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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
Open accessAbstract
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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“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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Working Conditions of Young People in Luxembourg – A Health Perspective
Sischka, P. E., & Steffgen, G. (2022) · Springer eBooks · doi:10.1007/978-3-658-35744-3_12 · Cited by 1
Self-citationA Cognitive Behaviour Therapy Chatbot (Otis) for Health Anxiety Management: Pilot Study (Preprint)Preprint
Goonesekera, Y., & Donkin, L. (2022) · doi:10.2196/preprints.37877
متولي, ه. أ. ع. (2022) · مجلة كلية التربية جامعة بنها · doi:10.21608/jfeb.2022.288605
The Impact of Microculture Cohorts on Organizational Culture Preference:A 40-Society AssessmentPreprint
Ralston, D. A., Terpstra-Tong, J. L. Y., Treviño, L. J., Caprar, D. V., Froese, F. J., Furrer, O., Dabić, M., Karam, C. M., Jabeen, F., Tjemkes, B. V., et al. (2023) · SSRN Electronic Journal · doi:10.2139/ssrn.4581816
Latifa, R., Chang, K., Liem, A., Idriyani, N., Roebianto, A., Rahmah, M., & Puri, V. G. S. (2023) · JP3I (Jurnal Pengukuran Psikologi dan Pendidikan Indonesia) · doi:10.15408/jp3i.v12i2.33964
“…when compared with previous validation studies conducted before the COVID-19 pandemic settings, for example, among elderly (Heun et al., 2001), employee in the 6th European Working Condition survey in 2015 (Sischka et al., 2020), and university students in China in 2018-2019 (Fung et al., 2022)”
ResultMental well-being of Microfinance Beneficiaries in the Post-Covid Scenario
Buragohain, T. (2023) · INTERANTIONAL JOURNAL OF SCIENTIFIC RESEARCH IN ENGINEERING AND MANAGEMENT · doi:10.55041/ijsrem27073
Klocek, A., & Řiháček, T. (2023) · Counselling Psychology Quarterly · doi:10.1080/09515070.2023.2292212
“The psychometric properties of the scale were reported to be excellent, with internal consistency between .83 and .93 across 35 countries (Sischka, Costa, Steffgen, & Schmidt, 2020), and the evidence of various validity types (Topp, Østergaard, Søndergaard, & Bech, 2015).”
Agarwal, I., & Juneja, A. (2023) · Journal of Datta Meghe Institute of Medical Sciences University · doi:10.4103/jdmimsu.jdmimsu_288_23
Nowak, A. C., Lumbi, S. L., & McCall, T. (2024) · BMC Public Health · doi:10.1186/s12889-024-18266-7
“But this is now the opportunity to try out whether you really want to do without it completely ” (I1, 29).”
Effect of childbirth experience on the psychological well-being of postpartum women in Accra, Ghana
Azusong, E., Teye‐Kwadjo, E., & Asante, K. O. (2024) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2024.2329721 · Cited by 1
“The WHO-5 Well-Being Index (WHO-5; Sischka et al., 2020; Topp et al., 2015) was used to assess psychological well-being in this study.”
Clinical Screening for Unipolar and Bipolar Disorders
Lex, C., & Meyer, T. D. (2024) · Cambridge University Press eBooks · doi:10.1017/9781108973922.006
Leung, R. Y. F., Ye, M. Z., Zhang, F. Y. Q., Kwok, T. T.-O., Sun, Y., Lai, A. Y. K., Jiang, J., & Tse, M. Y. M. (2024) · doi:10.2196/preprints.67765
Wu, S.-Y., Li, G., Wortham, A., & Hall, B. J. (2024) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-024-02790-3
“It is a widely reliable tool across countries [35].”
Viksveen, P., Ree, E., Bjønness, S. E., Hansen, K. L., Meldahl, L. G., Krijger, L., Relton, C., Cornaglia, F., Berg, S. H., Hodne, S., et al. (2024) · doi:10.2196/preprints.64531
Teno, S. C., Silva, M. N., Silva, H., & Júdice, P. B. (2024) · Ergonomics · doi:10.1080/00140139.2024.2441451
“…to 0 (none of the time). the raw score therefore theoretically ranges from 0 (absence of wellbeing) to 25 (maximal wellbeing). the WhO-5 was evaluated as a psychometrically sound brief measure with non-invasive questions that tap into the subjective wellbeing of respondents (sischka et al. 2020).”
Mapping of the trans population in the Baixada Santista region, Brazil, 2023: a descriptive study
Barroso, B. I. D. L., Bassichetto, K. C., Vieira, D. L., Gois, Í., Rodrigues, J. L., Santos, N. J. S., de Souza, P. A., Tayra, Â., Kumow, A., Moreira, K. D. M., et al. (2024) · Epidemiologia e Serviços de Saúde · doi:10.1590/s2237-96222024v33e2024409.especial.en
Mapeamento da população trans da Baixada Santista, 2023: estudo descritivo
Barroso, B. I. D. L., Bassichetto, K. C., Vieira, D. L., Gois, Í., Rodrigues, J. L., Santos, N. J. S., de Souza, P. A., Tayra, Â., Kumow, A., Moreira, K. D. M., et al. (2024) · Epidemiologia e Serviços de Saúde · doi:10.1590/s2237-96222024v33e2024409.especial.pt
Validation of the Spanish Version of the Parent Diabetes Distress Scale
Vázquez, M. B., & Fisher, L. (2025) · Clínica y Salud · doi:10.5093/clh2025a3
Dunphy, M., & Nuske, H. J. (2025) · Journal of Medical Internet Research · doi:10.2196/71155 · Cited by 1
“It has high internal consistency and reliability ( α =.81-.90), is valid in screening for depression, has strong construct validity among adolescents and adults, and is sensitive to change in interventions [54,55].”
Minns, L. C., Newman, M., Herbland, A., Heneghan, N. R., Moulson, A., Owusu, N. K., & Beeton, K. (2025) · Physiotherapy · doi:10.1016/j.physio.2025.101806
“The 5 item WHO (World Health Organisation) well-being questionnaire is a valid, reliable measure of general well-being [13–15].”
Kozlowski, D., Provost, S., & Kern, M. L. (2025) · Research Square · doi:10.21203/rs.3.rs-6625617/v1
Challenging the Norm: Psychosocial Correlates of Nontraditional Sexuality in Italian Women
Caricati, L., Bonetti, C., Grossi, S. M., Rossi, F., & Bassi, S. (2025) · Journal of Community & Applied Social Psychology · doi:10.1002/casp.70119 · Cited by 1
Caycho‐Rodríguez, T., Sánchez‐Villena, A. R., Torales, J. C., Hualparuca‐Olivera, L., Carbajal‐León, C., Ferrufino-Borja, D., Puerta-Cortés, D. X., Lobos-Rivera, M. E., Soloaga, P. S., Moreta‐Herrera, R., et al. (2025) · Counselling Psychology Quarterly · doi:10.1080/09515070.2025.2556697
“This perspective posits well-being as an important outcome measure in various populations, both clinical and non-clinical, and an indicator of treatment efficacy (Sischka et al., 2020).”
Cullberg-Weston, M., Berman, A. H., & Klintwall, L. (2025) · Counselling Psychology Quarterly · doi:10.1080/09515070.2025.2560407
“The specific measures included the PHQ-9 (Kroenke & Spitzer, 2002), the GAD-7 (Spitzer et al., 2006), and the WHO-5 Well Being Index (Sischka et al., 2020).”
Viksveen, P., Ree, E., Bjønness, S. E., Hansen, K. L., Meldahl, L. G., Krijger, L., Relton, C., Cornaglia, F., Berg, S. H., Hodne, S., et al. (2025) · JMIR Research Protocols · doi:10.2196/64531
Metadata
- 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.
- Venue
- Journal of Affective Disorders Reports
- Publisher
- Elsevier BV
- Published
- 2020-12
- Volume
- 1
- Pages
- 100020
- ISSN
- 2666-9153 (ISSN-L)
- 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
- 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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