What Is the World Health Organization Well-Being Index (WHO-5)?

Written By: Elizabeth Kroll

Clinically Reviewed By: Dr. Don Gasparini

The well-being screening tool is popular in many different contexts — from school to research — because it frames questions in a positive light.

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When clinicians and researchers want to assess someone’s overall well-being, one tool they turn to is the World Health Organization Five Well-being Index (WHO-5). This standardized screening tool uses positive questions to measure well-being (also making it popular in schools and workplaces, where it may be unlikely for people to answer more vulnerable questions). In essence, higher scores indicate positive mood and generally balanced well-being, whereas lower scores may indicate depressive symptoms or the need for additional mental healthcare. 

Continue reading to learn more about the WHO-5 and its use in research and healthcare settings—including Charlie Health’s virtual Intensive Outpatient Program (IOP). 

What is the WHO-5 screener?

The World Health Organization Well-Being Index (WHO-5) is a standardized set of five questions that assess well-being in people ages nine and up. The measure was first developed in 1982 with a total of 28 questions covering both positive and negative well-being. However, researchers thought it was important to have a scale that specifically measured the positive qualities of life, so they narrowed down the questions until only five remained.

In 1998, the World Health Organization adopted the WHO-5 as part of a broader public health project to measure well-being in European primary care settings. It has since been translated into 30 different languages, including Albanian, Farsi, Icelandic, and Urdu, and is used internationally. 

How is the WHO-5 used for well-being screening?

The WHO-5 is often used to measure well-being in different settings. It is widely used in healthcare, school, and work settings because the questions are positively framed and non-invasive. 

Patients may be asked to fill out the well-being screener when they see a primary care physician or during intake appointments with mental health specialists. In these clinical contexts, healthcare providers can use the WHO-5 to guide treatment planning or identify areas of concern (low scores on the WHO-5 may indicate a need for further evaluation). For patients experiencing major health concerns like diabetes, heart disease, or cancer, the WHO-5 is often used to assess well-being during treatment. The screening tool can also be used to measure the well-being of medical providers, as done for nurses during the pandemic. 

The WHO-5 is quick and easy to score. It prompts people to rate how often they’ve experienced certain positive feelings or positive states during the past two weeks. Responses include “at no time,” “some of the time,” “less than half of the time,” “more than half of the time,” “most of the time,” and “all of the time,” each linked to a score from zero to five, respectively. 

1. I have felt cheerful and in good spirits
2. I have felt calm and relaxed
3. I have felt active and vigorous
4. I woke up feeling fresh and rested
5. My daily life has been filled with things that interest me

Once all items are rated, the scores are summed up and multiplied by four to produce a total score ranging from zero to 100. Low scores may indicate a risk of psychological distress or mental health issues, while higher scores suggest better overall well-being and positive mood.

How is the WHO-5 used in research?

In research, participants may use the WHO-5 in place of depressive disorder screeners, like the Patient Health Questionnaire-9 (PHQ-9). The WHO-5 can actually help measure depression, but because its questions are worded more positively than a typical depression screening tool, it’s less triggering to participants struggling with a depressive disorder or other mental health condition. Also, anonymous research surveys may use the WHO-5 to reduce the risk of triggering respondents since very little direct support can be offered when a name isn’t included.

What Is the Patient Health Questionnaire-9 (PHQ-9)?

Elizabeth Kroll

Depression

The well-being screening tool is also regularly used in public health research studies. Recently, the WHO-5 has been used to study the impact of social media use among adolescents and young adults during the pandemic, the association between lifestyle factors and low-grade inflammation (and their effects on well-being), and the relationship between experiencing climate anxiety and well-being. 

How does Charlie Health use the WHO-5?

Charlie Health uses the WHO-5 screener multiple times throughout treatment. Clients first come across the WHO-5 on our intake survey during group orientation. This provides a baseline well-being score for us to refer to throughout treatment. The WHO-5 is also given to the majority of clients on a weekly basis so that we can gather ongoing information about their well-being. Monitoring clients’ well-being allows us to spot downward trends early and adjust, as well as celebrate wins.

We also use the WHO-5 well-being scores to evaluate the success of our program (also known as an outcome measure). For example, in a recent analysis of the physical health of Charlie Health clients, we found that clients show significant improvement in well-being during treatment. Also, physical symptoms like headaches and stomach aches became less prevalent as the client's well-being improved, showing both the mind-body connection and an outcome measure of the efficacy of our IOP. 

Also, in our pilot study for improved measurement-based care, we found that clients who were exposed to their well-being data week over week and had conversations based on that data had significantly better outcomes than those who did not. We have since launched this program company-wide so that all clients will benefit from this practice and learning this information. 

Improving client well-being at Charlie Health 

If you or a loved one are struggling with your mental health and well-being, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for teens and adolescents dealing with serious mental health conditions, including depressive symptoms. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions to improve mental health and well-being. With treatment, managing your well-being is possible. Fill out the form below or give us a call to start healing today.