World Health Organization Quality of Life, BREF (WHOQOL-BREF)
The WHOQOL-BREF is a 26-item self-report instrument developed by the World Health Organization to assess overall quality of life and subjective wellbeing across four key domains: physical health, psychological health, social relationships, and environment. It is used internationally in clinical, public health, and research settings.
The WHOQOL-BREF is an assessment tool that measures quality of life across various domains. It is designed for individuals seeking to evaluate their well-being and is useful for identifying areas for improvement.
About the WHOQOL-BREF
The WHOQOL-BREF is a short-form version of the original 100-item WHOQOL instrument. 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.
Psychometric Properties
The WHOQOL-BREF has shown excellent internal consistency (domain α = 0.68–0.82), test-retest reliability, and cross-cultural validity. Domain scores correlate strongly with global health and wellbeing ratings.
- Validated in over 20 countries
- Factor structure supports 4 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
Source: WHOQOL Group, 1998
The Scale
The 26 items are scored on a 5-point Likert scale (e.g., “Not at all” to “Completely”). Each domain is scored and transformed onto a 0–100 scale, with higher scores indicating better perceived quality of life.
Example item: “How satisfied are you with your ability to perform daily living activities?”
Two additional items provide global assessments of overall quality of life and general health.
Score Range
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.
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 instrument 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.
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
Bill this assessment
The World Health Organization Quality of Life, BREF (WHOQOL-BREF) qualifies for reimbursement under these CPT codes (US).
Last reviewed: Jun 3, 2026
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