Not feeling good in yourself: what can lie behind it, and what five questions from the WHO measure about it

In this article you will read what often lies behind not feeling comfortable in your own skin, and what five questions from the WHO measure about it. That matters, because a vague feeling becomes easier to place once you know what you can measure. Nothing is really wrong. Your work is going fine, things are calm at home, and still you have not felt good for weeks: flat, tired of things that used to give you energy, quieter than before. Not feeling comfortable in your own skin is the Dutch name for precisely that, and it is one of the few complaints for which a questionnaire exists that the World Health Organization published itself: five questions about the past two weeks. The BioProfile wellbeing scan measures how much you are affected by those complaints, and gives you an indication of where you stand today in this area, as the first of the 11 health areas that the full scan assesses. This is not a diagnosis. It is insight, to see where you stand today. And to help you make better choices in your food and your lifestyle. What this scan does not do: explain why, or make a diagnosis. Only a doctor can do that.

How common it is

More often than ten years ago. In the third Dutch population study into mental health, 6,194 people between 18 and 75 were interviewed at home. 26 percent had had a mental health condition in the twelve months before; in the same study from 2007 to 2009 that was 17 percent. The rise was strongest among students, among people between 18 and 34 and in the city, and the coronavirus years did not explain it.⁠²

Feeling low is usually an ordinary reaction to unpleasant events, and it lifts again after a few weeks or months.⁠³ The point is that you yourself can hardly see when “a few weeks” has become a few months.

What often lies behind it

Three things have been measured, and all three you can influence yourself.

Sleep is the first one. In a meta-analysis of 21 studies that followed people for years, people with insomnia were about twice as likely to become seriously low in mood later as people who slept well.⁠⁴ So poor sleep often runs ahead of the mood, and not behind it.

Movement is the second. Fifteen studies with 191,130 adults showed that people who reached half the recommended amount of movement were 18 per cent less likely to have symptoms of low mood than people who did nothing; those who reached the recommended amount, 25 per cent less likely. Above that, moving more added little extra.⁠⁵

Contact is the third. In research, people who are lonely, live in isolation or live alone have a 26 to 32 per cent higher chance of dying early, an effect that is comparable to known risk factors.⁠⁶ And sometimes it is none of the three but a question about your life itself; for that, someone who knows you well, your GP or the practice nurse is the place, Thuisarts says.⁠⁷

What the wellbeing scan measures

The wellbeing scan asks the five questions of the WHO-5 Well-Being Index, in the official Dutch translation, about the past two weeks: whether you were cheerful and in good spirits, calm and relaxed, active and energetic, woke up fresh and rested, and whether your days were filled with things that interest you. The raw score of 0 to 25 is converted into a percentage. It is the only instrument in the whole analysis that we use word for word, because it is freely available and because it is exactly that wording that gives the cut-off values their meaning: 50 per cent or lower reads as low wellbeing, 28 per cent or lower as a signal that deserves follow-up.⁠¹

The questionnaire has been translated into more than thirty languages since 1998, and a review of 213 studies found it valid as a measure of wellbeing and sensitive and specific enough as a screening for low mood.⁠¹ In 9,542 Danes it also turned out to be better than the well known mental health scale of the SF-36 at noticing who had gone downhill over a year, because it measures wellbeing and not only the absence of symptoms.⁠⁸ If you come out at 50 per cent or lower, four short follow-up questions about mood and worrying follow, so we know whether we should point you towards support, never to give you a label.

What the wellbeing scan does not measure

A wellbeing score does not make a diagnosis, and two low weeks are not a condition. The scan cannot explain why those two weeks were low, and it does not replace a person. What it is good at is noticing, and that is exactly what a screening is for: a reason for a conversation, never a conclusion. If it does not pass after a few months, your GP is the next step. If you have had thoughts of harming yourself, get in touch now: call 113.⁠³

What you do with your score

A score today is your starting value. Repeat the scan in two weeks, on the same five questions, and you have two numbers instead of a feeling. If you want to change something in those two weeks, take the list from Thuisarts: get up on time and go to bed on time, go outside every day, half an hour of movement a day, and talk about your problems.⁠³ The fourth question of the scan is about waking up rested; what a sleep test measures about that is in why you wake up tired.