44. Vadenberg R, Lance C. A review and synthesis of the measurement in variance literature: Suggestions, practices, and recommendations for organizational research. Organ Res Methods. 2000;3(1):4–70.
- View Article
- Google Scholar
45. Swami V, Todd J, Azzi V, Malaeb D, El Dine AS, Obeid S, et al. Psychometric properties of an Arabic translation of the Functionality Appreciation Scale (FAS) in Lebanese adults. Body Image. 2022;42:361–9. pmid:35926365
- View Article
- PubMed/NCBI
- Google Scholar
46. Dunn TJ, Baguley T, Brunsden V. From alpha to omega: a practical solution to the pervasive problem of internal consistency estimation. Br J Psychol. 2014;105(3):399–412. pmid:24844115
- View Article
- PubMed/NCBI
- Google Scholar
47. Arafat SY, Chowdhury HR, Qusar MMAS, Hafez MA. Cross cultural adaptation and psychometric validation of research instruments: a methodological review. J Behav Health. 2016;5(3):129–36.
- View Article
- Google Scholar
48. Cohen J. Statistical power analysis for the behavioral sciences. New York, NY: Routledge Academic; 1988.
49. Aldridge VK, Dovey TM, Wade A. Assessing test-retest reliability of psychological measures: persistent methodological problems. Eur Psychol. 2017;22(4):207–18.
- View Article
- Google Scholar
50. El Khoury-Malhame M, Harajli D, Rekowska D, Jakubowska M, Ohm R. Can the phoenix still rise? Traumatic effect of Beirut port explosion on Lebanese people’s experiences. Psychol Trauma: Theory Res Pract Policy. 2024.
- View Article
- Google Scholar
51. Loewenthal KM, Lewis CA. An introduction to psychological tests and scales. Psychology Press; 2018.
52. Bech P. Measuring the dimension of psychological general well-being by the WHO-5. Qual Life Newslett. 2004:15–6.
- View Article
- Google Scholar
53. Awata S, Bech P, Yoshida S, Hirai M, Suzuki S, Yamashita M, et al. Reliability and validity of the Japanese version of the World Health Organization-Five Well-Being Index in the context of detecting depression in diabetic patients. Psychiatry Clin Neurosci. 2007;61(1):112–9. pmid:17239048
- View Article
- PubMed/NCBI
- Google Scholar
54. Ghazisaeedi M, Mahmoodi H, Arpaci I, Mehrdar S, Barzegari S. Validity, reliability, and optimal cut-off scores of the WHO-5, PHQ-9, and PHQ-2 to screen depression among university students in Iran. Int J Ment Health Addict. 2022;20(3):1824–33. pmid:33495691
- View Article
- PubMed/NCBI
- Google Scholar
55. Krieger T, Zimmermann J, Huffziger S, Ubl B, Diener C, Kuehner C, et al. Measuring depression with a well-being index: further evidence for the validity of the WHO Well-Being Index (WHO-5) as a measure of the severity of depression. J Affect Disord. 2014;156:240–4. pmid:24412323
- View Article
- PubMed/NCBI
- Google Scholar
56. Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 well-being index: a systematic review of the literature. Psychother Psychosom. 2015;84(3):167–76. pmid:25831962
- View Article
- PubMed/NCBI
- Google Scholar

[ref1] 1. Keyes CLM, Shmotkin D, Ryff CD. Optimizing well-being: the empirical encounter of two traditions. J Pers Soc Psychol. 2002;82(6):1007–22. pmid:12051575
View Article
PubMed/NCBI
Google Scholar

[2] View Article

[3] PubMed/NCBI

[4] Google Scholar

[ref2] 2. World Health Organization. Basic documents. 49th ed. Geneva: The Organization; 2020. pp. 1.

[ref3] 3. Bech P, Lundt I. The WHO-5 reliability and validity in Danish general population surveys. 2004.

[ref4] 4. Dupuy HJ. The General Well-being Schedule. In: McDowell I, Newell C, editors. Measuring Health: A Guide to Rating Scales and Questionnaire. 2nd ed. 1977. p. 206–13.

[ref5] 5. Bonacchi A, Chiesi F, Lau C, Marunic G, Saklofske DH, Marra F, et al. Rapid and sound assessment of well-being within a multi-dimensional approach: The Well-being Numerical Rating Scales (WB-NRSs). PLoS One. 2021;16(6):e0252709. pmid:34125831
View Article
PubMed/NCBI
Google Scholar

[9] View Article

[10] PubMed/NCBI

[11] Google Scholar

[ref6] 6. Ryff CD, Keyes CL. The structure of psychological well-being in older adults: a longitudinal study. J Pers Soc Psychol. 1995;69(4):719–27. pmid:7473027
View Article
PubMed/NCBI
Google Scholar

[13] View Article

[14] PubMed/NCBI

[15] Google Scholar

[ref7] 7. Diener E, Wirtz D, Tov W, Kim-Prieto C, Choi D, Oishi S, et al. New well-being measures: short scales to assess flourishing and positive and negative feelings. Soc Indic Res. 2009;97(2):143–56.
View Article
Google Scholar

[17] View Article

[18] Google Scholar

[ref8] 8. Fekih-Romdhane F, Cherif W, Alhuwailah A, Fawaz M, Shuwiekh HAM, Helmy M, et al. Cross-Country Validation of the Arabic version of the WHO-5 Well-Being Index in non- clinical young adults from six Arab countries. Springer Science and Business Media LLC. 2023. https://doi.org/10.21203/rs.3.rs-2988215/v1

[ref9] 9. Perera BPR, Jayasuriya R, Caldera A, Wickremasinghe AR. Assessing mental well-being in a Sinhala speaking Sri Lankan population: validation of the WHO-5 well-being index. Health Qual Life Outcomes. 2020;18(1):305. pmid:32912245
View Article
PubMed/NCBI
Google Scholar

[21] View Article

[22] PubMed/NCBI

[23] Google Scholar

[ref10] 10. Mendle J, Koch MK. The psychology of puberty: what aren’t we studying that we should? Child Dev Perspectives. 2019;13(3):166–72.
View Article
Google Scholar

[25] View Article

[26] Google Scholar

[ref11] 11. Heim C, Newport DJ, Mletzko T, Miller AH, Nemeroff CB. The link between childhood trauma and depression: insights from HPA axis studies in humans. Psychoneuroendocrinology. 2008;33(6):693–710. pmid:18602762
View Article
PubMed/NCBI
Google Scholar

[28] View Article

[29] PubMed/NCBI

[30] Google Scholar

[ref12] 12. Rapee RM, Oar EL, Johnco CJ, Forbes MK, Fardouly J, Magson NR, et al. Adolescent development and risk for the onset of social-emotional disorders: a review and conceptual model. Behav Res Ther. 2019;123:103501. pmid:31733812
View Article
PubMed/NCBI
Google Scholar

[32] View Article

[33] PubMed/NCBI

[34] Google Scholar

[ref13] 13. Fenwick-Smith A, Dahlberg EE, Thompson SC. Systematic review of resilience-enhancing, universal, primary school-based mental health promotion programs. BMC Psychol. 2018;6(1):30. pmid:29976252
View Article
PubMed/NCBI
Google Scholar

[36] View Article

[37] PubMed/NCBI

[38] Google Scholar

[ref14] 14. Available from: https://www.who.int/health-topics/adolescent-health#tab=tab_1
View Article
Google Scholar

[40] View Article

[41] Google Scholar

[ref15] 15. Ayyash-Abdo H, Sánchez-Ruiz M-J. Subjective wellbeing and its relationship with academic achievement and multilinguality among Lebanese university students. Int J Psychol. 2012;47(3):192–202. pmid:22047001
View Article
PubMed/NCBI
Google Scholar

[43] View Article

[44] PubMed/NCBI

[45] Google Scholar

[ref16] 16. Quansah F, Hagan JE Jr, Ankomah F, Agormedah EK, Nugba RM, Srem-Sai M, et al. Validation of the WHO-5 well-being scale among adolescents in ghana: evidence-based assessment of the internal and external structure of the measure. Children (Basel). 2022;9(7):991. pmid:35883975
View Article
PubMed/NCBI
Google Scholar

[47] View Article

[48] PubMed/NCBI

[49] Google Scholar

[ref17] 17. McMahon EM, Corcoran P, O’Regan G, Keeley H, Cannon M, Carli V, et al. Physical activity in European adolescents and associations with anxiety, depression and well-being. Eur Child Adolesc Psychiatry. 2017;26(1):111–22. pmid:27277894
View Article
PubMed/NCBI
Google Scholar

[51] View Article

[52] PubMed/NCBI

[53] Google Scholar

[ref18] 18. Sirpal MK, Haugen W, Sparle K, Haavet OR. Validation study of HSCL-10, HSCL-6, WHO-5 and 3-key questions in 14-16 year ethnic minority adolescents. BMC Fam Pract. 2016;17:7. pmid:26817851
View Article
PubMed/NCBI
Google Scholar

[55] View Article

[56] PubMed/NCBI

[57] Google Scholar

[ref19] 19. Cosma A, Költő A, Chzhen Y, Kleszczewska D, Kalman M, Martin G. Measurement invariance of the WHO-5 Well-Being Index: evidence from 15 European Countries. Int J Environ Res Public Health. 2022;19(16):9798. pmid:36011429
View Article
PubMed/NCBI
Google Scholar

[59] View Article

[60] PubMed/NCBI

[61] Google Scholar

[ref20] 20. Sischka PE, Martin G, Residori C, Hammami N, Page N, Schnohr C, et al. Cross-National validation of the WHO-5 well-being index within adolescent populations: findings from 43 countries. Assessment. 2025. pmid:39884717
View Article
PubMed/NCBI
Google Scholar

[63] View Article

[64] PubMed/NCBI

[65] Google Scholar

[ref21] 21. Allgaier A-K, Pietsch K, Frühe B, Prast E, Sigl-Glöckner J, Schulte-Körne G. Depression in pediatric care: is the WHO-Five Well-Being Index a valid screening instrument for children and adolescents? Gen Hosp Psychiatry. 2012;34(3):234–41. pmid:22325631
View Article
PubMed/NCBI
Google Scholar

[67] View Article

[68] PubMed/NCBI

[69] Google Scholar

[ref22] 22. Middle East and North Africa: Youth Facts. Available from: https://www.youth-policy.org/mappings/regionalyouthscenes/mena/facts/
View Article
Google Scholar

[71] View Article

[72] Google Scholar

[ref23] 23. Maalouf FT, Haidar R, Mansour F, Elbejjani M, Khoury JE, Khoury B, et al. Anxiety, depression and PTSD in children and adolescents following the Beirut port explosion. J Affect Disord. 2022;302:58–65. pmid:35085669
View Article
PubMed/NCBI
Google Scholar

[74] View Article

[75] PubMed/NCBI

[76] Google Scholar

[ref24] 24. El Khoury-Malhame M, Bou Malhab S, Chaaya R, Sfeir M, El Khoury S. Coping during socio-political uncertainty. Front Psychiatry. 2024;14:1267603. pmid:38318483
View Article
PubMed/NCBI
Google Scholar

[78] View Article

[79] PubMed/NCBI

[80] Google Scholar

[ref25] 25. El Khoury-Malhame M, Rizk R, Joukayem E, Rechdan A, Sawma T. The psychological impact of COVID-19 in a socio-politically unstable environment: protective effects of sleep and gratitude in Lebanese adults. BMC Psychol. 2023;11(1):14. pmid:36658665
View Article
PubMed/NCBI
Google Scholar

[82] View Article

[83] PubMed/NCBI

[84] Google Scholar

[ref26] 26. El Hajj S. Writing (from) the Rubble: Reflections on the August 4, 2020 Explosion in Beirut, Lebanon. Life Writing. 2020;18(1):7–23.
View Article
Google Scholar

[86] View Article

[87] Google Scholar

[ref27] 27. Sfeir M, Akel M, Hallit S, Obeid S. Factors associated with general well-being among Lebanese adults: The role of emotional intelligence, fear of COVID, healthy lifestyle, coping strategies (avoidance and approach). Curr Psychol. 2022:1–10. pmid:35018085
View Article
PubMed/NCBI
Google Scholar

[89] View Article

[90] PubMed/NCBI

[91] Google Scholar

[ref28] 28. Sanchez-Ruiz M-J, Tadros N, Khalaf T, Ego V, Eisenbeck N, Carreno DF, et al. Trait emotional intelligence and wellbeing during the pandemic: the mediating role of meaning-centered coping. Front Psychol. 2021;12:648401. pmid:34054650
View Article
PubMed/NCBI
Google Scholar

[93] View Article

[94] PubMed/NCBI

[95] Google Scholar

[ref29] 29. Bhandari N, Gupta S. Trends in mental wellbeing of US Children, 2019-2022: erosion of mental health continued in 2022. Int J Environ Res Public Health. 2024;21(2):132. pmid:38397623
View Article
PubMed/NCBI
Google Scholar

[97] View Article

[98] PubMed/NCBI

[99] Google Scholar

[ref30] 30. Aldridge VK, Dovey TM, Wade A. Assessing test-retest reliability of psychological measures. Eur Psychol. 2017;22(4):207–18.
View Article
Google Scholar

[101] View Article

[102] Google Scholar

[ref31] 31. Mundfrom DJ, Shaw DG, Ke TL. Minimum sample size recommendations for conducting factor analyses. Int J Testing. 2005;5(2):159–68.
View Article
Google Scholar

[104] View Article

[105] Google Scholar

[ref32] 32. Giner-Sorolla R, Montoya AK, Reifman A, Carpenter T, Lewis NA Jr, Aberson CL, et al. Power to detect what? considerations for planning and evaluating sample size. Pers Soc Psychol Rev. 2024;28(3):276–301. pmid:38345247
View Article
PubMed/NCBI
Google Scholar

[107] View Article

[108] PubMed/NCBI

[109] Google Scholar

[ref33] 33. Johansen SK. The use of well-being measures in primary health care – the Dep-Care project in World Health Organization, Regional Office for Europe. Well-Being Measures in Primary Health Care – the DepCare Project. Geneva: World Health Organization; 1998. pp. E60246.

[ref34] 34. Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008;46(3):266–74. pmid:18388841
View Article
PubMed/NCBI
Google Scholar

[112] View Article

[113] PubMed/NCBI

[114] Google Scholar

[ref35] 35. Sawaya H, Atoui M, Hamadeh A, Zeinoun P, Nahas Z. Adaptation and initial validation of the Patient Health Questionnaire - 9 (PHQ-9) and the Generalized Anxiety Disorder - 7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample. Psychiatry Res. 2016;239:245–52. pmid:27031595
View Article
PubMed/NCBI
Google Scholar

[116] View Article

[117] PubMed/NCBI

[118] Google Scholar

[ref36] 36. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13. pmid:11556941
View Article
PubMed/NCBI
Google Scholar

[120] View Article

[121] PubMed/NCBI

[122] Google Scholar

[ref37] 37. Jorgensen TD, et al. semTools: Useful Tools for Structural Equation Modeling (0.5-6) [Computer software]. 2022; Available from: https://cran.r-project.org/web/packages/semTools/index.html
View Article
Google Scholar

[124] View Article

[125] Google Scholar

[ref38] 38. Rosseel Y, et al. Lavaan: Latent Variable Analysis (0.6-16) [Computer software]. 2023; Available from: https://cran.r-project.org/web/packages/lavaan/index.html
View Article
Google Scholar

[127] View Article

[128] Google Scholar

[ref39] 39. Li C-H. Confirmatory factor analysis with ordinal data: Comparing robust maximum likelihood and diagonally weighted least squares. Behav Res Methods. 2016;48(3):936–49. pmid:26174714
View Article
PubMed/NCBI
Google Scholar

[130] View Article

[131] PubMed/NCBI

[132] Google Scholar

[ref40] 40. Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Model: Mltidiscip J. 1999;6(1):1–55.
View Article
Google Scholar

[134] View Article

[135] Google Scholar

[ref41] 41. Malhotra N, Dash S. Marketing research: An applied orientation. Delhi: Pearson; 2011.

[ref42] 42. Chen FF. Sensitivity of goodness of fit indexes to lack of measurement invariance. Struct Equ Model: Multidiscip J. 2007;14(3):464–504.
View Article
Google Scholar

[138] View Article

[139] Google Scholar

[ref43] 43. Available from: https://www.healthychildren.org/English/ages-stages/teen/Pages/Stages-of-Adolescence.aspx
View Article
Google Scholar

[141] View Article

[142] Google Scholar

[ref44] 44. Vadenberg R, Lance C. A review and synthesis of the measurement in variance literature: Suggestions, practices, and recommendations for organizational research. Organ Res Methods. 2000;3(1):4–70.
View Article
Google Scholar

[144] View Article

[145] Google Scholar

[ref45] 45. Swami V, Todd J, Azzi V, Malaeb D, El Dine AS, Obeid S, et al. Psychometric properties of an Arabic translation of the Functionality Appreciation Scale (FAS) in Lebanese adults. Body Image. 2022;42:361–9. pmid:35926365
View Article
PubMed/NCBI
Google Scholar

[147] View Article

[148] PubMed/NCBI

[149] Google Scholar

[ref46] 46. Dunn TJ, Baguley T, Brunsden V. From alpha to omega: a practical solution to the pervasive problem of internal consistency estimation. Br J Psychol. 2014;105(3):399–412. pmid:24844115
View Article
PubMed/NCBI
Google Scholar

[151] View Article

[152] PubMed/NCBI

[153] Google Scholar

[ref47] 47. Arafat SY, Chowdhury HR, Qusar MMAS, Hafez MA. Cross cultural adaptation and psychometric validation of research instruments: a methodological review. J Behav Health. 2016;5(3):129–36.
View Article
Google Scholar

[155] View Article

[156] Google Scholar

[ref48] 48. Cohen J. Statistical power analysis for the behavioral sciences. New York, NY: Routledge Academic; 1988.

[ref49] 49. Aldridge VK, Dovey TM, Wade A. Assessing test-retest reliability of psychological measures: persistent methodological problems. Eur Psychol. 2017;22(4):207–18.
View Article
Google Scholar

[159] View Article

[160] Google Scholar

[ref50] 50. El Khoury-Malhame M, Harajli D, Rekowska D, Jakubowska M, Ohm R. Can the phoenix still rise? Traumatic effect of Beirut port explosion on Lebanese people’s experiences. Psychol Trauma: Theory Res Pract Policy. 2024.
View Article
Google Scholar

[162] View Article

[163] Google Scholar

[ref51] 51. Loewenthal KM, Lewis CA. An introduction to psychological tests and scales. Psychology Press; 2018.

[ref52] 52. Bech P. Measuring the dimension of psychological general well-being by the WHO-5. Qual Life Newslett. 2004:15–6.
View Article
Google Scholar

[166] View Article

[167] Google Scholar

[ref53] 53. Awata S, Bech P, Yoshida S, Hirai M, Suzuki S, Yamashita M, et al. Reliability and validity of the Japanese version of the World Health Organization-Five Well-Being Index in the context of detecting depression in diabetic patients. Psychiatry Clin Neurosci. 2007;61(1):112–9. pmid:17239048
View Article
PubMed/NCBI
Google Scholar

[169] View Article

[170] PubMed/NCBI

[171] Google Scholar

[ref54] 54. Ghazisaeedi M, Mahmoodi H, Arpaci I, Mehrdar S, Barzegari S. Validity, reliability, and optimal cut-off scores of the WHO-5, PHQ-9, and PHQ-2 to screen depression among university students in Iran. Int J Ment Health Addict. 2022;20(3):1824–33. pmid:33495691
View Article
PubMed/NCBI
Google Scholar

[173] View Article

[174] PubMed/NCBI

[175] Google Scholar

[ref55] 55. Krieger T, Zimmermann J, Huffziger S, Ubl B, Diener C, Kuehner C, et al. Measuring depression with a well-being index: further evidence for the validity of the WHO Well-Being Index (WHO-5) as a measure of the severity of depression. J Affect Disord. 2014;156:240–4. pmid:24412323
View Article
PubMed/NCBI
Google Scholar

[177] View Article

[178] PubMed/NCBI

[179] Google Scholar

[ref56] 56. Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 well-being index: a systematic review of the literature. Psychother Psychosom. 2015;84(3):167–76. pmid:25831962
View Article
PubMed/NCBI
Google Scholar

[181] View Article

[182] PubMed/NCBI

[183] Google Scholar

Figures

Abstract

Introduction

Methods

Results

Conclusion

Introduction

Methods

Procedure

Minimum sample size

Questionnaires

WHO-5 (World Health Organization Wellbeing Index; [33]).

GAD-7 (The Generalized Anxiety Disorder; [34]).

PHQ-9 (Patient health questionnaire-9; [36]).

Analytic strategy

Results

Participants

Confirmatory factor analysis of the WHO-5 scale.

Gender invariance.

Test-retest reliability: Intraclass correlation.

Concurrent validity.

Discriminant validity.

Discussion

Implications, limitations and recommendations for future research

Conclusion

Supporting information

S1 Table. Validated Arabic Scales.

S2 Table. Validated Scales.

Acknowledgments

References