> ## Documentation Index > Fetch the complete documentation index at: https://docs.getrivet.ca/llms.txt > Use this file to discover all available pages before exploring further. # WHO-5 — Well-Being Index > The WHO's 5-item positive-frame measure of subjective well-being — a depression screen that doesn't read like one. 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. ## 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. ## 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. ## Scoring and severity cutoffs Sum of 5 items × 4 = percentage score on a 0–100 scale (higher = better well-being). | Score | Band | | ------ | -------------------------------------------------------- | | 0–28 | Poor well-being — further depression screening indicated | | 29–50 | Reduced well-being | | 51–72 | Moderate well-being | | 73–100 | High 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). ## 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](/clinical-templates/screening/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. ## Is it free to use? **Yes.** Free clinical use, per the WHO. ## 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. ## 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. ## Related articles The classic 9-item depression screen with risk flagging. The WHO's 12-item functional-disability measure.