The WHO-5 Wellbeing Index: The 5-Question Screener Every Practice Should Use

At five items and roughly one minute of patient time, the WHO-5 Wellbeing Index is the shortest validated mental health screener in widespread clinical use. It's also one of the most underappreciated.

Developed by the World Health Organization, the WHO-5 takes a fundamentally different approach from most clinical instruments. Instead of asking about symptoms of a specific disorder, it asks about positive wellbeing: cheerfulness, calm, vigor, interest, and rest. This inversion is both its greatest strength and the source of frequent misunderstanding about its clinical purpose.

The Five Items

Patients rate how often they've experienced each of the following over the past two weeks, on a scale from 0 (at no time) to 5 (all of the time):

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

The raw score (0–25) is multiplied by 4 to give a percentage score from 0 to 100.

Clinical Interpretation

• Score above 50: Generally adequate wellbeing
• Score 28–50: Low wellbeing, further assessment warranted
• Score below 28: Likely depression, clinical assessment strongly recommended
• Change of 10+ points: Clinically meaningful change

A WHO-5 score below 28 has sensitivity of approximately 86% for major depression. This makes the WHO-5 a surprisingly effective depression screener despite never mentioning depression, sadness, or any pathological symptom.

Why a Positively Framed Instrument Matters

Most mental health assessments ask about problems: "How often have you felt down?" "Have you lost interest?" "Do you worry too much?" This deficit-focused approach is necessary for diagnosis and severity monitoring, but it shapes the clinical encounter in subtle ways.

The WHO-5 opens a different conversation. Asking "How often have you felt cheerful?" shifts the frame from pathology identification to wellbeing assessment. This matters in several contexts.

Primary care screening. Patients seeing a general practitioner for a sore throat may balk at a questionnaire about depression and anxiety. The WHO-5 feels like a general health check rather than a psychiatric screening, reducing resistance and stigma.

Destigmatized entry point. In cultures or populations where mental illness carries significant stigma, a positively worded wellbeing scale is far more acceptable than a symptom checklist. The WHO-5 has been translated into over 30 languages and validated across highly diverse cultural contexts.

Therapy onboarding. For new therapy patients who are already nervous, starting with "How good have you been feeling?" rather than "How bad have you been feeling?" sets a different tone.

Treatment outcome measurement. Recovery isn't just the absence of symptoms. It's the presence of wellbeing. The WHO-5 captures the positive dimension that instruments like the PHQ-9 miss entirely. A patient can score 4 on the PHQ-9 (minimal depression) but still report poor wellbeing on the WHO-5, indicating they've left symptomatic depression but haven't yet achieved positive mental health.

Pairing the WHO-5 with Symptom Measures

The WHO-5 and disorder-specific instruments (PHQ-9, GAD-7, etc.) are complementary, not competing. A sensible assessment strategy might look like:

Initial screening: WHO-5 as a universal screener → if score below 50, follow up with disorder-specific measures based on clinical impression.

Ongoing monitoring: WHO-5 at every session as a quick wellbeing check + disorder-specific measure (e.g., PHQ-9) at regular intervals (every 2–4 sessions) for detailed symptom tracking.

Outcome evaluation: WHO-5 at intake and discharge to measure overall wellbeing change, supplemented by disorder-specific measures for symptom-level outcomes.

This layered approach gives you both the broad view (is wellbeing improving?) and the specific view (are target symptoms resolving?).

Practical Advantages

Universal applicability. Because the WHO-5 isn't tied to any specific diagnosis, it works across the full spectrum of presenting problems. You can use the same instrument for depression, anxiety, adjustment disorders, chronic stress, and subclinical distress.

Sensitivity to change. The WHO-5 responds quickly to both deterioration and improvement. Its 0–100 scaling provides fine-grained tracking that helps you detect small changes over time.

Patient acceptability. The WHO-5 has among the highest acceptability ratings of any clinical instrument. Patients find it quick, non-intrusive, and relevant.

No cost. The WHO-5 is freely available for clinical use: no licensing fees, no restrictions.

Limitations

The WHO-5 is a screening and monitoring tool, not a diagnostic instrument. A low score tells you something is wrong; it doesn't tell you what. Follow-up assessment is always needed.

It also has a ceiling effect in healthy populations: most people without mental health difficulties score above 60, which compresses the measurement range for wellbeing promotion contexts (as opposed to clinical contexts).

The WHO-5 doesn't differentiate between types of distress. A patient in a depressive episode and a patient with severe anxiety may produce similar WHO-5 scores. For treatment planning, you need additional information.