Validating the Emotional Well-Being Questionnaire in Type 2 Diabetes: A Pilot Confirmatory Factor Analysis

The Emotional Well-Being Questionnaire (EWQ) assesses a broad spectrum of mental health conditions and related symptoms-depression, anxiety, asthenia, and insomnia-highly relevant in type 2 diabetes (T2D), where emotional distress can impair adherence and outcomes. This pilot cross-sectional study provides preliminary validation evidence for the EWQ six-factor model in a T2D cohort using confirmatory factor analysis (CFA), evaluating reliability and convergent validity for mental-health screening.

A sample of 240 adults (T2D n = 122; control n = 118) with T2D completed the EWQ and nine-item Patient Health Questionnaire (PHQ-9). Confirmatory factor analysis (CFA) was conducted to assess the six-factor model fit, and convergent validity was evaluated through analysis of EWQ scores with PHQ-9 scores.

Confirmatory factor analysis indicated acceptable-borderline fit for a pilot sample (CFI = 0.886; TLI = 0.883; RMSEA = 0.071), providing preliminary support for the six-factor structure. The EWQ demonstrated reliability in the T2D group (Cronbach's α = 0.79). Convergent validity was supported by a significant positive correlation with PHQ-9 scores (r = 0.652, p < 0.001), confirming the EWQ's capacity to assess depressive symptoms in this population.

The EWQ's six-factor structure showed preliminary adequacy in adults with T2D. While internal consistency and convergent validity with the PHQ-9 were supportive, overall model fit indices were moderate; therefore, findings should be interpreted with caution and replicated in larger, more diverse samples before clinical implementation. Future studies should focus on cross-cultural validation, measurement invariance, and longitudinal assessment to refine its clinical utility.