WHO-5 Well-Being Index
The five-item WHO-5 Well-Being Index, reproduced in full with raw and percentage scoring, the recommended cut-off for further depression screening, and guidance on tracking change. A positively worded measure of subjective well-being over the past two weeks.
About this resource
The WHO-5 was developed by the World Health Organization Regional Office for Europe in 1998 as part of a project on well-being in primary care. Unlike most mood measures it contains no negatively worded items: it asks how often, over the last two weeks, the person has felt cheerful, calm, active, rested and interested in daily life. This makes it acceptable to people who would be put off by a depression questionnaire, and it is used across general medicine, diabetes care, geriatrics and mental health.
Each item is rated on a six-point frequency scale from 0 (at no time) to 5 (all of the time). The raw score of 0 to 25 is multiplied by 4 to give a percentage from 0 (worst imaginable well-being) to 100 (best imaginable). A systematic review by Topp and colleagues (2015) found that the measure has good validity as a screen for depression and as an outcome measure, and that it is sensitive to change over the course of treatment. The WHO makes the instrument freely available in many languages.
Two thresholds are in common use. A percentage score of 50 or below (raw score of 12 or below) is the recommended trigger for further assessment of depression. A change of 10 percentage points (2.5 raw points) between administrations is usually treated as clinically relevant. This professional version adds notes on using the WHO-5 alongside the PHQ-9, on its role in measurement-based care, and on interpreting it in physical health populations.
How to use it
- Use the WHO-5 at intake as a low-threat first measure, or as a routine well-being check at the start of every session or every few sessions. It takes about a minute.
- Add the five item scores for the raw total (0 to 25) and multiply by 4 for the percentage (0 to 100). Record both.
- If the percentage score is 50 or below, follow up with a depression measure such as the PHQ-9 and a clinical conversation. A score of 50 or below indicates poor well-being, not a diagnosis.
- Track the score over time. A rise or fall of 10 percentage points or more is a meaningful change; discuss what the client thinks accounts for it.
- Because the items are positive, the WHO-5 is well suited to behavioural activation and values-based work: the client can see which of the five areas moved and connect that to what they did differently.
References
- Topp, C. W., Østergaard, S. D., Søndergaard, S., & Bech, P. (2015). The WHO-5 Well-Being Index: A systematic review of the literature. Psychotherapy and Psychosomatics, 84(3), 167-176.
- World Health Organization Regional Office for Europe. (1998). Wellbeing measures in primary health care / the DepCare Project: Report on a WHO meeting, Stockholm, Sweden, 12-13 February 1998. WHO Regional Office for Europe.
- Bech, P., Olsen, L. R., Kjoller, M., & Rasmussen, N. K. (2003). Measuring well-being rather than the absence of distress symptoms: A comparison of the SF-36 Mental Health subscale and the WHO-Five Well-Being Scale. International Journal of Methods in Psychiatric Research, 12(2), 85-91.
