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World Health Organization-Five Well-Being Index:
Scoring and Interpretation
The World Health Organization-Five Well-Being Index (WHO-5) is a five-item, positively worded self-report of subjective well-being over the previous two weeks, scored raw from 0 to 25 and transformed to 0 to 100 by multiplying by four (WHO, 2024). Higher scores mean better well-being, the reverse of most symptom scales. WHO-5 scoring runs on two metrics, and the raw threshold (below 13) and the percentage threshold (below 50) flag exactly the same respondents, as the code further down shows.
What the WHO-5 Measures
The WHO-5 is a short, positively worded assessment of subjective mental well-being over the preceding two weeks. It was developed at the Psychiatric Research Unit, WHO Collaborating Centre for Mental Health, Frederiksborg General Hospital, Denmark (Bech, 1998), and WHO publishes the five-item instrument with a current scoring sheet (WHO, 2024). Unlike symptom-focused questionnaires, high scores reflect a more favorable state, which makes the WHO-5 useful as an outcome measure for quality-of-life and mental-health programs.
The measure has also been investigated as a screening indicator of possible depression or poor mental health. In that role a low score is an invitation for further assessment; it cannot establish a psychiatric diagnosis (WHO, 2024; Topp et al., 2015).
Structure of the WHO-5
- Items: five positively phrased items, none reverse coded.
- Response scale: six frequency points keyed 0 to 5, referring to the previous two weeks.
- Subscales: none. The index yields a single positive mental well-being score.
- Total: one raw sum from 0 to 25. Multiplying the raw total by 4 expresses it on a 0 to 100 percentage-like scale.
- Unscored content: none. There are no additional subscale scores or normally unscored questions.
- Direction: higher WHO-5 scores indicate better well-being, opposite to PHQ-9 or K6 symptom totals.
- Versions: earlier WHO well-being measure versions exist; the WHO-5 is the current standard form.
- Translations: WHO publishes over 30 language versions.
The instrument itself is available from the World Health Organization official 2024 WHO-5 publication.
How to Score the WHO-5
- Confirm that who1 to who5 are coded so that 0 corresponds to the least frequent positive well-being and 5 to the most frequent.
- Sum all five responses to form who5_raw (0 to 25), then multiply by four to create who5_pct (0 to 100).
- The code requires complete responses. The official WHO scoring sheet describes a total but does not provide a universal prorating rule for incomplete forms, so pre-specify any alternative.
- When analyzing a possible poor-well-being indicator, classify raw scores below 13 (equivalent to a transformed score below 52). The WHO document also expresses the suggested cut-off as a transformed score below 50. The integer raw and percentage boundaries differ for a raw score of 12 (48) versus 13 (52), so no actual raw value falls at 50.
* Illustrative syntax: variables must already be valid item scores (0 to 5).
COMPUTE who5_raw=SUM.5(who1 TO who5).
COMPUTE who5_pct=4*who5_raw.
IF (NOT MISSING(who5_raw)) who5_low=(who5_raw<13).
EXECUTE.# data: one row per respondent; items who1 to who5 coded 0 to 5.
data$who5_raw <- rowSums(data[paste0("who",1:5)],na.rm=FALSE)
data$who5_pct <- 4*data$who5_raw
data$who5_low <- ifelse(is.na(data$who5_raw),NA,data$who5_raw<13)Interpreting WHO-5 Scores
| Score band | Interpretation |
|---|---|
| 0 to 25 raw | Full raw mental well-being score; larger = better |
| 0 to 100 transformed | Raw sum multiplied by 4 |
| 0 to 12 raw / 0 to 48 transformed | Below suggested poor-well-being screening threshold |
| 13 to 25 raw / 52 to 100 transformed | At or above suggested screening threshold |
Source: WHO (2024) official scoring guidance, citing Topp et al. (2015).
An official WHO document notes that a transformed score below 50, or a raw score below 13, can indicate poor well-being and support further assessment for a mental-health condition. Neither threshold supplies a diagnosis, and performance depends on setting and population.
The WHO-5 direction is the reverse of many symptom scales: higher means better. Avoid describing the WHO-5 as a five-item depression severity score or using the clinical threshold as a fixed treatment-response definition.
Psychometric Properties
| Property | Published finding | Source |
|---|---|---|
| Construct validity | Measures positive mental well-being and relates to depression and other mental-health indicators | Topp et al. (2015) |
| Evidence synthesis | A 2015 systematic review summarizes applications and psychometric findings across numerous studies | Topp et al. (2015) |
| Internal consistency | Varies across reviewed samples; no single alpha value applies to every setting | Topp et al. (2015) |
| Responsiveness | A 10% change on the 0 to 100 scale (10 points) is commonly treated as a clinically relevant difference | Topp et al. (2015) |
| Screening threshold | WHO official guidance suggests raw below 13 or transformed below 50 for further assessment | WHO (2024) |
| Diagnostic sensitivity and specificity | Population-dependent; do not assert one universal pair of accuracy figures | Topp et al. (2015) |
These are source-specific results and cannot be assumed to hold as reliability or accuracy estimates in a new sample.
Using the WHO-5 in a Study
Transformed WHO-5 values are attractive as continuous outcomes in population surveys and pre/post intervention studies, but the 0 to 100 score is a linear transformation of the same five responses, not a percentage probability. Report the chosen raw or transformed metric consistently. When reporting change, specify the scale metric and account for baseline score; in a two-group intervention study, ANCOVA does this with the baseline as a covariate and gives the adjusted difference with its 95% confidence interval.
Estimate reliability in the current sample, as set out under Reliability Analysis (Cronbach’s Alpha). Where the continuous score is modeled against several covariates, a Multiple Linear Regression is the usual starting point, and if the low-score indicator is evaluated against an interview reference, Sensitivity & Specificity (Diagnostic Accuracy) reports the estimates with confidence intervals. A universal minimum important change may differ by disease and study context, so do not quote one unqualified value without a matching population-specific validation.
Related field: Health Psychology
Reporting the WHO-5
Mental well-being was measured using the WHO-Five Well-Being Index (WHO-5; World Health Organization, 2024). Five items referring to the previous two weeks were scored 0 to 5, summed to a raw score of 0 to 25, and multiplied by four to obtain a 0 to 100 outcome; higher scores indicated better well-being. Internal consistency was [α = XX], and missing data were handled using [method].
References
Bech, P. (1998). Quality of life in the psychiatric patient. Mosby-Wolfe.
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. https://doi.org/10.1159/000376585
World Health Organization. (2024). The World Health Organization-Five Well-Being Index (WHO-5). https://www.who.int/publications/m/item/WHO-UCN-MSD-MHE-2024.01
Frequently Asked Questions
How do I convert a WHO-5 score to 0 to 100?
Add the five items, each scored 0 to 5, and multiply the raw total by four. The result is a linear rescaling of the same responses, so it carries no new information.
Is a low WHO-5 score a depression diagnosis?
No. Low well-being may warrant further evaluation, but a clinical diagnosis requires a separate assessment.
What is the WHO-5 screening threshold?
WHO suggests a raw score below 13, which corresponds to a transformed score of 0 to 48 on the achievable four-point increments.
Should a higher WHO-5 score be interpreted as more symptoms?
No. A higher score represents better mental well-being, the opposite direction to symptom totals such as the PHQ-9 or K6.
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