The WHO-5 well-being index – validation based on item response theory and the analysis of measurement invariance across 35 countries

Sischka, Philipp E.; Costa, Andreia P.; Steffgen, Georges; Schmidt, Alexander F.

doi:10.1016/j.jadr.2020.100020

Cited by 245Psychometric Methodologies and TestingAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Research Topics

The WHO-5 well-being index – validation based on item response theory and the analysis of measurement invariance across 35 countries

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Sischka, Philipp E., Costa, Andreia P., Steffgen, Georges, Schmidt, Alexander F.·2020·Journal of Affective Disorders Reports

DOI 10.1016/j.jadr.2020.100020

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Abstract

The five-item World Health Organization Well-Being Index (WHO-5) is a frequently used brief standard measure in large-scale cross-cultural clinical studies. Despite its frequent use, some psychometric questions remain that concern the choice of an adequate item response theory (IRT) model, the evaluation of reliability at important cutoff points, and most importantly the assessment of measurement invariance across countries. Data from the 6th European Working Condition survey (2015) were used that collected nationally representative samples of employed and self-employed individuals (N = 43,469) via computer-aided personal interviews across 35 European countries. An in-depth IRT analysis was conducted for each country, testing different IRT assumptions (e.g., unidimensionality), comparing different IRT-models, and calculating reliabilities. Furthermore, measurement invariance analysis was conducted with the recently proposed alignment procedure. The graded response model fitted the data best for all countries. Furthermore, IRT assumptions were mostly fulfilled. The WHO-5 showed overall and at critical points high reliability. Measurement invariance analysis revealed metric invariance but discarded scalar invariance across countries. Analysis of the test characteristic curves of the aligned graded response model indicated low levels of differential test functioning at medium levels of the WHO-5, but differential test functioning increased at more extreme levels. The current study has no external criterion (e.g., structured clinical interviews) to assess sensitivity and specificity of the WHO-5 as a depression screening-tool. The WHO-5 is a psychometrically sound measure. However, large-scale cross-cultural studies should employ a latent variable modeling approach that accounts for non-invariant parameters across countries (e.g., alignment).

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The WHO-5 has validity and reliability supported by a vast set of literature in several populations.
“A vast set of literature supports the validity and reliability of the measure in several populations [42-45].”
From A Cognitive Behavioral Therapy Chatbot (Otis) for Health Anxiety Management: Mixed Methods Pilot Study (2022) · cites this paper as [44]

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Further Evidence for Criterion Validity and Measurement Invariance of the Luxembourg Workplace Mobbing Scale
Sischka, P., Schmidt, A. F., & Steffgen, G. (2020) · European Journal of Psychological Assessment · doi:10.1027/1015-5759/a000483 · Cited by 13 · see citing works
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Model Fit with Residual Analyses
Wells, C. S., & Hambleton, R. K. (2017) · Chapman & Hall/CRC eBooks · doi:10.1201/b19166-20 · Cited by 11 · see citing works
A Comparison of Aggregation Rules for Selecting Anchor Items in Multigroup DIF Analysis
Huelmann, T., Debelak, R., & Strobl, C. (2019) · Journal of Educational Measurement · doi:10.1111/jedm.12246 · Cited by 8 · see citing works
Selecting among polytomous IRT models
Ostini, R., Finkelman, M., & Nering, M. L. (2014) · doi:10.4324/9781315736013.ch14 · Cited by 3 · see citing works
Model Fit with Residual Analyses
Wells, C. S., & Hambleton, R. K. (2016) · doi:10.1201/b19166-25 · Cited by 2 · see citing works
Unidimensional Item Response Theory Modeling [R package irtplay version 1.6.1]
Lim, H. (2020) · Cited by 2 · see citing works

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Sorted by citations

Psychometric Properties of the WHO-5 Well-Being Index among Nurses during the COVID-19 Pandemic: A Cross-Sectional Study in Three Countries
Lara‐Cabrera, M. L., Betancort, M., Muñoz-Rubilar, C. A., Novo, N. R., Bjerkeset, O. A., & Cuevas, C. D. L. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191610106 · Cited by 64 · see citing works
“A recent validation study using item response theory (IRT) suggested that cross-cultural validation studies are needed for the WHO-5 [23].”
Method
The Quality of Work Index and the Quality of Employment Index: A Multidimensional Approach of Job Quality and Its Links to Well-Being at Work
Steffgen, G., Sischka, P. E., & de Henestrosa, M. F. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17217771 · Cited by 56 · see citing works
Self-citation
Spiritual Needs, Religious Coping and Mental Wellbeing: A Cross-Sectional Study among Migrants and Refugees in Germany
Maier, K., Konaszewski, K., Skalski‐Bednarz, S. B., Büssing, A., & Surżykiewicz, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19063415 · Cited by 68 · see citing works
“All items of the WHO-5 are phrased positively with a six-point response format ranging from 0 (none of the time) to 5 (all of the time).”
MethodInfluential
Mechanisms underlying childhood exposure to blue spaces and adult subjective well-being: An 18-country analysis
Vitale, V., Martin, L., White, M. P., Elliott, L. R., Wyles, K. J., Browning, M. H. E. M., Pahl, S., Stehl, P., Bell, S., Bratman, G. N., et al. (2022) · Journal of Environmental Psychology · doi:10.1016/j.jenvp.2022.101876 · Cited by 53 · see citing works
Post-migration Stressors and Subjective Well-Being in Adult Syrian Refugees Resettled in Sweden: A Gender Perspective
Nissen, A., Sengoelge, M., & Solberg, Ø. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.717353 · Cited by 51 · see citing works
A brief psychological intervention for improving the mental health of Venezuelan migrants and refugees: A mixed-methods study
Perera, C., Aldamman, K., Hansen, M., Haahr-Pedersen, I., Caballero-Bernal, J., Caldas-Castañeda, O. N., Chaparro-Plata, Y., Dinesen, C., Wiedemann, N., & Vallières, F. (2022) · SSM - Mental Health · doi:10.1016/j.ssmmh.2022.100109 · Cited by 48 · see citing works
Oxford COVID-19 Vaccine Hesitancy in School Principals: Impacts of Gender, Well-Being, and Coronavirus-Related Health Literacy
Duong, T. V., Lin, C.-Y., Chen, S., Huang, Y., Okan, O., Dadaczynski, K., & Lai, C.-F. (2021) · Vaccines · doi:10.3390/vaccines9090985 · Cited by 50 · see citing works
“Subjective well-being was assessed using the WHO-5 well-being index with 5 items [53], which has been widely used across 35 countries [54].”
Method
A Cognitive Behavioral Therapy Chatbot (Otis) for Health Anxiety Management: Mixed Methods Pilot Study
Goonesekera, Y., & Donkin, L. (2022) · JMIR Formative Research · doi:10.2196/37877 · Cited by 43 · see citing works
“A vast set of literature supports the validity and reliability of the measure in several populations [42-45].”
Background
Item Response Theory Analysis of the Fear of COVID-19 Scale (FCV-19S): A Systematic Review
Alimoradi, Z., Lin, C.-Y., Ullah, I., Griffiths, M. D., & Pakpour, A. H. (2022) · Psychology Research and Behavior Management · doi:10.2147/prbm.s350660 · Cited by 44 · see citing works
Cross-cultural validity of the WHO-5 Well-Being Index and Euthymia Scale: A clinimetric analysis
Carrozzino, D., Christensen, K. S., Patierno, C., Woźniewicz, A., Møeller, S. B., Arendt, I. T. P., Zhang, Y., Yuan, Y., Sasaki, N., Nishi, D., et al. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.05.111 · Cited by 44 · see citing works
Mothers’ Domestic Responsibilities and Well-Being During the COVID-19 Lockdown: The Moderating Role of Gender Essentialist Beliefs About Parenthood
Thorsteinsen, K., Parks‐Stamm, E. J., Kvalø, M., Olsen, M., & Martiny, S. E. (2022) · Sex Roles · doi:10.1007/s11199-022-01307-z · Cited by 42 · see citing works
Effects of limiting digital screen use on well-being, mood, and biomarkers of stress in adults
Pedersen, J., Rasmussen, M. G. B., Sørensen, S. O., Mortensen, S. R., Olesen, L. G., Brage, S., Kristensen, P. L., Puterman, E. M., & Grøntved, A. (2022) · npj Mental Health Research · doi:10.1038/s44184-022-00015-6 · Cited by 39 · see citing works
Use and non-use of parks are dictated by nature orientation, perceived accessibility and social norm which manifest in a continuum
Sia, A., Tan, P. Y., Yu Jin, K. I. M., & Kenneth Boon Hwee, E. R. (2023) · Landscape and Urban Planning · doi:10.1016/j.landurbplan.2023.104758 · Cited by 33 · see citing works
Measurement Invariance of the WHO-5 Well-Being Index: Evidence from 15 European Countries
Cosma, A. P., Költő, A., Chzhen, Y., Kleszczewska, D. W., Kalman, M., & Martin, G. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19169798 · Cited by 32 · see citing works
“To our knowledge, there is only one published study that explored cross-national MI of the WHO-5 [28].”
BackgroundMethod
Validating the Five-Item World Health Organization Well-Being Index
Nylén‐Eriksen, M., Bjørnnes, A. K., Hafstad, H., Lie, I., Grov, E. K., & Lara‐Cabrera, M. L. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191811489 · Cited by 35 · see citing works
“Validation studies have been conducted in different countries and fields [24,25].”
Background
Tolerance of immersive head-mounted virtual reality among older nursing home residents
Rmadi, H., Maillot, P., Artico, R., Baudouin, É., Hanneton, S., Dietrich, G., & Duron, E. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1163484 · Cited by 31 · see citing works
“Furthermore, recently, the WHO-5 was found to be reliable in 35 countries (including France) and has parameters that do not vary across countries (35).”
Background
Cross-National Validation of the WHO-5 Well-Being Index Within Adolescent Populations: Findings From 43 Countries
Sischka, P. E., Martin, G., Residori, C., Hammami, N., Page, N., Schnohr, C., & Cosma, A. P. (2025) · Assessment · doi:10.1177/10731911241309452 · Cited by 30 · see citing works
“…investigating the psychometric properties of the WHO-5 have been conducted among adults (e.g., Jami & Kemmelmeier, 2020; Lara-Cabrera et al., 2022; Sischka, Costa, et al., 2020; Topp et al., 2015), and thus, cannot be unambiguously generalized to adolescent populations (e.g., Borgers et al.,…”
InfluentialSelf-citation
Belonging and adjustment for LGBTQ+ and non-LGBTQ+ students during the social transition to university.
Sotardi, V. A., Surtees, N., Vincent, K., & Johnston, H. (2021) · Journal of Diversity in Higher Education · doi:10.1037/dhe0000305 · Cited by 29 · see citing works
Psychological Contract Violation or Basic Need Frustration? Psychological Mechanisms Behind the Effects of Workplace Bullying
Sischka, P. E., Melzer, A., Schmidt, A. F., & Steffgen, G. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.627968 · Cited by 28 · see citing works
“The five-item WHO-5 Well-Being Index is a well-validated brief general index of subjective psychological well-being (Topp et al., 2015; Sischka et al., 2020a) with responses ranging from 1 (at no time) to 6 (all of the time).”
MethodSelf-citation
Study and personal resources of university students’ academic resilience and the relationship with positive psychological outcomes
Bagdžiūnienė, D., Žukauskaitė, I., Bulotaitė, L., & Sargautytė, R. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1517359 · Cited by 27 · see citing works
Antecedents, outcomes and measurement of work related-cognition in non-work time: A multistudy report using the work-related rumination questionnaire in two languages
Pauli, R., Gaum, P. M., Cropley, M., & Lang, J. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1013744 · Cited by 23 · see citing works
“WHO-5 measurements are language invariant (Sischka et al., 2020) and are suitable to screen for depression (Krieger et al., 2014).”
Background
Experiences of conflict, non-acceptance and discrimination are associated with poor mental well-being amongst LGBTQ-identified individuals in Singapore
Toh, G. W., Koh, W. L., Ho, J., Chia, J., Maulod, A., Tirtajana, I., Yang, P., & Lee, M. (2023) · Equality Diversity and Inclusion An International Journal · doi:10.1108/edi-10-2021-0270 · Cited by 24 · see citing works
Validation of the WHO-5 Well-Being Scale among Adolescents in Ghana: Evidence-Based Assessment of the Internal and External Structure of the Measure
Quansah, F., Hagan, J. E., Ankomah, F., Agormedah, E. K., Nugba, R. M., Srem‐Sai, M., & Schack, T. (2022) · Children · doi:10.3390/children9070991 · Cited by 21 · see citing works
“Numerous studies have assessed the validity and psychometric properties of the WHO-5 well-being index across different geographical contexts such as in Europe [35,39,40], Asia [41–44], and Africa [45,46].”
BackgroundMethodInfluential
Translation and Validation of the Malay Version of the WHO-5 Well-Being Index: Reliability and Validity Evidence from a Sample of Type 2 Diabetes Mellitus Patients
Suhaimi, A. F., Makki, S. M., Tan, K., Silim, U. A., & Ibrahim, N. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19074415 · Cited by 21 · see citing works
Firm resilience, stressors, and entrepreneurial well-being: insights from women entrepreneurs in Ghana
Essuman, D., Boso, N., Asamany, P. A., Ataburo, H., & Asiedu-Appiah, F. (2024) · International Journal of Entrepreneurial Behaviour & Research · doi:10.1108/ijebr-07-2023-0742 · Cited by 20 · see citing works
Development and Validation of an Arabic Version of the World Health Organization Well-Being Index (WHO-5)
Alshayea, A. K. (2023) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-023-10027-x · Cited by 20 · see citing works
Is the meaning of subjective well-being similar in Latin American countries? A cross-cultural measurement invariance study of the WHO-5 well-being index during the COVID-19 pandemic
Caycho‐Rodríguez, T., Vilca, L. W., Valencia, P. D., Carbajal‐León, C., Reyes-Bossio, M. A., White, M., Rojas-Jara, C., Polanco-Carrasco, R., Gallegos, M., Cervigni, M., et al. (2023) · BMC Psychology · doi:10.1186/s40359-023-01149-8 · Cited by 20 · see citing works
“This result is consistent with a study conducted in 35 countries where item 3 was also one of the items that allowed for a better and more accurate assessment of people with moderate and high levels of subjective well-being [9].”
BackgroundResultInfluential
Efficacy of a Conversational AI Agent for Psychiatric Symptoms and Digital Therapeutic Alliance
Shoshani, A., Gurfinkel, B., Kor, A., Ben-Haim, Y., Kanarek, O., Segev, R., Shafir, O., & Arbel, R. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.6713 · Cited by 19 · see citing works
Effectiveness and cost effectiveness of a stress management training for leaders of small and medium sized enterprises – study protocol for a randomized controlled-trial
Lehmann, J., Schwarz, E., Azad, Z. R., Gritzka, S., Seifried-Dübon, T., Diebig, M., Gast, M., Kilian, R., Nater, U. M., Jarczok, M. N., et al. (2021) · BMC Public Health · doi:10.1186/s12889-021-10398-4 · Cited by 19 · see citing works
Predicting subjective well-being in a high-risk sample of Russian mental health app users
Panicheva, P., Mararitsa, L. V., Sorokin, S., Koltsova, O. Y., & Rosso, P. (2022) · EPJ Data Science · doi:10.1140/epjds/s13688-022-00333-x · Cited by 19 · see citing works
“That is why WHO-5 has been adopted in many research fields such as suicidology, geriatrics, youth and alcohol abuse studies, personality disorder research, and occupational psychology [15, 24].”
BackgroundMethod
A multicultural comparative study of self‐stigma in epilepsy: Differences across four cultures
Iwayama, T., Mizuno, K., Yıldız, E., Lim, K. S., Soon, M.-Y., Lynn, Y. J., Hin, C. W., Jean, J. C. Z., Fong, S., Xuen, Y., et al. (2024) · Epilepsia Open · doi:10.1002/epi4.13051 · Cited by 18 · see citing works
Cross-Country Validation of the Arabic version of the WHO-5 Well-Being Index in non- clinical young adults from six Arab countriesPreprint
Fekih‐Romdhane, F., Cherif, W., Alhuwailah, A., Fawaz, M. A., Shuwiekh, H. A. M., Helmy, M. S., Hassan, I. H. M., Naser, A. Y., Zarrouq, B., Chebli, M., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-2988215/v1 · Cited by 18 · see citing works
Brief screening for maternal mental health in Vietnam: Measures of positive wellbeing and perceived stress predict prenatal and postnatal depression
Do, H. P., Baker, P., Vo, T. V., Luong-Thanh, B.-Y., Nguyen, H. L., Valdebenito, S., Eisner, M., Tran, B. X., Hoang, T. D., & Dunne, M. P. (2020) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2020.100047 · Cited by 17 · see citing works
Fear of contamination among older adults in the post-COVID-19 era
Alhalal, E., Alkhair, Z., Alghazal, F., Muhaimeed, F., & Halabi, R. (2022) · Geriatric Nursing · doi:10.1016/j.gerinurse.2022.08.010 · Cited by 16 · see citing works
Measurement Invariance of the Meaning in Life Questionnaire Across 17 Countries
Schutte, L., Brdar, I., Wissing, M. P., Tončić, M., de Araújo, U. F., Carlquist, E., Solano, A. C., Freire, T., Pozo, M. D. R. H., Jose, P. E., et al. (2023) · Applied Research in Quality of Life · doi:10.1007/s11482-023-10150-7 · Cited by 16 · see citing works
“This method has been recently used to assess measurement invariance across many groups (e.g., Glassow et al., 2021; Jang et al., 2017; Raudenská, 2020; Sischka et al., 2020; Zakariya et al., 2020).”
Method
Well-being and ill-being on campus
Morrison, P. S., Liu, I., & Zeng, D. (2023) · International Journal of Wellbeing · doi:10.5502/ijw.v13i3.2785 · Cited by 16 · see citing works
“The scale has been widely tested for its validity, sensitivity, and reliability: see for example DeWit (2007), Downs et al. (2017), Sischka et al. (2020), Hill et al. (2015 and Topp et al. (2015).”
Method
A collaborative application of design thinking and Taguchi approach in restaurant service design for food wellbeing
Rejikumar, G., Ajitha, A. A., Jose, A., & Mathew, S. (2021) · Journal of Service Theory and Practice · doi:10.1108/jstp-12-2020-0284 · Cited by 17 · see citing works
The Mental Well-Being of Health Care Professionals During the COVID-19 Pandemic
Ariza‐Montes, A., Mahmood, F., Han, H., & Saleem, M. (2021) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000002470 · Cited by 17 · see citing works
The Hospitality Stress Matrix: Exploring Job Stressors and Their Effects on Psychological Well-Being
Yoo, D. Y. (2023) · Sustainability · doi:10.3390/su151713116 · Cited by 14 · see citing works
Defining patient-reported outcomes in diabetes, obesity, cardiovascular disease, and chronic kidney disease for clinical practice guidelines - perspectives of the taskforce of the Guideline Workshop
Barnard-Kelly, K. D., Battelino, T., Brosius, F. C., Ceriello, A., Cosentino, F., Gavin, J. R., Giorgino, F., Green, J., Ji, L., Kellerer, M., et al. (2025) · Cardiovascular Diabetology · doi:10.1186/s12933-024-02550-2 · Cited by 15 · see citing works
“• Diabetes psychosocial assessment tool (DPAT) [65] • WHO Well-Being Index (WHO-5) [66] • Patient Health Questionnaire-9 (PHQ-9) [67] • Problem Areas in Diabetes (PAID) [ [78] more involved in their own care and found conversations with healthcare professionals more relevant [92].”
A workplace mindfulness training program may affect mindfulness, well-being, health literacy and work performance of upper-level ICT-managers: An exploratory study in times of the COVID-19 pandemic
Schubin, K., Seinsche, L., Pfaff, H., & Zeike, S. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.994959 · Cited by 13 · see citing works
“The WHO-5 has been used extensively in international research showing adequate validity and high reliability (Topp et al., 2015; Sischka et al., 2020).”
Method
A cross‐sectional study of university students' pocket money variance and its relationship with digital health literacy and subjective well‐being in Ghana
Quansah, F., Ankomah, F., Agormedah, E. K., Ntumi, S., Hagan, J. E., Srem‐Sai, M., Dadaczynski, K., Okan, O., & Schack, T. (2023) · Health Science Reports · doi:10.1002/hsr2.1095 · Cited by 13 · see citing works
Naturalistic Evaluation of HeadGear: A Smartphone App to Reduce Depressive Symptoms in Workers
Deady, M., Collins, D., Glozier, N., Gardiner, E. R. K., Arena, A. F. A., Gayed, A., Bryant, R. A., Calvo, R. A., & Harvey, S. B. (2024) · Behavior Therapy · doi:10.1016/j.beth.2024.01.001 · Cited by 13 · see citing works
COVID-19 countermeasures at the workplace, psychological well-being, and mental health - a nationally representative latent class analysis of Luxembourgish employees
Sischka, P. E., Schmidt, A. F., & Steffgen, G. (2022) · Current Psychology · doi:10.1007/s12144-022-03377-4 · Cited by 13 · see citing works
“General psychological well‑being The five-item WHO-5 Well-Being Index is a well-validated and psychometrically sound brief general index of subjective psychological well-being (Topp et al., 2015; Sischka et al., 2020) with a response format ranging from 1 (= at no time ) to 6 (= all of the time ).”
Self-citation
Optimizing Resistance Training Outcomes: Comparing In-Person Supervision, Online Coaching, and Self-Guided Approaches: A Randomized Controlled Trial
Gavanda, S., Held, S., Schrey, S., Oberwetter, K., Lazzaro, P.-G. M., Pergelt, M., & Geisler, S. (2025) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000005216 · Cited by 12 · see citing works
“The WHO-5 is considered highly reliable (36).”
Assessing Well-Being Across Space and Time: Measurement Equivalence of the WHO-5 in 36 European Countries and Over 8 Years
Jami, W. A., & Kemmelmeier, M. (2020) · Journal of Well-Being Assessment · doi:10.1007/s41543-021-00042-8 · Cited by 12 · see citing works
The longitudinal directional associations of meaningful work with mental well-being – initial findings from an exploratory investigation
Herr, R., Brokmeier, L., Baron, B. N., Mauss, D., & Fischer, J. E. (2023) · BMC Psychology · doi:10.1186/s40359-023-01308-x · Cited by 12 · see citing works
“The five items of the WHO-5 Well-Being Index assessed mental well-being [24, 25].”
Method
Post-migration stressors, mental health and well-being in resettled refugees from Syria: Do individuals’ coping strategies matter?
Solberg, Ø., Nissen, A., & Saboonchi, F. (2023) · Conflict and Health · doi:10.1186/s13031-023-00556-3 · Cited by 12 · see citing works
“Subjective well-being (SWB) was measured with the WHO-5 index, which has been extensively used and validated across populations and cultures, including among refugee populations [19, 20].”
Method
Paths to Autonomous Motivation and Well-being: Understanding the Contribution of Basic Psychological Needs Satisfaction in Health Professions Students
Zhu, Y., Dolmans, D. H. J. M., Köhler, E. S., Kusurkar, R. A., Abidi, L., & Savelberg, H. H. C. M. (2024) · Medical Science Educator · doi:10.1007/s40670-024-02106-9 · Cited by 12 · see citing works
“The WHO (Five) Well-Being Questionnaire [42] is a brief measure with non-invasive questions into respondents’ subjective well-being, and its measurement has shown high validity [43].”
Psychological distress and well-being in university and high school students: a cross-sectional study in Italy
Nosè, M., Turrini, G., Muriago, G., Badino, M., Cristofalo, D., Sartori, R., Tedeschi, F., & Barbui, C. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-101446 · Cited by 12 · see citing works
“Scores range from 0 to 25 and the scale has demonstrated sensitivity to change in well-being and is available in numerous languages 35 (online supplemental file 1).”
COVID-19 anxiety, psychological well-being and preventive behaviors during the COVID-19 pandemic in Latin America and the Caribbean: relationships and explanatory model
Caycho‐Rodríguez, T., Tomás, J. M., Valencia, P. D., Ventura‐León, J., Vilca, L. W., Carbajal‐León, C., Reyes-Bossio, M. A., White, M., Rojas-Jara, C., Polanco-Carrasco, R., et al. (2022) · Current Psychology · doi:10.1007/s12144-022-03389-0 · Cited by 12 · see citing works
“Furthermore, well-being can be used as an important outcome measure of quality of life in different populations and an indicator of the efficacy of various treatment conditions (Sischka et al., 2020).”
Holding a foster child’s mind in mind: study protocol for a cluster-randomized controlled trial of mentalization-based therapy (MBT) for foster families
Dalgaard, N. T., Villumsen, A. M., Sørensen, K. M., Midgley, N., Væver, M. S., Almlund, M., & Pontoppidan, M. (2023) · BMC Psychology · doi:10.1186/s40359-023-01103-8 · Cited by 13 · see citing works
“The WHO-5 index [60, 61] is a five-item questionnaire assessing the emotional well-being of foster parents.”
Background
Associations between well-being and nature-based recreation: A cross-sectional study among adults in the United States, Brazil, and Spain
Rosa, C. D., Larson, L. R., Collado, S., Geiger, S. J., Profice, C. C., & Menuchi, M. R. T. P. (2024) · Journal of Environmental Psychology · doi:10.1016/j.jenvp.2024.102438 · Cited by 12 · see citing works
Association of chronotype and sleep behaviors with mental well-being, eating behaviors, and adiposity traits: a cross-sectional study among a sample of urban Malaysian adults
Say, Y., Nordin, M. S., & Ng, A. L. O. (2025) · BMC Public Health · doi:10.1186/s12889-025-22340-z · Cited by 11 · see citing works
“The reliability of the WHO-5 is satisfactory across 35 countries in general and at important cutoffs [27].”
The Role of Sports in the Subjective Psychological Well-Being of Hungarian Adult Population in Three Waves of the COVID-19 Pandemic
Laczkó, T., Ács, P., Morvay-Sey, K., Cselik, B., & Stocker, M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20010660 · Cited by 11 · see citing works
“The scale is also suitable for measuring the results of clinical procedures and for comparisons with the average population or different social groups and/or periods [23,25].”
BackgroundMethod
Money can’t buy happiness: A randomized controlled trial of a digital mental health app with versus without financial incentives
Chang, C., Palermo, E. H., Deswert, S., Brown, A., & Nuske, H. J. (2023) · Digital Health · doi:10.1177/20552076231170693 · Cited by 10 · see citing works
COVID-19 Pandemic and Lockdown: Associations With Personality and Stress Components
Smrdu, M., Kuder, A., Turk, E., Čelik, T., Šet, J., & Kralj‐Fišer, S. (2021) · Psychological Reports · doi:10.1177/00332941211043451 · Cited by 9 · see citing works
“WHO-5 was developed as a subjective measure of well-being, and is a screening instrument for depression, with its reliability ranging from /¼ 0.83 to 0.93 (Sischka et al., 2020).”
Influential
Wellbeing Heterogeneity within and Among University Students
Liu, I., Morrison, P. S., & Zeng, D. (2023) · Applied Research in Quality of Life · doi:10.1007/s11482-023-10238-0 · Cited by 9 · see citing works
“12 The instrument has also been subject to several methodological interrogations (Bech et al., 1996, deWit, 2007; Sischka et al., 2020; Krieger et al., 2014).”
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“This measure has been shown to be suitable for individuals over 9 years, has good construct validity among younger persons and older adults (Topp et al ., 2015), and has satisfactory reliability across 35 countries (Sischka et al ., 2020).”
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Effectiveness of a Self-Guided Digital Intervention for Mental Health and Psychological Well-Being in University Students: Pre- and Postintervention Study
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“…psychological distress with the Kessler-10 (K-10) [24], depressive symptoms with the Patient Health Question-naire-9 (PHQ-9) depression scale[25], anxiety symptoms with the Generalized Anxiety Disorder-7 (GAD-7) scale [26], and psychological well-being with the WHO-5 Well-Being Index (WHO-5) [27].”
Psychometric evaluation and updated community norms of the WHO-5 well-being index, based on a representative German sample
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A Screening Measure of Emotion Regulation Difficulties: Polish Norms and Psychometrics of the Difficulties in Emotion Regulation Scale-8 (DERS-8)
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“The WHO-5 is a brief self-report questionnaire for measuring positive well-being [27–29].”
Cross-country validation of the Arabic version of the WHO-5 Well-Being Index in non-clinical young adults from six Arab countries
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“Furthermore, most of the evidence regarding the validity of the WHO-5 deals with its application in diagnostic settings, not in relation to other positively-laden qualities such as quality of life (for a review, see Topp et al., 2015).”
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“The level of the WHO-5 is slightly below the level of wellbeing in a sample representative of the resident population in Germany aged 41–60 years (17.5 ± 4.9) (43).”
MethodInfluential
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“Hedonic well-being was measured using the WHO-5 (Bech, 2004 [25–27]).”
Method
The Polish version of the Emotion Regulation Questionnaire-Short Form (ERQ-S): Psychometric properties, Polish norms and relationships with psychopathology and well-being
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“The PHQ-4 and WHO-5 are widely used, and psychometrically sound brief measures of anxiety and depression symptoms (Caro-Fuentes and Sanabria-Mazo, 2023) or subjective well-being (Topp et al., 2015; Sischka et al., 2020), respectively.”
Method
Psychometrics Validation of the WHO-5 Wellbeing Index in Botswana, Zimbabwe, and Malaysia: Coping With COVID-19 Pandemic in the Global South Study
Pheko, M. M., Mhaka‐Mutepfa, M., Mfolwe, L. M., Mathoothe, K. D., Seok, C. B., & Low, W. Y. (2023) · SAGE Open · doi:10.1177/21582440231198387 · Cited by 6 · see citing works
“The WHO-5 items were extracted from the WHO-10 scale, which was based on a scale containing 28-items (Bech et al., as cited in Topp et al., 2015; Sischka et al., 2020).”
BackgroundMethodInfluential
Well-being of park users in a tropical city may be more influenced by their nature connectedness and exposure than bird diversity
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“The WHO-5 is a widely recognized and validated scale for use across many ethnicities, including the Hong Kong population [54-56].”
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“The WHO-5 Well-Being Index is a psychometrically sound measure [28,29].”
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“Although the WHO-5 primarily captures positive aspects of well-being and does not directly assess symptoms of anxiety or depression, it remains a widely validated and reliable tool across diverse populations and clinical settings [39, 40].”
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“The depressive group was defined using the World Health Organization WellBeing Index (WHO-5), which is used worldwide for assessing subjective well-being (31) (cut-off score: < 50) (32).”
Method
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“An international validation study by Sischka et al. (2020), found that the WHO-5 showed high reliability.”
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“32,33 The Arabic version of the WHO-5 was validated in Lebanon and showed acceptable reliability ( a = 0.80).”
Influential
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Lindahl, M., Hansen, E. A., Skinneholm, M. E., Abed-Allatief, R. H., Mortensen, M. P., Vestergaard, A., Windskov, C., Jørgensen, A.-S. H., Jensen, L., & Juneja, H. (2024) · European Journal of Physiotherapy · doi:10.1080/21679169.2024.2444963 · Cited by 4 · see citing works
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Influential
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“The raw scores are transformed to a score from 0 to 100, where 0 is low level of well-being and 100 high level [35, 36].”
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“Findings complement previous research asserting that all well-being items are strongly entrenched onto one dimension, suggesting a single construct [12, 27].”
Background
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“For applied studies see, for example, Sischka et al. (2020) and Heinz et al. (2022).”
Self-citation
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“World Health Organization-Five Well-Being World Health Organization-Five Well-Being Index [23]: This is a self-reported short questionnaire commonly used to assess subjective well-being. questionnaire commonly used to assess subjective well-being.”
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Zhou, D., Deng, Y., Globa, A., Davies, R., Hu, Y. '., Wu, R.-X., Fu, L., & Quigley, A. J. (2024) · Australian Conference on Human-Computer Interaction (OzCHI) · doi:10.1145/3726986.3727035 · Cited by 4 · see citing works
“This approach facilitates tracking changes in user well-being, particularly in relation to the long-term effects of interventions or significant life changes [33].”

The cross-country validation of the WHO 5 well-being index with item response theory and the alignment procedure
Sischka, P. E. (2021) · Open Repository and Bibliography (University of Luxembourg)
Self-citation
Rating scales for psychopathology, health status and quality of life
Sharpe, M. (1995) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(95)90075-6 · Cited by 3 · see citing works
The WHO-5 Well-Being Index – Testing measurement invariance across 33 countries
Sischka, P. E. (2018) · Open Repository and Bibliography (University of Luxembourg)
Self-citation
Measurement Invariance of the WHO-5 Well-Being Index: Evidence from 15 European Countries
Cosma, A. P., Költő, A., Chzhen, Y., Kleszczewska, D. W., Kalman, M., & Martin, G. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19169798 · Cited by 32 · see citing works
Assessing Well-Being Across Space and Time: Measurement Equivalence of the WHO-5 in 36 European Countries and Over 8 Years
Jami, W. A., & Kemmelmeier, M. (2020) · Journal of Well-Being Assessment · doi:10.1007/s41543-021-00042-8 · Cited by 12 · see citing works

Authors: Sischka, P. E., Costa, A. P., Steffgen, G., & Schmidt, A. F.
Affiliations: University of Luxembourg (LU)
Johannes Gutenberg University Mainz (DE)
Corresponding author: Sischka, Philipp E.
ORCID: Sischka, Philipp E.
Costa, Andreia P.
Steffgen, Georges
Schmidt, Alexander F.
Venue: Journal of Affective Disorders Reports
Publisher: Elsevier BV
Published: 2020-12
Volume: 1
Pages: 100020
ISSN: 2666-9153 (ISSN-L)
DOI: 10.1016/j.jadr.2020.100020
OpenAlex: W3094404984
Cited by: 245
References: 88
Citations by year: 2026: 50 · 2025: 55 · 2024: 61 · 2023: 35 · 2022: 28 · 2021: 13 · 2020: 3
FWCI: 12.56
Type: journal article
Language: en
Update notices: erratum (2022-12-01)
Open access: gold
doi.org
Licence: cc-by-nc-nd
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
Locations: Journal of Affective Disorders Reports (publishedVersion, cc-by-nc-nd)
Open Repository and Bibliography (University of Luxembourg) (submittedVersion, cc-by-nc-sa)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
OSF Preprints (OSF Preprints) (submittedVersion)
Topics: Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Keywords: WHO-5, well-being index, measurement invariance, graded response model, alignment procedure, differential item functioning, depression screening, psychometric validation, cross-cultural measurement, European Working Conditions Survey, reliability statistics, unidimensionality

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The WHO-5 well-being index – validation based on item response theory and the analysis of measurement invariance across 35 countries

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