Cross-Country Validation of the Arabic version of the WHO-5 Well-Being Index in non- clinical young adults from six Arab countries

Abstract

Abstract Background: Subjective well-being (SWB) is a culturally-dependent and context-driven concept; It thus varies widely across- and within cultures. Therefore, cross-cultural validation studies are crucial to prove that the well-being measure covers transcultural components of the construct subjective, and can be used for cross-cultural comparison purposes in international multicenter research. In this regard, we aimed to perform a cross-country validation of the Arabic version of the WHO 5-item Well-Being Index (WHO-5) in terms of factor structure, composite reliability, cross-gender measurement invariance, and concurrent validity by calculating Pearson correlation coefficients between the WHO-5 and measures of depression, anxiety, stress, suicidal ideation and insomnia. Method: We carried-out a cross-sectional, web-based study among a total of 3247 young adults (aged 18-35 years) fromsix Arab countries (i.e., Tunisia, Lebanon, Egypt, Jordan, Morocco and Kuwait). Results: We found that WHO-5 mean scores varied significantly across countries, ranging from 32.2 ± 22.72 in Egypt to 44.2 ± 26.84 in Morocco. Confirmatory Factor Analyses showed that the fit of a one-factor model to the data proved to be acceptable in all six countries. In addition, the Arabic WHO-5 yielded high reliability coefficients in samples from each of the six countries (McDonald’s ω = 0.92-0.96) and both genders. Results from multi-group analyses demonstrated that configural, metric, and scalar invariance was supported across gender in the total sample and by country. As for concurrent validity, WHO-5 scores showed a strong significant inverse correlation with depression scores. Negative correlations have also been demonstrated between WHO-5 scores and different symptoms of mental health problems (anxiety, stress, suicidal ideation, insomnia) in our sample. Conclusion: By verifying the cross-country validity of the Arabic WHO-5, our study opens its wider application to epidemiologically explore SWB among Arabic-speaking community young adults from broad geographic areas.