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Cited by 15Health Education and ValidationPsychometric Methodologies and TestingHealth Systems, Economic Evaluations, Quality of Life

Psychometric properties of the Five‐item World Health Organization Well‐being Index used in mental health services: Protocol for a systematic review

Open access
Lara‐Cabrera, Mariela L., Bjørkly, Stål, De las Cuevas, Carlos, Pedersen, Sindre Andre, Mundal, Ingunn Pernille·2020·Journal of Advanced Nursing
DOI 10.1111/jan.14445
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Abstract

Aims: To synthesize evidence of the psychometric properties of the Five‐item World Health Organization Well‐being Index in mental health settings and critically appraise the methodologies of the included studies. Design: Protocol for a systematic psychometric review. Methods: The review protocol has been registered in the International Prospective Register for Systematic Reviews. The bibliographic databases MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, and Web of Science will be searched for relevant studies. The psychometric properties of each study will be evaluated according to the Consensus‐based Standards for the Selection of Health Measurements Instruments. Discussion: The results of our psychometric review will synthesize the psychometric properties of the Five‐item World Health Organization Well‐being Index in mental health settings and identify possible gaps in the literature regarding methodological quality and its reliability, validity, and responsiveness to change. Impact: The evaluation of patient well‐being is important, and the Five‐item World Health Organization Well‐being Index is an increasingly used patient‐reported outcome measure. It is simple to collect, free to use, and consists of five questions using positive health statements. Although the number of studies assessing the validity, reliability, and responsiveness of the questionnaire is increasing worldwide, there is a need to summarize the existing evidence of the psychometric properties of this questionnaire. The proposed study's findings will contribute to future research recommendations and help midwives and nurses in different settings pick an effective, appropriate questionnaire to evaluate patient well‐being.

AI snapshot

Written from the paper’s full text.

TL;DR

This is a registered protocol (PROSPERO 165,013) for a planned systematic review and meta-analysis of the psychometric properties of the Five-item World Health Organization Well-being Index (WHO-5) in mental health settings. No results are reported; the paper describes the search, eligibility, quality-appraisal, and synthesis methods to be used.

Key findings

No empirical findings are reported; this is a protocol.

  • The authors state that no systematic review or meta-analysis has yet summarized the WHO-5's psychometric properties in mental health settings, despite the tool having been validated in 30 languages across several clinical populations.
  • The stated research questions concern (RQ1) the evidence for the WHO-5's reliability, validity, and responsiveness to change in mental health services, and (RQ2) recommendations for clinical practice and future studies based on eligible-study quality.
  • The protocol notes that a prior 2015 review (Topp et al.) used a clinimetric approach, mostly included screening studies, and presented data narratively without meta-analytic pooling.

Methods

  • Design: systematic psychometric review protocol developed per PRISMA-P and registered in PROSPERO (reference 165,013); ethics approval not required.
  • Data sources: six bibliographic databases (MEDLINE, PsycINFO, Embase, CINAHL, Cochrane Library, Web of Science), plus Google Scholar for studies citing the two original WHO reports, handsearching of reference lists and the WHO-5 website, and author contact for missing data.
  • Eligibility: peer-reviewed studies reporting psychometric evaluation data (reliability, validity, responsiveness) from self-reported WHO-5 data in mental health populations with diagnosed or self-reported psychiatric disorders; no limits on age, gender, ethnicity, diagnosis, or setting; exclusion of studies validating other questionnaires, grey literature, and samples with non-mental main diagnoses or somatic-only samples.
  • Screening and extraction: two independent reviewers, with a third reviewer resolving disagreements; data extracted in duplicate using piloted tables covering publication information, population and study characteristics, and psychometric properties.
  • Quality appraisal: COSMIN Risk of Bias checklist, four-point rating across 10 boxes, results rated sufficient (+), insufficient (−), or indeterminate (?), with evidence graded per measurement property by two independent reviewers.
  • Synthesis: narrative synthesis with tables/charts; heterogeneity tests to decide whether meta-analysis is feasible using Comprehensive Meta-Analysis Software V.3 to pool intraclass correlation coefficient and Cronbach's α; otherwise explorative/narrative synthesis.

Limitations

  • Stated by the paper: findings may be limited by low-quality study designs; different mental health conditions may cause significant heterogeneity; and results may be impossible to pool into a meta-analysis.
  • Evident from the text: as a protocol, no psychometric estimates, pooled results, or appraised evidence are yet available, so all conclusions about the WHO-5's measurement properties remain to be established.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1111/jan.14445

Cites

53 of 53 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 12 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    The Five-item World Health Organization Well-being Index (WHO-5) is a validated outcome measure tool designed to assess self-reported patient well-being.

    “The Five-item World Health Organization Well-being Index (WHO-5) is a validated outcome measure tool designed to assess self-reported patient well-being.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites WHO, 1998

      Not checked in the free run.

  • Premisecitation

    The 2015 review focused on the clinimetric approach.

    “The study focused on the clinimetric approach, indicating an applied clinical measurement approach with a specific set of rules for validity testing.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Topp et al., 2015

      Not checked in the free run.

  • Premisereasoning

    The 2015 review presented data narratively without any meta-analytic pooled assessment of the included studies.

    “Given the nature of the clinimetric approach, the review mostly included screening studies and presented the data narratively without any meta-analytic pooled assessment of the included studies.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Topp et al., 2015

      Not checked in the free run.

  • Premisecitation

    A 2015 review demonstrated preliminary robustness of using the WHO-5 in diverse settings, including paediatric, hospital, and primary care settings.

    “A 2015 review demonstrated the preliminary robustness of using the WHO-5 in diverse settings, including paediatric, hospital, and primary care setting (Topp et al., 2015).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Topp et al., 2015

      Not checked in the free run.

  • Premisereasoning

    The 2015 review mostly included screening studies.

    “Given the nature of the clinimetric approach, the review mostly included screening studies and presented the data narratively without any meta-analytic pooled assessment of the included studies.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Topp et al., 2015

      Not checked in the free run.

  • Classified as probably not a substantial claim. 23
  • May combine two claims. 4

  • Classified as probably not a substantial claim.

    Premisecitation

    The WHO-5 is suitable for monitoring treatment response.

    “Furthermore, studies have reported that the WHO-5 is a useful screening tool for depression (Allgaier et al., 2013;Omani-Samani, Maroufizadeh, Almasi-Hashiani, Sepidarkish, & Amini, 2019) and it is also suitable for monitoring treatment response (Newnham, Hooke, & Page, 2010a, 2010b).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Newnham, Hooke, & Page, 2010a, 2010b

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The WHO-5 questionnaire is free to use and focuses on positive health statements.

    “In addition to its simplicity of use, the questionnaire is also free to use and focuses on positive health statements (Topp, Ostergaard, Sondergaard, & Bech, 2015).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Topp, Ostergaard, Sondergaard, & Bech, 2015

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The review protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols, PRISMA-P.

    “The review protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols, PRISMA-P (Moher et al., 2015).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Moher et al., 2015

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The WHO-5 is a useful screening tool for depression.

    “Furthermore, studies have reported that the WHO-5 is a useful screening tool for depression (Allgaier et al., 2013;Omani-Samani, Maroufizadeh, Almasi-Hashiani, Sepidarkish, & Amini, 2019) and it is also suitable for monitoring treatment response (Newnham, Hooke, & Page, 2010a, 2010b).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Allgaier et al., 2013

      Not checked in the free run.

    • cites Omani-Samani, Maroufizadeh, Almasi-Hashiani, Sepidarkish, & Amini, 2019

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The protocol proposal has been registered in the PROSPERO database under reference number 165,013.

    “The protocol proposal has been registered in the PROSPERO database under reference number 165,013.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Study selection will be made according to pre-defined eligibility criteria.

    “The study selection will be made according to pre-defined eligibility criteria.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The WHO-5 assesses well-being using five items scored on a five-point scale, representing maximum severity over a 2-week period.

    “Introduced in 1998 and originally developed for use in diabetic care services, the WHO-5 assesses well-being using five items scored on a five-point scale, representing maximum severity over a 2-week period (WHO, 1998).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites WHO, 1998

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The methodological quality of each included study will be assessed by two independent reviewers, and a third reviewer will be consulted to reach consensus in case of disagreement.

    “This will be done by two independent reviewers and in case of a disagreement regarding the quality assessment, a third reviewer will be consulted to reach a consensus (Mokkink et al., 2018).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Mokkink et al., 2018

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Two independent reviewers will screen all titles and abstracts to determine whether a full-text review is needed.

    “Two independent reviewers will screen all titles and abstracts to determine whether a full-text review is needed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All studies eligible for full-text assessment will be read independently and examined for inclusion by two reviewers.

    “All studies eligible for full-text assessment will then be read independently and examined for inclusion by two reviewers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    Different mental health conditions may cause significant heterogeneity in the planned review.

    “Different mental health conditions may cause significant heterogeneity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Discrepancies in data extraction will be resolved by a third reviewer.

    “Data extraction will be undertaken in duplicate by two independent reviewers; discrepancies will be resolved by a third reviewer, who will also extract data from the study in question.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The search strategies were developed in collaboration with a medical research librarian who is part of the research team.

    “The search strategies were developed in collaboration with a medical research librarian who is part of the research team.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The findings of the planned review may be limited by low-quality study designs.

    “The findings may be limited by low-quality study designs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    There is a risk that the results in the included studies will be impossible to pool into a meta-analysis.

    “There is also a risk that the results in the included studies are impossible to pool into a meta-analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Data extraction will be undertaken in duplicate by two independent reviewers.

    “Data extraction will be undertaken in duplicate by two independent reviewers; discrepancies will be resolved by a third reviewer, who will also extract data from the study in question.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Data screening and data extraction will be conducted in duplicate to ensure reliable results.

    “Data screening and data extraction will be conducted in duplicate to ensure reliable results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The review strategy will involve a systematic literature search covering six of the most frequently used bibliographic databases.

    “The review strategy will involve a systematic literature search covering six of the most frequently used bibliographic databases.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    In case of disagreement regarding the eligibility of a study, a third reviewer will be consulted to reach a consensus.

    “In case of a disagreement regarding the eligibility of a study, a third reviewer will be consulted to reach a consensus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    Approval from an ethics committee is not required for this review.

    “Approval from an ethics committee is not required.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The tables and templates will be piloted before data extraction using three validation studies.

    “The tables and templates will be piloted before data extraction using three validation studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationnone given

    Publishing and adhering to the proposed protocol will increase the quality of the findings and reduce potential bias.

    “Publishing and adhering to the proposed protocol will increase the quality of the findings and reduce potential bias.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    An assessment of the risk of bias using the COSMIN will strengthen the level of confidence that can be placed on the identified evidence and guidance for interpreting findings.

    “An assessment of the risk of bias using the COSMIN will strengthen the level of confidence that can be placed on the identified evidence and guidance for interpreting findings.”
    Quote in the paperNot a substantial claim
23 of 23

  • The paper relies on this without support.

    No systematic review or meta-analysis has summarized the psychometric properties of the WHO-5 in mental health settings.

    “Despite considerable evidence of the utility of the WHO-5 in assessing patient well-being worldwide, to date, no systematic review or meta-analysis has summarized the psychometric properties of the WHO-5 in mental health settings.”

  • The paper relies on this without support.

    Evidence of the measurement properties of the WHO-5 in mental health settings was presented in a fragmented fashion.

    “Furthermore, despite the growing use of the WHO-5 in mental health settings, the evidence of the measurement properties in these settings was presented in a fragmented fashion.”

  • The paper relies on this without support.

    No systematic review or meta-analysis of the measurement properties of the WHO-5 in mental health settings has been conducted to date.

    “Despite the increasing use of this tool in mental health settings, a systematic review summarizing the psychometric properties of this questionnaire when used with this population has not yet been conducted.”
    “To date, there has been no systematic review or meta-analysis of the measurement properties of the WHO-5 in mental health settings.”

  • The paper relies on this without support.

    The WHO-5 is an important patient-reported outcome measure in a wide range of medical settings.

    “The WHO-5 is considered an important patient-reported outcome measure in a wide range of medical settings and a valuable research”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The WHO-5 is a widely administered PRO that can be used irrespective of underlying illness (or lack of illness), and has been thoroughly validated across many different mental health settings.

    “The WHO-5 is a widely administered PRO that can be used irrespective of underlying illness (or lack of illness), and has been thoroughly validated across many different mental health settings [84–87].”

    From Patient-reported outcome measures for life engagement in mental health: a systematic review (2022) · cites this paper as [87]

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Kennelly M. A., 2016, Maternal wellbeing, sleep and stage of exercise behavior change impacts on maternal anthropometry and body composition in an overweight and obese pregnancy, Obesity Facts, 1, 206
  2. WHO, 1998, Use of well‐being measures in primary health care‐the DepCare project health for all, Target, 12, E60246
  3. Yelverton C., 2019, Maternal well‐being in early pregnancy is important for breast feeding initiation in welleducated women: Findings from the ROLO Study, BJOG: An International Journal of Obstetrics and Gynaecology, 126, 28

Cited by

Sorted by citations

Related

Authors
Lara‐Cabrera, M. L., Bjørkly, S., De las Cuevas, C., Pedersen, S. A., & Mundal, I. P.
Affiliations
  • Norwegian University of Science and Technology (NO)
  • Oslo University Hospital (NO)
  • Department of Internal Medicine, Dermatology and Psychiatry University of La Laguna Santa Cruz de Tenerife Spain
  • Molde University College (NO)
Corresponding author
Lara‐Cabrera, Mariela L.
ORCID
Venue
Journal of Advanced Nursing
Publisher
Wiley
Published
2020-06-29
Volume
76
Issue
9
Pages
2426-2433
ISSN
  • 0309-2402 (ISSN-L)
  • 1365-2648
DOI
10.1111/jan.14445
OpenAlex
W3033138624
Cited by
15
References
53
Citations by year
2026: 1 · 2025: 4 · 2024: 4 · 2023: 2 · 2022: 3 · 2021: 1
FWCI
0.48
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Advanced Nursing (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Helse Midt-Norge (90327500)
Topics
  • Social Sciences › Education › Health Education and Validation
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Keywords
patient well-being, psychometric properties, mental health services, patient-reported outcome measures, reliability statistics, validity, responsiveness to change, questionnaire evaluation
MeSH terms
Systematic Reviews as Topic, Humans, Mental Health Services, Psychometrics, World Health Organization, Reproducibility of Results

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

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