WHO-5 Well-Being Index
This tool implements the standard 5-item WHO-5 Well-Being Index, a brief, positively framed subjective well-being screening instrument originally developed and published by the World Health Organization Regional Office for Europe, Mental Health Division (Copenhagen, 1998) under the title Well-being measures in primary health care: the WHO-5. The WHO-5 is explicitly designated a public-domain instrument by the WHO with no permission, license, or fee required for any lawful use. In contrast to symptom-based inventories such as the PHQ-9 or GAD-7, the WHO-5 operationalizes a positive well-being construct, sampling five core domains of positive subjective experience: cheerful and good spirits, calm and relaxation, active and vigorous energy, fresh and rested awakening, and daily interesting-activity engagement. All five items use a common six-point frequency response scale anchored to the past two weeks: 0 = At no time through 5 = All of the time. No items are reverse-keyed; all five items are positively worded and are summed directly to produce a raw total in the 0-20 range. The official WHO-recommended percentage conversion, as specified in the 1998 user manual and adopted by the vast majority of subsequent validation research, is: percentage well-being score = raw sum × 5, yielding a 0-100 well-being index. The standard three-tier descriptive classification, consistent with the original WHO manual conventions and subsequent population validation, is applied: ≥72 = High / Good well-being; 50-71 = Average well-being; and <50 = Low well-being / possible low mood threshold. The widely studied screening cutoff corresponding approximately to the percentage threshold of ≥50 (equivalent to a raw score of about 10 or greater in many formulations) has demonstrated, across multiple primary care validation studies including the Tølz et al. work and the comprehensive 2015 Topp et al. systematic review in Psychotherapy and Psychosomatics (84:167-176), a published sensitivity of approximately 86% and specificity of approximately 66% for detecting clinically significant depressive symptomatology — values presented here as neutral, descriptive, population-level reference statistics only.
WHO-5 Assessment — Past Two Weeks
Never during the past two weeks
Occasionally, on a minority of occasions
Present but on fewer than 50% of occasions or days
Present on more than 50% of occasions or days
On a large majority of occasions or days
Virtually always, without meaningful exception
Never during the past two weeks
Occasionally, on a minority of occasions
Present but on fewer than 50% of occasions or days
Present on more than 50% of occasions or days
On a large majority of occasions or days
Virtually always, without meaningful exception
Never during the past two weeks
Occasionally, on a minority of occasions
Present but on fewer than 50% of occasions or days
Present on more than 50% of occasions or days
On a large majority of occasions or days
Virtually always, without meaningful exception
Never during the past two weeks
Occasionally, on a minority of mornings
Fewer than half of mornings in the past two weeks
More than half of mornings in the past two weeks
On a large majority of mornings
Virtually every morning, without meaningful exception
Never during the past two weeks
Occasionally, on a minority of days
Fewer than half of days in the past two weeks
More than half of days in the past two weeks
On a large majority of days
Virtually every day, without meaningful exception
WHO-5 Well-Being Index: Scoring Formula, Tiers, Validation, and Public Domain Status
Item Content, Positive Construct Design, and Standard Response Anchors
The WHO-5 Well-Being Index is methodologically distinctive among common primary-care mental health screening instruments in that it operationalizes an exclusively positive well-being construct rather than a negative symptom construct. Rather than asking respondents to endorse the frequency of depressive, anxious, or stress-related symptoms, the WHO-5 invites respondents to rate the frequency of five positively valenced subjective experience domains over the immediately preceding two-week recall window. Specifically, the five items sample: (Q1) cheerful mood and good spirits (positive hedonic tone); (Q2) calmness and relaxation (positive low-arousal affective state); (Q3) activeness and vigor (positive high-arousal energy and vitality); (Q4) waking up feeling fresh and rested (positive sleep-related restoration and recovery quality); and (Q5) daily life being filled with things that interest the respondent (positive engagement with daily activities and the external environment). Critically, all five items are uniformly positively framed; there are no negatively keyed items and therefore no reverse-scoring transformations are required. All items share a common six-point Likert frequency response scale with anchors formally specified in the 1998 WHO manual: 0 = At no time, 1 = Some of the time, 2 = Less than half the time, 3 = More than half the time, 4 = Most of the time, and 5 = All of the time. This deliberate positive-construct design confers both conceptual and practical advantages: it reduces floor-ceiling artifacts in nonclinical populations, minimizes social-desirability and stigma-related response biases associated with direct symptom endorsement, and supports the instrument's utility as a population-level well-being monitor as well as a low-mood screening triage tool.
Official WHO Scoring Formula, Percentage Conversion, and Three-Tier Classification
Because all five WHO-5 items are keyed in the same positive direction and no reverse transformations are required, the raw scoring algorithm is maximally straightforward. Formally, for each of the five items i (i = 1 … 5) with raw Likert response ri ∈ {0, 1, 2, 3, 4, 5}, the scored contribution si equals ri. The raw WHO-5 sum is the arithmetic sum across the five items: Raw = Σ si for i = 1 … 5. Since each item contributes between 0 and 5 points, the closed theoretical range of the raw WHO-5 sum is [0, 20], with a population midpoint of 10 under a uniform distribution. The official, canonical percentage-transformation formula specified in the 1998 WHO Regional Office for Europe user manual and subsequently adopted in the overwhelming majority of published validation studies — including the comprehensive 2015 Topp et al. systematic review — is: Percentage Well-Being Score = Raw sum × 5. This simple linear rescaling produces an intuitive 0-100 percentage-style index, where 0 corresponds to minimum possible well-being (all five items endorsed at At no time) and 100 corresponds to maximum possible well-being (all five items endorsed at All of the time). Alternative rescalings (e.g., multiplying raw sum by 4 or by other coefficients) occasionally appear in historical or regional literature, but the sum × 5 → 0-100 percentage convention is the standard, consensus format. The three-tier interpretive scheme widely used and broadly consistent with the original 1998 WHO manual guidance partitions the 0-100 percentage continuum as follows: (1) Low well-being, score 0 through 49, interpreted as a level of subjective well-being sufficiently reduced that the possibility of low mood or other clinical concerns warranting further evaluation should be considered; (2) Average well-being, score 50 through 71, interpreted as moderate, population-normative positive subjective functioning; and (3) High or Good well-being, score 72 through 100, interpreted as a generally high level of positive subjective well-being across all five domains. These three tiers are descriptive interpretive classifications, not diagnostic boundaries.
The ≥50 Screening Cutoff: ~86% Sensitivity and ~66% Specificity for Depressive Symptomatology
Although the WHO-5 is fundamentally a positive well-being measure, extensive validation research has documented its operating characteristics as a reverse-indicator triage screen for clinically significant depressive symptomatology, leveraging the empirically robust negative correlation between positive well-being quality and depressive symptom severity. The most widely studied screening threshold, formally equivalent or closely analogous to a raw score of approximately 10 or greater and mapping onto the percentage-scale boundary at approximately ≥50, has been evaluated in multiple adult primary care, general population, occupational health, and clinical samples. In the primary care validation studies conducted by Tølz and colleagues — and as quantitatively synthesized in the comprehensive 2015 systematic review by Topp, Søndergaard, Søndergaard, and Østergaard published in Psychotherapy and Psychosomatics (84:167-176) — the approximate ≥50-equivalent cutoff demonstrated a pooled or representative sensitivity of approximately 86% (meaning that roughly 86% of participants meeting study criteria for current, clinically significant depressive symptomatology scored at or above the screening threshold, i.e., exhibited sufficiently reduced well-being) and a specificity of approximately 66% (meaning that roughly 66% of participants not meeting depressive symptomatology criteria scored below the threshold, i.e., exhibited well-being sufficiently above the cutoff). The somewhat moderate specificity relative to sensitivity is consistent with the WHO-5's positive-construct design: the instrument is intentionally calibrated to be relatively permissive in flagging reduced well-being, minimizing missed cases at the cost of a higher false-positive rate appropriate for first-stage population screening purposes. As with all psychometric screening measures, these sensitivity and specificity values are population-level descriptive statistics derived from specific study samples and may vary across demographic subgroups, comorbidity profiles, languages, and clinical settings. They are presented here solely as documented published reference values for informational purposes, not as operational decision thresholds for any individual user.
Public Domain Status by WHO Documentation, Translations, and Permitted Use
The WHO-5 Well-Being Index was developed and published by the World Health Organization Regional Office for Europe, Mental Health Division, in the 1998 reference document entitled Well-being measures in primary health care: the WHO-5 (Copenhagen: WHO Regional Office for Europe). As explicitly and repeatedly documented — both in the original 1998 WHO manual itself and in subsequent authoritative publications including the 2015 Topp et al. systematic review in Psychotherapy and Psychosomatics — the WHO-5 instrument text, response format, and scoring convention are placed in the public domain. No written permission, license, royalty, or fee of any kind is required to reproduce, administer, translate, culturally adapt, modify appropriately, or use the WHO-5 for any lawful purpose including: routine clinical practice, clinical documentation, public health and population-level well-being screening programs, research (both commercial and non-commercial), education and training, commercial software and electronic health record integration, mobile health application implementation, occupational health programs, and web-based screening platforms. Formal translation and cultural validation of the WHO-5 has been coordinated by WHO and independent investigators into well over two dozen languages, all consistent with the instrument's no-fee public-domain status. Consistent with scholarly convention, formal written, regulatory, or research reports that present WHO-5-derived results are customarily expected to cite the original 1998 WHO source documentation, and — where discussing psychometric properties or the validation evidence base — the 2015 Topp et al. systematic review. No restrictions apply to use of the instrument itself; the only customary caveat, analogous to all standardized psychometric instruments, is that materially altered versions of item wording, response anchors, recall period, or scoring convention should not be labeled identically to the WHO-5 without appropriate qualification of the modifications made.
| WHO-5 Score Range (0-100 %) | Well-Being Tier | Interpretive Reference |
|---|---|---|
| 72 – 100 % | High / Good Well-Being | Consistent endorsement of high positive subjective well-being across all five WHO-5 domains (cheerful mood, calmness, energy, restful awakening, daily interest engagement). Typically associated with favorable psychological functioning profiles in general population samples. |
| 50 – 71 % | Average Well-Being | Moderate or population-typical level of positive subjective well-being. Often reflects a mixture of high-functioning days and more challenging periods consistent with normative life variation. Standard population-based health guidance (regular physical activity, sleep consistency, social connection, stress recovery) remains appropriate. |
| 0 – 49 % | Low Well-Being / Possible Low Mood Threshold | Reduced subjective well-being across the two-week window below the approximate ≥50 screening cutoff (documented sensitivity ~86% / specificity ~66% in Tølz et al. and Topp 2015 review for depressive symptomatology detection). Per standard guidance, scores in this range typically warrant consideration of further evaluation or formal discussion with a qualified healthcare or mental health professional, especially if low scores persist across repeated administrations or are accompanied by functional impairment, persistent low mood, anhedonia, or other concerns. |
Data Source and References
- [1] World Health Organization (1998). Well-being measures in primary health care: the WHO-5. WHO Regional Office for Europe, Mental Health Division, Copenhagen, Denmark. — Original WHO-5 instrument publication, item wording, response anchors, recall window, raw 0-20 scoring, ×5 → 0-100 percentage conversion formula, and three-tier interpretive conventions. Explicit public-domain designation.
- [2] Topp CW, Søndergaard S, Søndergaard L, Østergaard SD (2015). The WHO-5 Well-Being Index: A systematic review of the literature. Psychotherapy and Psychosomatics, 84(3):167-176. doi.org — Comprehensive systematic review of WHO-5 psychometric properties, validation across languages and settings, screening cutoff performance (≥50-equivalent sensitivity ~86%, specificity ~66% consistent with Tølz et al. primary care studies), and reconfirmation of public-domain status with no permission or fee required.
- [3] Tølz I and colleagues / WHO-5 primary care validation studies. — Original and replicated WHO-5 depression-screening validation data in general practice and primary care populations documenting approximate ≥50-equivalent cutoff sensitivity of 86% and specificity of 66% for clinically significant depressive symptomatology, as synthesized and referenced in Topp et al. 2015.
Frequently Asked Questions
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No. The WHO-5 Well-Being Index is a positive-construct, subjective well-being screening instrument, not a diagnostic tool. It does not and cannot diagnose major depressive disorder, persistent depressive disorder, generalized anxiety disorder, bipolar disorder, adjustment disorders, or any other psychiatric, psychological, or medical condition. The WHO-5 was designed by the WHO Mental Health Division as a brief, population-level screen for subjective well-being quality and as an initial indicator of possible low mood warranting further evaluation. A low WHO-5 score, or a score below the ≥50 screening cutoff, may suggest a level of reduced subjective well-being potentially warranting further discussion, but a WHO-5 score alone is never sufficient for any clinical diagnosis. All diagnostic decisions and treatment recommendations must be made by a qualified psychiatrist, licensed clinical psychologist, or other appropriately trained mental health or healthcare professional following a formal clinical evaluation.
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The WHO-5 Well-Being Index consists of five positively worded items, all of which are scored in the same forward direction with no reverse-keyed items. Each item uses a common six-point Likert frequency response scale anchored to the past two weeks: 0 = At no time, 1 = Some of the time, 2 = Less than half the time, 3 = More than half the time, 4 = Most of the time, and 5 = All of the time. The raw WHO-5 score is the arithmetic sum of the five item responses, yielding a closed theoretical range of 0 to 20. The standard, officially recommended WHO percentage conversion formula is: Percentage score = Raw sum × 5. This linear transformation produces a percentage-style well-being score in the 0 to 100 range, where 0 represents the complete absence of well-being across all five items and 100 represents maximum endorsed well-being across all five items at the "All of the time" frequency. Alternative formulations (raw score × 4 or other linear rescalings) occasionally appear in older literature, but the sum × 5 → 0-100 percentage transformation is the official convention specified in the 1998 WHO user manual and adopted by the overwhelming majority of subsequent validation studies including the comprehensive 2015 Topp et al. systematic review.
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The three-tier WHO-5 interpretive scheme follows the descriptive classifications originally outlined in the 1998 WHO Regional Office for Europe user manual and widely replicated in subsequent population studies and validation work. Specifically, a percentage well-being score of 72 or higher is classified as High or Good well-being, reflecting a generally high level of positive subjective functioning; a score in the 50 through 71 range is classified as Average well-being, consistent with moderate or population-typical levels of positive subjective functioning; and a score below 50 is classified as Low well-being, a threshold that in many studies corresponds approximately to the point at which low-mood symptomatology becomes sufficiently prevalent to warrant further evaluation. The most extensively studied screening cutoff for WHO-5-based detection of current depressive symptomatology is a raw score of 13 or greater, which maps to the percentage threshold of ≥50 (since 13 × 5 = 65; the percentage ≥50 threshold is commonly interpreted analogously). In published validation studies — including the Tølz et al. primary care investigations and the evidence base synthesized in the 2015 Topp et al. systematic review of Psychotherapy and Psychosomatics — the approximate ≥50 equivalent cutoff has demonstrated a sensitivity of approximately 86% (meaning approximately 86% of individuals meeting research criteria for clinically significant depressive symptomatology scored at or above the threshold) and a specificity of approximately 66% (meaning approximately 66% of individuals not meeting such criteria scored below the threshold). As with all psychometric screening instruments, these sensitivity and specificity values are population-level descriptive statistics derived from specific validation samples; individual operating characteristics vary across settings, demographic subgroups, and comorbidity profiles, and the tiers as well as the ≥50 cutoff represent interpretive reference points, not diagnostic boundaries.
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Yes. The WHO-5 Well-Being Index is explicitly placed in the public domain by the World Health Organization Regional Office for Europe and the WHO Mental Health Division, as documented in the original 1998 WHO-5 user manual and repeatedly confirmed in subsequent WHO publications and the comprehensive 2015 Topp et al. systematic review in Psychotherapy and Psychosomatics. No written permission, license, royalty, or fee of any kind is required to reproduce, administer, translate, culturally adapt, or use the WHO-5 for any lawful purpose including clinical practice, public health screening, research (commercial and non-commercial), education, commercial software and electronic health record integration, mobile health application implementation, and web-based screening platforms. The WHO-5 has been formally translated and culturally adapted into dozens of languages worldwide through both WHO-coordinated and independent translation processes, consistent with its public-domain, no-fee status. The only customary expectation, consistent with standard academic practice and scholarly convention, is that users of the WHO-5 appropriately cite the original 1998 WHO Mental Health Division source documentation ("Well-being measures in primary health care: the WHO-5. WHO Regional Office for Europe, Mental Health Division, Copenhagen") and — where specifically discussing psychometric properties or validation evidence — the 2015 Topp et al. systematic review in Psychotherapy and Psychosomatics 84:167-176, when formally reporting WHO-5 results in written, research, or regulatory contexts.