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Scoring psychological wellbeing

Screening for psychological distress is an effective approach in workers who are at risk of distress due to their level of exposure to trauma. This additional section has been included in the Work PositiveCI to assess employee wellbeing levels and it considers both negative and positive aspects of employee wellbeing.

An index was created through a combination of two validated tools - the PHQ4, a screening tool for psychological distress and the WHO-5 Well-being Index, which measures an individual’s wellbeing over the last two weeks. The scales were combined through the categorisation of the threshold score values  to create a ‘traffic light’ summary score (‘Green’, ‘Amber’ and ‘Red’).


WHO-5 threshold score

  • The WHO-5 measures the degree of positive well-being present in the last two weeks across five items.  Each item is scored on a six-point Likert scale ranging from 0 (not present) to 5 (constantly present).  The total raw score ranges from 0 to 25, with scores below 13 indicate poor wellbeing and possible depression and a reduced quality of life.  The WHO-5 has proven to be a valid and reliable instrument in a wide variety of settings and amongst diverse patient and population groups, including managers [1].


PHQ-4 threshold scores

  • The Patient Health Questionnaire (PHQ-4) assesses employees experience over the past 2 weeks and generates screening scores for anxiety and depression. It is a 4-item screening measure which ranges from a score of 0 to 12, and serves as a good measure of caseness (i.e., higher scores indicate higher levels of distress (i.e. worry or low mood).  PHQ-4 scores determine ‘Severe’ (score range 9-12), ‘Moderate’ (6-8), ‘Mild’ (3-5), ‘Normal’ (0-2) risk of anxiety or depression [2].


Using the published cut-off points results are then combined to create a ‘traffic light’ summary score as detailed below.


Composite wellbeing measure threshold categorisation

Combined measure colour code PHQ-4 threshold category WHO-5 threshold category
Green None Not poor
Amber None Poor
Amber Mild Not poor
Amber Mild Poor
Amber Moderate Not poor
Red Moderate Poor
Red Severe Not poor
Red Severe Poor


The psychosocial domains identified by the Work Positive approach are essentially bipolar in nature as they carry both pathogenic and salutogenic potential. Consider, for example, the psychosocial hazard of social support at work; a multitude of studies have shown that low levels of support may have a negative impact on an individual’s health, yet, conversely, high levels may protect and enhance it.  A recent report (Eurofound and EU-OSHA, 2014) confirmed that work can have a positive impact on individual health and wellbeing.


Work PositiveCI addresses the causes and consequences of poor psychosocial working conditions, but does so within a positive framework aiming to enhance and cultivate positive workplace factors that can improve the health and wellbeing of the full working population. By adopting a positive framework the message communicated to the workforce is not so much an organisational intention to ‘move away from ill health’ but rather an intention tomove towards good health’, a subtle but significant difference.



  1. SCHUTTE, S., CHASTANG, J.F., MALARD, L., PARENT-THIRION, A., VERMEYLEN, G. and NIEDHAMMER, I., 2014. Psychosocial working conditions and psychological well-being among employees in 34 European countries. International archives of occupational and environmental health.
  2. Kroenke K, Spitzer RL, Williams JBW, Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4 Psychosomatics 2009;50:613-621.