WHO-5 — Well-Being Index

The WHO-5 is the well-being measure to reach for when the client pushes back on problem-framed instruments. Five items, six-point Likert, all phrased as positive statements about the past two weeks (“I have felt cheerful and in good spirits”). It’s a depression screen — low scores trigger further PHQ-9-style assessment — but it doesn’t sound like one. WHO developed it in 1998 for the DepCare Project. Topp’s 2015 systematic review of 200+ studies established it as one of the most widely used global mental-health measures, validated across 30+ languages.

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What it measures

Positive subjective well-being across five items:

• Feeling cheerful and in good spirits
• Feeling calm and relaxed
• Feeling active and vigorous
• Waking up feeling fresh and rested
• Daily life filled with things that interest you

All rated 0–5, looking back over the past two weeks.

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When to send it

• Older-adult clients who flinch at PHQ-9 framing
• Primary-care embedded mental-health practice where the WHO recommends the WHO-5 as one of the briefest viable depression screens
• Pre/post for positive-psychology, mindfulness, or supportive protocols
• Outcome tracking in any therapy where well-being itself is the measured construct
• As a complement to the PHQ-9 — the positive and negative framings surface different things

The five items take under two minutes. Async administration works well and the positive framing is often the lightest instrument in a multi- measure intake.

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Scoring and severity cutoffs

Sum of 5 items × 4 = percentage score on a 0–100 scale (higher = better well-being). Cutoff ≤28% is the clinically-actionable threshold for further depression screening with the PHQ-9 or a diagnostic instrument (Topp et al. 2015 systematic review).

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WHO-5 vs PHQ-9

They ask opposite questions. The PHQ-9 asks how much is wrong; the WHO-5 asks how good the last two weeks felt. That makes the WHO-5 the easier instrument to hand to a client who pushes back on symptom checklists — older clients, people early in treatment, anyone for whom a page of problem statements is itself a barrier. It is not a replacement. A score at or below 28% is the published trigger for a proper depression screen, which means a low WHO-5 usually leads to a PHQ-9 rather than standing in for one. Where the WHO-5 does stand alone is as an outcome measure: if the work is about well-being rather than symptom reduction, it measures the thing you’re actually trying to move.

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Is it free to use?

Yes. Free clinical use, per the WHO.

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Citation

World Health Organization (1998). Well-being measures in primary health care: The DepCare Project. WHO Regional Office for Europe, Copenhagen. Review and clinical interpretation: 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. Free clinical use per WHO.

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When not to use it

The WHO-5 is a well-being and depression screen — it doesn’t differentiate depression from other low-mood presentations and doesn’t carry a suicide-risk item. When risk assessment matters, use the PHQ-9 (with its Item 9 suicidal-ideation question and Rivet’s flag) or pair the WHO-5 with the PHQ-9 for the positive-and-negative pair. For anxiety, pair it with the GAD-7.

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