World Health Organization Quality of Life, BREF (WHOQOL-BREF)
The WHOQOL-BREF (World Health Organization Quality of Life, BREF) is a 26-item self-report questionnaire that measures perceived quality of life over the previous two weeks across four domains: physical health, psychological health, social relationships and environment. Each domain is scored 0–100, with higher scores meaning better quality of life.
About the WHOQOL-BREF
The WHOQOL-BREF is a short-form version of the original 100-item WHOQOL assessment. It was developed through a multinational field study and reflects cross-cultural understandings of quality of life. It captures an individual’s perceived quality of life over the previous two weeks in relation to health, autonomy, social connection, and access to resources.
It is suitable for use in medical, mental health, rehabilitation, and community settings and is available in over 20 languages.
What the WHOQOL-BREF measures
The WHOQOL-BREF produces a profile of four quality-of-life domains:
- Physical Health – energy, sleep, mobility, pain, daily activities
- Psychological Health – self-esteem, body image, cognition, mood
- Social Relationships – personal relationships, social support, intimacy
- Environment – safety, home, finances, health care access, leisure
Two additional items provide global assessments of overall quality of life and general health.
How to administer the WHOQOL-BREF
The WHOQOL-BREF is a self-report questionnaire completed by the respondent without clinician input or structured interview. It asks about experiences over the previous two weeks, and each of the 26 items is rated on a 5-point Likert scale (e.g., "Not at all" to "Completely"). Administer it at intake and discharge, or every 3–6 months in long-term care, recovery monitoring or health promotion.
Example item: “How satisfied are you with your ability to perform daily living activities?”
WHOQOL-BREF scoring and interpretation
Each domain is scored and transformed onto a 0–100 scale using the World Health Organization scoring syntax, with higher scores indicating better perceived quality of life. The two global items are not included in the domain calculations. Each domain yields a separate 0–100 score:
- 0–39: Low perceived quality of life
- 40–69: Moderate
- 70–100: High
There is no single cutoff; results should be interpreted in context, with attention to trends over time and comparisons across domains. The ranges above are a descriptive guide, not cutoffs published by the World Health Organization.
Psychometric properties
- Development (WHOQOL Group, 1998): WHOQOL-BREF domain scores correlated highly (0.89 or above) with WHOQOL-100 domain scores and showed good discriminant validity, content validity, internal consistency and test-retest reliability.
- International field trial (Skevington et al., 2004): In 11,830 adults from 23 countries, including sick and well respondents from general population, hospital, rehabilitation and primary care settings, internal consistency, item-total correlations, discriminant validity and confirmatory factor analysis showed good to excellent reliability and supported the four-domain structure.
- Factor structure (Lin & Yao, 2022): A meta-analysis of 16 exploratory factor analyses supported the theory-based four-factor model, with all items except item 8 loading on their intended domains.
Limitations
- Not a diagnosis. It measures perceived quality of life, not any medical or psychiatric condition.
- No cutoffs. There is no single cutoff; interpret domain scores in context and over time.
- Profile, not a total. Domains are scored separately, so a low score in one does not mean poor quality of life overall.
- Self-report. Scores reflect the respondent's own perception; use a validated translation.
- Construct validity questions. An earlier systematic review found poor construct validity in some studies, although the four-factor model was supported in meta-analysis (Lin & Yao, 2022).
This library is an academic and clinical reference. A scale described here is not necessarily offered in HiBoop; each page says whether it is.
Frequently Asked Questions
How is the WHOQOL-BREF scored?
The 26 items are each rated on a 5-point Likert scale. Scores are grouped into four domain scores — Physical Health, Psychological Health, Social Relationships, and Environment — each transformed to a 0–100 scale using the World Health Organization scoring syntax. Higher scores reflect better perceived quality of life. Two additional items provide global ratings of overall quality of life and general health but are not included in the domain calculations.
Is the WHOQOL-BREF self-report or clinician-administered?
The WHOQOL-BREF is a self-report questionnaire completed by the respondent. It asks about experiences and perceptions over the two weeks prior to administration, without requiring clinician input or structured interview techniques.
Can the WHOQOL-BREF diagnose a mental health condition?
No. The WHOQOL-BREF measures perceived quality of life across four domains; it is not a diagnostic tool and does not diagnose any medical or psychiatric condition. It is designed to complement clinical assessment by capturing the respondent's subjective view of their health and wellbeing.
What does a score of 0–39 on a WHOQOL-BREF domain indicate?
A domain score of 0–39 reflects low perceived quality of life in that area, such as significant difficulty with physical functioning, psychological distress, limited social support, or constrained access to environmental resources. Because each domain is scored independently, a low score in one domain does not imply poor quality of life across all domains. Results should always be interpreted in clinical context and alongside the respondent's history.
Bill this assessment
The World Health Organization Quality of Life, BREF (WHOQOL-BREF) qualifies for reimbursement under these CPT codes (US).
Using this assessment in practice
For clinicians
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For individuals
This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.
References
- 1.The WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998;28(3):551-558.View source
- 2.Skevington SM, Lotfy M, O'Connell KA; WHOQOL Group. The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. Qual Life Res. 2004;13(2):299-310.View source
- 3.Lin LC, Yao G. Validation of the factor structure of the WHOQOL-BREF using meta-analysis of exploration factor analysis and social network analysis. Psychol Assess. 2022;34(7):660-670.View source
Last reviewed: Jun 3, 2026
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