The WHO-5 Well-Being Index: Scoring, the Percentage Score, and Clinical Use

The WHO-5 Well-Being Index was introduced in 1998 by the World Health Organization Regional Office for Europe. It was drafted at the Psychiatric Research Unit of Frederiksborg General Hospital in Hillerod, Denmark, and presented as part of the DepCare project, an effort to bring a usable measure of well-being into ordinary primary care visits.

The design brief ran against the grain of the instruments around it. Instead of counting symptoms, the WHO-5 asks whether good states have been present over the past two weeks: cheerfulness, calm, energy, restful sleep, and interest in daily life. Five statements, plain wording, under a minute to complete.

It travelled. The WHO-5 has been translated into more than 30 languages and sits among the most widely used brief well-being measures in the world, showing up in diabetes clinics, geriatric medicine, occupational health research, and psychiatric outcome studies.

The scale is free to use, with no licensing fee and no registration step, which is a large part of why it spread through research and routine practice at the same time. The free WHO-5 hosted here uses the standard five items and shows both the raw total and the percentage conversion.

Internal consistency sits around .84 across studies, which is strong for a five-item scale. The items behave as a single dimension, so the total carries the information. There are no subscales to report and no reverse-coded items to catch.

As a depression screen, the WHO-5 performs at a level comparable to much longer instruments. The systematic review by Topp, Ostergaard, Sondergaard, and Bech (2015) reports a sensitivity of 0.86 and a specificity of 0.81 in its key meta-analytic estimate. In practice that means the scale flags most people who do have a depressive disorder while producing a moderate number of false positives, the usual trade for a screener.

That review, drawing on studies across clinical populations from cardiology to psychiatry, also documents construct validity and responsiveness: the scores move when a person's condition moves. A monitoring measure that stays flat through real clinical change is worthless, so this property is the one that earns the WHO-5 its place in repeat administration.

All five items use the same six-point frequency scale for the past two weeks: At no time (0), Some of the time (1), Less than half of the time (2), More than half of the time (3), Most of the time (4), All of the time (5).

Every statement is worded positively: I have felt cheerful and in good spirits; I have felt calm and relaxed; I have felt active and vigorous; I woke up feeling fresh and rested; my daily life has been filled with things that interest me.

Add the five responses for a raw score between 0 and 25, then multiply that total by 4 for a percentage score between 0 and 100. The multiplication has a purpose. Most published thresholds and most of the research literature are stated in percentage terms, so reporting a raw 13 as 52 lines the score up with the numbers a reader will find everywhere else.

A raw score of 12 or below, equal to a percentage score of 50 or below, indicates poor well-being and is the standard trigger for further depression screening. In monitoring, a change of 10 percentage points, which works out to 2.5 raw points, is treated as clinically meaningful.

A low score is a reason to ask more questions, and nothing more than that. The WHO-5 describes how a person has felt over 14 days. It does not establish duration criteria, rule out medical contributors, or assess risk. A score at or below the cutoff calls for a clinical interview and usually a symptom-based screen such as the PHQ-9. A comfortable score does not close the subject either, since a person can report decent well-being and still meet criteria for a disorder.

The WHO-5 runs opposite to every symptom scale it usually sits next to. On the PHQ-9 and the GAD-7, a bigger number means more trouble. On the WHO-5, a bigger number means the person is doing better, and 25 out of 25 is the best possible result.

This trips people up in real charts. A clinician who has just scored a PHQ-9 of 21 and then reads WHO-5 22 in the same intake packet can register the second number as another alarm. The fix is small. Write the band word next to the number in the note, so that WHO-5 22 becomes WHO-5 22/25, high well-being, and nobody reading the chart later has to remember which way the scale points.

The direction follows from what the instrument asks. Its five items look for the presence of good states rather than the absence of bad ones. Someone who can honestly deny every item on a depression checklist may still answer At no time to whether their days hold anything that interests them.

That gap is where the WHO-5 earns its keep. A low score alongside a clean PHQ-9 is a real finding: burnout, caregiver strain, chronic illness, grief that has settled into flatness, a job that has gone gray, or early and residual depression that has not yet organized itself into countable symptoms. Symptom scales go quiet in those situations. This one does not.

Initial screening: the WHO-5 takes under a minute and gives a global reading before any diagnosis-specific instrument narrows the frame. Many settings pair it with the PHQ-9 and use a raw score of 12 or below as the trigger to run the fuller depression screen and to ask directly about sleep, appetite, and safety.

Monitoring cadence: the items reference the past two weeks, so weekly administration measures overlapping windows and mostly adds noise. Every two weeks during active treatment and every four weeks in maintenance are common intervals, which is also the rhythm the PHQ-9 uses, so the two travel together well.

Meaningful change: a 10 percentage point move, equal to 2.5 raw points, is the conventional threshold for a shift worth acting on. In practice, a raw change of 3 points or more counts as signal, and a 1-point wobble between administrations does not.

Measurement-based care: the WHO-5 adds an axis that symptom counts leave out. When a PHQ-9 stalls at 8 for six weeks while the WHO-5 climbs from 9 to 17, the treatment is clearly moving something a depression score alone would call a plateau. The items also map onto behavioral activation targets, since being active and vigorous and having days filled with things that interest you are precisely what an activity schedule is built to change.

0-7 (Very Low Well-Being): a raw score of 7 converts to a percentage score of 28, so this band covers the bottom quarter of the scale. People scoring here typically report that the good states are rare or absent across all five domains at once, which is a broad flattening rather than one bad week of sleep. Scores in this range call for a full depression screen, a conversation about functioning at work and at home, and direct risk screening, since the WHO-5 contains no item about self-harm.

8-12 (Low Well-Being): the entire band sits at or below the cutoff of 12, so any score in it is a positive screen for poor well-being and the standard trigger for further depression assessment. A 12 is the edge case worth watching, since it crosses the threshold by a single point. Repeating the measure in two weeks usually settles whether it reflects a trend or one rough fortnight.

13-19 (Moderate Well-Being): scores here clear the screening cutoff, so no automatic follow-up screen is indicated on the basis of the number alone. This is the widest band, and the pattern across items often tells you more than the total. A client who reaches 15 by answering More than half of the time to four items looks quite different from one who reaches 15 by answering All of the time to three items and At no time to the other two. The second pattern is worth asking about.

20-25 (High Well-Being): the top of the scale, corresponding to percentage scores of 80 and above. The good states are present most or all of the time. In monitoring, a move into this band is a reasonable marker of recovery, and in a treatment that is winding down it supports spacing sessions further apart. A high score does not rule out a disorder by itself, particularly where minimization or impression management is in play.

Is a WHO-5 score of 10 low? Yes. A raw score of 10 converts to a percentage score of 40, which sits below the cutoff of 50 and falls in the Low Well-Being band. It indicates poor well-being over the past two weeks and is the standard signal to screen further for depression. The number carries no diagnosis on its own; duration, functional impairment, medical contributors, and risk all still have to be assessed in an interview.

What does a WHO-5 percentage score of 52 mean? A percentage of 52 comes from a raw score of 13, which clears the poor-well-being threshold of 50 by one raw point and lands at the bottom of the Moderate Well-Being band. That is a thin margin. If the person describes real distress or the score has fallen from a much higher baseline, the interview is the stronger evidence and further screening is still reasonable.

How do you convert a WHO-5 raw score to the percentage score? Multiply the raw total by 4. A raw 13 becomes 52, a raw 20 becomes 80, a raw 25 becomes 100. The percentage is the same information on a 0 to 100 scale, and the two are interchangeable as long as the chart says which one it is reporting. Confusion between them is the most common WHO-5 charting error: a percentage of 40 and a raw score of 40 cannot both exist, since 25 is the raw ceiling.

Are any WHO-5 items reverse scored? No. All five statements are worded in the positive direction, so every item is scored exactly as answered and the five values are simply added. This separates the WHO-5 from instruments like the CES-D or the Rosenberg self-esteem scale, where a subset of items has to be flipped before summing. A WHO-5 total that looks wrong is almost always a data entry problem rather than a coding one.

What counts as a good WHO-5 score? One threshold carries the evidence: 12 raw, or 50 percent. At or below it, further depression screening is indicated. Above it, the most useful comparison is the person's own earlier scores. General population samples typically score well clear of the cutoff, but norms vary enough by country, age, and health status that a single universal average is not worth quoting. Track the individual trajectory and treat the cutoff as the fixed reference point.

Can the WHO-5 replace the PHQ-9? No, for structural reasons. The PHQ-9 maps onto the DSM criteria for major depressive disorder and includes an item about thoughts of self-harm. The WHO-5 does neither. Use the WHO-5 as the quick global reading that decides whether the fuller screen is needed, and keep risk assessment on the instrument and the interview built for it. If you or someone you know is in crisis, contact the 988 Suicide and Crisis Lifeline by calling or texting 988.

Topp, C. W., Ostergaard, S. D., Sondergaard, S., and Bech, P. (2015). The WHO-5 Well-Being Index: A systematic review of the literature. Psychotherapy and Psychosomatics, 84(3), 167-176.

World Health Organization Regional Office for Europe (1998). Wellbeing measures in primary health care: The DepCare Project. Copenhagen: WHO Regional Office for Europe.

Kroenke, K., Spitzer, R. L., and Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613.