Measurement properties and optimal cutoff point of the WHO-5 among Chinese healthcare students

Nongnong YANG, Haiyan MA, Mengyi HUANG, Esther Yuet Ying LAU, Daniel Yee Tak FONG, Meng WANG, Pengqiao WANG, Siyi XU, Jiale XU, Chen JIANG, Yi LUO, Runtang MENG

Research output: Contribution to journalArticlespeer-review


Purpose: The World Health Organization-Five Well-Being Index (WHO-5) is widely used to assess subjective well-being. Nevertheless, measurement invariance and optimal cutoff point of the WHO-5 have not been examined in Chinese samples. We aimed to assess measurement properties of the Chinese version of the WHO-5 (WHO-5-C) among healthcare students. 

Patients and Methods: A two-wave longitudinal assessment was conducted among 343 Chinese healthcare students from September to November 2022. Measurement properties of the WHO-5-C were assessed through structural validity using confirmatory factor analysis (CFA), measurement invariance using multigroup CFA (MGCFA) and longitudinal CFA (LCFA), convergent validity using correlation analysis with the Self-Rated Health Questionnaire (SRHQ) and Patient Health Questionnaire-4 (PHQ-4), reliability using internal consistency and test–retest reliability, and optimal cutoff point using receiver operating characteristic (ROC) analysis. 

Results: The WHO-5-C demonstrated satisfactory structural validity with comparative fit index (CFI) of 0.968 at baseline and 0.980 at follow-up, and adequate measurement invariance in different sociodemographic variables at baseline (gender, age, major, home location, being only child, monthly household income, part-time job, physical exercise, hobby, frequency of visiting home, and stress coping strategy) (CFI changes [∆CFI] = −0.009–0.003) and over a week (∆CFI = −0.006–0.000). The WHO-5-C also had good internal consistency (Cronbach’s α = 0.907–0.934; McDonald’s ω = 0.908–0.935) and test–retest reliability (intraclass correlation coefficient [ICC] = 0.803). Convergent validity was supported by moderate correlations of the WHO-5-C with the SRHQ and PHQ-4. The optimal cutoff point of the WHO-5-C was found to be 50, with an area under the ROC curve of 0.882 at baseline data, with sensitivity of 0.803 and specificity of 0.762 at follow-up. 

Conclusion: The WHO-5-C demonstrated adequate measurement properties, especially concerning cross-sectional and longitudinal measurement invariance, with a recommended optimal cutoff point of ≥ 50 for assessing adequate level of psychological well-being in healthcare students. Copyright © 2023 Yang et al.

Original languageEnglish
Pages (from-to)5141-5158
JournalPsychology Research and Behavior Management
Early online dateDec 2023
Publication statusPublished - 2023


Yang, N., Ma, H., Huang, M., Lau, E. Y. Y., Fong, D. Y. T., Wang, M., Wang, P., Xu, S., Xu, J., Jiang, C., Luo, Y., & Meng ,R. (2023). Measurement properties and optimal cutoff point of the WHO-5 among Chinese healthcare students. Psychology Research and Behavior Management, 16, 5141-5158.


  • WHO-5 well-being index
  • Subjective well-being
  • Measurement properties
  • Diagnostic performance
  • Observational longitudinal design
  • Healthcare students


Dive into the research topics of 'Measurement properties and optimal cutoff point of the WHO-5 among Chinese healthcare students'. Together they form a unique fingerprint.