5952-MentalHealth - Imp - 5 - 2676 - 12008

Guide 5: Selecting scales to assess mental wellbeing in adults
Mental Health Improvement:

Evidence and Practice
Guide 5: Selecting scales to

assess mental wellbeing in adults
evaluation guides
22
22
Published by Health Scotland

Edinburgh Office
Woodburn House,
Canaan Lane,
Edinburgh EH10 4SG
Glasgow Office
Clifton House,
Clifton Place,
Glasgow G3 7LS
NHS Health Scotland, 2008
ISBN: 1-84485-396-9
Health Scotland is a WHO Collaborating
Centre for Health Promotion and Public
Health Development
Mental Health Improvement: Evidence and Practice

Evaluation Guides
November 2007
Acknowledgements
The Mental Health Improvement: Evidence and Practice Guides series was
commissioned by Health Scotland, with funding from the National Programme for
Improving Mental Health and Wellbeing.
Guide 5: Selecting scales to assess mental wellbeing in adults is based upon a review
commissioned and funded by Health Scotland. This work was developed by Dr Jane
Speight and Dr Carolyn McMillan (AHP Research Ltd), with Dr Mark Barrington (St
Bartholomews Hospital, London) and Professor Christina Victor (University of Reading).
Health Scotland would like to thank all those who participated in the consultation
process during the development of this Guide:
Dr Elizabeth Austin, Department of

Psychology, University of Edinburgh
Prof Felicia Huppert, Department of

Psychiatry, University of Cambridge
Dr Nick Baylis, Co-Director of the

Wellbeing Institute, University of
Cambridge
Dr Corey Keyes, Department of

Sociology, Emory University, USA
Dr Sandra Boersma, Faculty of Social

& Behavioural Sciences, Leiden
University
Prof Alan Carr, School of Psychology,
University College Dublin
Dr Elaine Duncan, Department of
Psychology, Glasgow Caledonian
University
Dr Louise Earll, Research That Works
Dr Anne Haase, Department of
Exercise & Health Sciences, University
of Bristol
Jan Henderson, Mental Health &
Wellbeing Health Promotion, NHS
Argyll & Clyde
Amanda Knight, Centre for Applied

Emotional Intelligence, Frampton on
Severn, Gloucestershire
Dr Alex Linley, School of Psychology,
University of Leicester
Prof Kate Loewenthal, Department of
Psychology, Royal Holloway, University
of London
Dr Ansa Ojanlatva, Centre for
Reproductive & Developmental
Medicine, University of Turku, Finland
Prof Maria Elena Magrin, Faculty of
Psychology, University of MilanoBicocca, Italy
Dr Nic Marks, New Economics
Foundation, London
Dr Derek McLeod-Petrie,
NHS Grampian Public Health
Dr Anne Stiggelbout, Leiden

University Medical Centre
Dr Ken Pakenham, School of

Psychology, University of Queensland,
Australia
Dr Veronica Vigan, Ambulatory

for Evaluation & Management of
Occupational Stress, San Gerardo
Hospital, Monza, Italy
Michael Rainsford, HSE Western

Region, Mental Health Promotion,
Sligo, Ireland
Prof Stephen Stansfield, Department
of Psychiatry, Barts & the London
Queen Marys School of Medicine,
London
Prof Joar Vitterso, Dept of Psychology,

University of Tromso, Norway
Prof Craig White, Consulting & Clinical
Psychology Services, NHS Ayrshire &
Arran
Prof Sarah Stewart-Brown, University

of Warwick Medical School
We would also like to thank the developers of scales/copyright holders who:
provided up-to-date copies of their scales (and in some cases, supporting evidence)
for us to review
gave their permission for a copy of their scale (or a selection of items) to be
included in an appendix of the Review of Scales of Positive Mental Health Validated
for Use with Adults in the UK: Technical report1 (which accompanies this guide) for
the benefit of users when selecting an appropriate measure.
Available from http://www.healthscotland.com/understanding/population/mental-health-indicators.aspx
Contents
Page no
1 Introduction
2 What is mental wellbeing?
3 Why use a scale?
12
4 How to select a scale
18
5 Some questions to ask before you select a scale
25
6 Measuring mental wellbeing
28
7 Scales of mental wellbeing
30
8 Concluding comments
55
9 References
56
Appendices
Appendix A Glossary
61
Appendix B Abbreviations of scale names
65
Appendix C How this review of scales was conducted
67
Appendix D Further reading
68
Introduction
1.1 What is the purpose of this guide?
This is the fifth in a series of Evaluation Guides2, which aim to encourage, support
and improve standards in the evaluation of mental health improvement initiatives.
This guide is based upon a Review of Scales of Positive Mental Health Validated for
Use with Adults in the UK: Technical Report. Parkinson, J (ed) (in press).
The guides are intended to help colleagues design evaluations that build on what
is known about what works to improve mental health and that take account
of the challenges of assessing the effectiveness of mental health improvement
interventions.
The first five guides in the series are:
Guide 1: Evidence-based practice. How can we use what we currently know
to inform the design and delivery of interventions? This guide explores current
debates about evidence of effectiveness and why they matter for mental
health improvement. It also considers how the evidence-base on mental health
improvement can be used to inform the design of interventions and their
evaluation.
Guide 2: Measuring success. How can we develop indicators to gauge progress
and access the effectiveness of mental health improvement interventions?
This guide covers the use of consultation to develop robust, valid and reliable
indicators, examines the differences between mental illness indicators and
mental health indicators and provides a useful source of indicators.
Guide 3: Getting results. How can we plan and implement an evaluation. This
guide gives an overview of the stages involved in planning and implementing
an evaluation, and outlines the key issues for consideration. It also indicates
sources of further, more detailed information on evaluation.
Guide 4: Making an impact. How do we analyse and interpret the results
from an evaluation and communicate the findings to key audiences. This
guide discusses how to use the data gathered. It explores how evaluation can
be used to inform practice and how the publication of results can add to the
evidence-base for mental health and improvement.
The Guides are available from http://www.healthscotland.com/mental-health-publications.aspx
Introduction
Guide 5: Selecting scales to assess mental wellbeing in adults. How do we

decide which scale to use for the evaluation of an intervention with respect
to its impact on mental wellbeing? This guide explores the selection and use
of scales for assessing several elements of mental wellbeing (MWB); factors
which influence MWB and the consequences of MWB (hereafter referred to as
aspects of mental wellbeing) in adults (for example, emotional wellbeing, life
satisfaction, optimism and hope). It provides a definition of the term scale,
explores the use of scales in evaluations and how to select suitable scales. It
also recommends various scales for each of the aspects of mental wellbeing
addressed.
Each guide contains a glossary3.
Terms in bold appear in the glossary in Appendix A
The guides have been compiled as part of Health Scotlands work to

support evidence and practice in mental health improvement (http://www.
healthscotland.com/mental-health-research.aspx) on behalf of the National
Programme for Improving Mental Health and Wellbeing (www.wellscotland.info)
and complement other resources commissioned by Health Scotland and the
Scottish Government:
Mental Health, Mental Wellbeing and Mental Health Improvement: What do
they mean? A practical guide to terms and definitions (Scottish Executive,
2004, www.wellscotland.info).
Mental Health Improvement: Evidence and Practice case studies (Health
Scotland, 2004). A selection of case studies of current mental health
improvement practice in Scotland. This resource provides 22 examples from
a range of sectors and settings of work that is evidence-based, follows good
practice guidelines and gives indications of effectiveness. The evaluation
guides cross-refer to these case study examples, where appropriate, for
illustrative purposes. http://www.healthscotland.com/documents/435.aspx.
Mental Health and Wellbeing Indicators Project (http://www.healthscotland.
com/understanding/population/mental-health-indicators.aspx). In support of
the National Programme for Improving Mental Health and Wellbeing, Health
Scotland is currently developing a set of public mental health indicators for
Scotland. The indicators will provide a way of monitoring the state of mental
health and wellbeing in Scotland at a national level. Although the indicators
will be designed for use at a national level, some of them may be collected
and applicable at a local level and will be helpful for those working locally in
mental health improvement.
The guides are designed to strengthen evidence-based practice in mental health
improvement and to support evidence from practice.
Introduction
Strengthening evidence-based practice involves:

increasing knowledge and awareness of the existing evidence-base among
practitioners and managers, i.e. what we know about what works in mental
health improvement. A summary of some of the literature on evidence of
effectiveness is available in Mental Health Improvement: What works? (Scottish
Executive, 2003, www.wellscotland.info/research-papers.html)
involving practitioners in producing guidance on evidence of effectiveness in
the context of local needs and priorities, to ensure local relevance
disseminating guidance on evidence in ways that are accessible and relevant
to practitioners and that acknowledge barriers to implementing evidencebased practice
building capacity, confidence, knowledge and expertise in working with the
evidence-base to ensure that the planning and delivery of interventions are
informed by an understanding of what works.
Supporting evidence from practice involves:
enabling practitioners to evaluate interventions in order to inform their own
practice and to guide local service development
supporting the publication of local evaluations in peer-reviewed journals to
add to our collective understanding of effective mental health improvement
interventions and strengthen the evidence-base
finding ways to bring together practitioner know-how and expertise drawn
from their experience of what works with findings from the research
literature.
1.2 Who are the guides for?

The guides are intended as a resource for colleagues across all sectors and settings. It
is anticipated that they will be relevant to those working in a wide range of disciplines
and services, both those with an explicit remit for mental health improvement and
those for whom mental health improvement is an integral but implicit aspect of their
work. The guides relate to activity that are central to the responsibilities and interests
of Community Planning Partnerships, Community Health Partnerships and multi-agency
service planning groups for children and your people and for adults of all ages.
They have been developed in response to a clearly identified need among practitioners
and service managers and programme managers, for information and guidance on the
evaluation of mental health improvement interventions. The guides therefore bring
together information on evaluation theory and practice and a discussion of current
debates and challenges in the field of mental health improvements, as well as pointers
for practical application in designing and evaluating interventions. This series is not
intended to be an evaluation manual more detailed advice on evaluation for those
who require it can be obtained from the resources listed in Appendix B in Guide 3:
Getting results.
1.3 What is the purpose of this guide?
This guide is intended to be a resource to inform policy makers and practitioners about
the potential strengths and shortcomings of the different scales for assessing mental
wellbeing in adults. It is hoped that this will facilitate the appropriate selection of scales
for the evaluation of interventions in terms of their impact on mental wellbeing. The
scale or scales that you choose will reflect information provided in this guide, but should
also be heavily influenced by the programme of work that you are planning:
which aspect of mental wellbeing fits best with what you hope to improve?
in what setting are you evaluating mental wellbeing?
Please note, too, that the use of scales is just one ingredient of a good evaluation.
Readers will need to look beyond this guide for information about how they can collect
relevant qualitative data (perhaps through interviews and focus groups) with which to
evaluate their intervention (see Guide 3: Getting results). Please also note that this guide
does not include the following:
issues relating to literacy
issues relating to cultural diversity and minority ethnic groups
the SF36 and some other commonly used scales this is because these scales did
not fit the criteria set for the review of scales4.
4
For further details on these scales see Review of Scales of Positive Mental Health Validated for Use with Adults in the UK: Technical
report, available from http://www.healthscotland.com/understanding/population/mental-health-indicators.aspx.
Introduction
1.4 What does this guide include?

This guide is about measuring mental wellbeing5 (MWB) in adults (see Section
2). This fifth guide in the series was commissioned as part of a review of scales
(see below) that measure selected aspects of MWB6 (e.g. emotional wellbeing, life
satisfaction, self-esteem, social functioning). A brief description of the review and how
it was conducted (including the selection of aspects of MWB and scales) is provided in
Appendix C7. The objectives of the review were to:
identify the scales suitable for measuring the chosen aspects of mental wellbeing
in the UK
describe and critically appraise the scales
recommend the most appropriate measures for assessing various aspects of
mental wellbeing.
What is a scale?
Scale is the technical term for what most people call a questionnaire. Scale
is defined here as a group or sequence of questions, statements or items
designed to elicit information from a participant in a standardised format.
The individual completes a scale using fixed choice responses, (rather than
explaining things in their own words), and this means that scores for each
question can then be combined to form sub-totals and totals which can
then be compared against average scores for similar participants. For more
information, see Section 3.
Terms in bold are defined in the Glossary (see Appendix A)

This guide is one of two written reports of the review, the other being a technical report, available from: http://
www.healthscotland.com/understanding/population/mental-health-indicators.aspx. The technical report provides a
full account of the background, methods, results and conclusions of the review. It also includes several appendices,
which provide copies of scales (and information on how to obtain permission if this is required), as well as brief
descriptions and copies of scales that were relevant to the review but excluded because they did not meet various
criteria for inclusion.
5
6
For full details of the methods used in the review, see Review of Scales of Positive Mental Health Validated for Use
with Adults in the UK: Technical report, available from: http://www.healthscotland.com/understanding/population/

mental-health-indicators.aspx.
This guide considers how to go about selecting a scale for the purposes of evaluating
the impact of interventions on mental wellbeing in adults. It is organised into two
main sections:
How to select a scale: general principles to guide your choice of scale (see Sections
3, 4 and 5)
The recommended scales: information about specific scales that have been
developed to measure various aspects of MWB in adults and that meet our
inclusion criteria (see Sections 6 and 7).
This guide is intended to be of use to practitioners and those responsible for
delivering and/or evaluating interventions in terms of their impact on adult MWB.
Using the results of evaluation to inform policy and practice development is critical in
strengthening the two-way link between evidence and practice, as indicated in Guide
1: Evidence-based practice.
Introduction
The Evaluation Process
Using Evidence to inform

Practice: Making an Impact
Using research findings to inform your
work (See Guide 1:
Evidence-based practice)
Using your findings to inform
your practice/develop your project
(See Guide 4: Making an Impact)
Using your own findings to inform
others (See Guide 4: Making an
Impact)
Getting Results: Analysis and

Interpretation
Quantitative analysis (statistics)
Quantitative analysis (surveys,
interviews and focus groups)
(See Guide 4: Making an Impact)
Developing Indicators to
Measure Success
Developing individual and
community indicators that suit your
intervention
Using risk and protective factors
to select indicators (See Guide 2:
Measuring success)
Selecting a scale to measure
the impact of your intervention
on mental wellbeing in adults
(See Guide 5: Selecting scales to
assess mental wellbeing in adults)
Designing and Implementing an Evaluation

Involving stakeholders
Agreeing the objectives of the
evaluation
Choosing methods
Choosing a scale to assess mental
wellbeing in adults if this is
appropriate to your intervention
(See Guide 5: Selecting scales
to assess mental wellbeing
in adults)
Data collection
Implementation issues
(See Guide 3:
Getting results)
What is mental wellbeing?

The focus of this guide is on scales of mental wellbeing (often referred to as
positive mental health8) and not on the construct itself. That is to say that this
guide does not aim to provide a detailed review of mental wellbeing (MWB), or
to consolidate the debate regarding terminology, definitions and relationships
between aspects of MWB.
There are various ways of conceptualising MWB (Keyes, 2005; Ryff and Keyes,
1995). It is unlikely that any one model will meet with universal approval
because the concept of MWB is so contentious. A distinction is often made
between transient feelings of wellbeing and longer-term concepts such as good
functioning and personal growth. The scales included in this guide measure
either or both of these dimensions, so we have attempted to integrate these into
one broad aspect of MWB, defined as:
more than the absence of mental illness or pathology. It implies

completeness and full functioning. It includes such concepts as emotional
wellbeing, satisfaction with life, optimism and hope, self-esteem, resilience
and coping, spirituality, social functioning, and emotional intelligence.
Our definition includes eight (often overlapping and interconnected) aspects of
MWB, which we have defined loosely for the purposes of preparing this guide (see
opposite). The aspects and their definitions are by no means exhaustive, nor are
they universally accepted.
With these issues in mind, it is hoped that the reader will find this a useful guide
to the appropriate selection and use of scales for the evaluation of the impact
of interventions on adult MWB. For those who wish to build an understanding
beyond the descriptions provided in this guide, please refer to Appendix D.
The term positive mental health is used as an alternative to mental wellbeing in the technical report which
supports this practical guide; Review of Scales of Positive Mental Health Validated for Use with Adults in the UK:
Technical report (http://www.healthscotland,com/understanding/population/mental-health-indicators.aspx)
8
What is mental wellbeing?
Aspects of mental
wellbeing used in this
guide
Working definition for this guide
Emotional wellbeing
More than the absence of psychological

morbidity (e.g. anxiety and depression); a more
positive concept that includes happiness and
vitality.
This includes, but is

not confined to, scales
addressing positive affect.
Scales with a more general
focus on overall MWB are
also included here.
Life satisfaction
Overall assessment of ones life, or a comparison

reflecting some perceived discrepancy between
ones aspirations and achievement; includes
optimistic outlook, perception of life as
pleasurable.
Optimism and hope
Positive expectations of the future; a tendency

to anticipate and plan for relatively favourable
outcomes.
Self-esteem
A belief or evaluation that one is a person

of value, accepting personal strengths and
weaknesses; sense of self-worth.
Related to emotional safety/security i.e. how one
feels about self; confidence in and how good
one feels in personal relationships (e.g. family,
wider community).
Resilience and coping
Resistance to mental illness in the face of

adversity; hardiness; learned resourcefulness;
a sense of coherence i.e. confidence that
internal and external events are predictable and
that things will work out as can reasonably be
expected; a cognitive evaluation of perceived
resources to deal with perceived demands;
personal control.
10
Aspects of mental
wellbeing used in this
guide
Working definition for this guide
Spirituality
Sense of purpose/meaning in life; a sense that

there is something beyond the material world;
attempts to harmonise life with a deeper
motivation.
Social functioning
a) Personal relationships (interpersonal trust,

respect and empathy)
Overall assessment of the quality of
personal relationships, social networks
and social cohesion; the degree to which
people function adequately as members
of a community; includes role-related
coping, social participation, family health,
social functioning, sense of belonging;
valuing oneself and others; perceiving fair
treatment by others (with respect, without
discrimination).
b) Social support/social networks
Interactive process in which emotional,
instrumental or financial aid is received
from ones social network; individuals belief
that he/she is cared for, esteemed; mutual
obligations; set of people with whom one
maintains contacts and has some form of
social bond; social reciprocity.
Emotional intelligence
11
The potential to feel, use, communicate,

recognise, remember, learn from, manage and
understand emotions (self and others).
Why use a scale?
Why use a scale?

Ensuring that the impact of an intervention on mental wellbeing (MWB) is
evaluated consistently requires:
agreement about terminology (see Sections 2 and 7)
a systematic approach - to measuring aspects of mental wellbeing.
Scales enable researchers to ask the same questions of each participant and to
obtain systematic responses to those questions. Scales provide the means to
identify the need for a policy or intervention and/or to evaluate its effectiveness.
Scales are just one of several ways in which information can be collected to
answer a research question. They are an example of quantitative data collection
i.e. using numerical data. By contrast, qualitative data is extremely varied and
includes virtually any information that can be captured that is not numerical.
Qualitative methods include observation, in-depth interviews, focus groups, and
analysis of written documents (such as diaries). In order to evaluate an intervention
thoroughly, it is often helpful to use a combination of methods (see Guide 3:
Getting results).
12
3.1 Different types of questions

The scales included in this handbook are all self-report, that is they involve the
subjective judgements of the participant (rather than subjective judgements of the
investigator who could use observation or interview to answer similar questions).
Thus, there are no purely objective measures (i.e. diagnostic tests that involve
no judgement) included in this guide. There are, however, some scales that
include relatively objective data. Both types of data have their advantages and
their limitations (see below). This is another reason why a combined approach
to evaluation is often helpful. Where objective measures exist, they should be
considered for inclusion in the clients notes to supplement the impression given by
the subjective self-report scales (see Guide 3: Getting results).
EXAMPLE Subjective v objective data
A question that often arises when planning the evaluation of an intervention is
whether to collect subjective or objective data, or both. Most scales included in
this guide include subjective questions only i.e. they require the participant to
indicate how they think or feel. Though this may well provide valuable insights,
such subjective data have the disadvantage that they cannot be corroborated
and, therefore, we have to take the participants answers at face value. Objective
data have the advantage that they can be confirmed by a third party if necessary
(i.e. an independent rater) so they can be considered more reliable but they have
the disadvantage that they may not provide sufficient information and insights
from which to draw helpful conclusions.
Some scales (particularly those concerned with social networks) include questions
that might require seemingly more objective data from the participant e.g.
a rating of the actual number of close friends he/she has (which could be
corroborated by a third party observer such as a family member). Objective
questions (e.g. number of friends) can provide useful indicators of MWB but the
data need to be interpreted with caution. For example, can one really infer that
someone has greater MWB on the basis that they have a large social network?
Might it be more likely that they would have greater MWB if they had fewer but
more helpful friendships? For this reason, objective data may be less useful than
the participants own perceptions of his/her social network.
13
Why use a scale?
3.2 Different types of response options

Most scales include several items i.e. individual statements or questions, to which
an individual is invited to respond. The responses may be categorical (e.g. yes/no);
alternatively, they may consist of a rating scale, and this may be either continuous
or a visual analogue scale (VAS) (see below).
EXAMPLE Response options

Questions can be answered using a range of response types:
I enjoy spending time with friends and family:

Yes / No

Very much Sometimes
Rarely
Never
(3)
(2)
(1)
(0)
[known as categorical]
10 9 8 7 6 5 4
Very much
[known as continuous]
Very much
2 1
Not at all
X
Not at all
[known as continuous]
[known as a visual analogue

scale (VAS)]
The type of response used in the scale will influence the level of sensitivity of the
data. Using the example shown above, you can see that the continuous responses
provide far more information than the categorical yes/no response. Moreover, the
greater the number of points in the response scale, the more sensitive the question
is likely to be at measuring changes (e.g. post- versus pre-intervention). The VAS
has advantages where participants may have literacy difficulties that would distort
their interpretation of questions. The disadvantage is that the researcher needs to
interpret what the cross (marked at a particular point on the line) means for the
participant. Moreover, a scoring grid is needed to place over the line to convert the
cross into a number for analysis purposes.
14
3.3 Pros and cons of scales versus other methods of data collection
As there are several limitations to using scales (see below), it is often useful to use a combined
approach when evaluating interventions in terms of mental wellbeing This is especially important
when considering the main shortcoming of scales: that they do not give participants the
opportunity to raise new important issues that the researcher did not expect to be relevant.
Advantages of using a scale
Disadvantages of using a scale
Standardisation of questions
allows comparisons to be made
(e.g. between groups, or before
and after an intervention),
because everyone receives the
same questions, in the same
format, with the same response
options.
Allows participants to answer only the fixed questions

that the researcher believes are important. It may
therefore miss important themes that were not
anticipated and/or not capture the full experience of the
participant.
Low-cost research (you can

send out a large number of
questionnaires with the
time/money it takes to conduct
a few interviews).
Generally, administering
scales (unlike interviews) does
not require expensive, timeconsuming training.
Participants can remain
anonymous.
Participants can complete the
scale when and where it suits
them.
There is no interviewer bias.
Analysis of scores is usually
relatively straight-forward
(developers often provide
guidelines).
15
Obtaining permission to use a scale can be timeconsuming.

Some developers/copyright holders charge for using
their scales.
Some scales require researchers to undergo training.
Some scales are poorly-worded and/or use unfamiliar
and old-fashioned expressions/concepts.
Wording of questions and the type of response options
can have a major effect on the scores.
Scales need to be brief and simple to use but are often
more complex.
Shortcomings in the quality of data collected (e.g.
missing responses because the participant, for some
unknown reason, did not answer the question).
Misunderstandings by the participant can go undetected,
resulting in scores that are misleading.
Low response rates are common, particularly to postal
surveys. This could mean that those who return a
completed scale are not sufficiently representative of the
wider group.
Information is being obtained without independent
observation or corroboration, so it may be highly
misleading to the researcher.
Why use a scale?
By supplementing the use of scales with other methods, such as interviews, the
practitioner is more likely to obtain a clearer picture of the ways in which an
intervention has affected the community it attempted to serve. For more information,
see Guide 3: Getting results.
3.4 Reasons not to design your own scale
Many people believe that designing a scale is easy, but it is a challenging, time
consuming and complicated task. Almost any newspaper or magazine that you care
to look in will include a questionnaire, supposedly designed to measure some aspect
of your personality or life e.g. What does your home say about you? Are you a party
bore? What kind of shopper are you?9
However, developing10 scales that yield worthwhile data that are insightful, reliable
and comparable, is more difficult. In particular, developing questions to measure
abstract concepts, such as optimism or self-esteem, is a complex process (see box).
Most well-known scales have been developed over several years with many revisions,
when flaws in the earlier versions became apparent. This ensures they have been
extensively tested and are valid and reliable. Thus, it is almost always better to use
scales that have been thoroughly tried and tested. It is also very important not to use
single questions or parts of a scale (unless the developer advises that this is possible)
because this may invalidate the scale.
Some of the processes involved in developing a new scale
A comprehensive literature review to understand the themes and issues
relating to your subject of interest.
A qualitative study (e.g. long interviews and focus groups) to investigate the
important issues among your participants.
Development of hypotheses about what you are measuring.
Design (and refining) of the items and responses.
A small pilot study (see box on p20) to test the clarity and practicality of your
scale, followed by revision of items/responses to improve as needed.
A large-scale quantitative survey using your new scale.
Statistical analyses to check if your scale is working as expected (known as
psychometric validation).
Real surveys available from www.tickle.com

Development of a scale involves not only designing the items but also testing them to make sure that they are
valid, reliable and responsive (for further details see Section 4.3 and Section 3 of Review of Scales of Positive
Mental Health Validated for Use with Adults in the UK: Technical report (http://www.healthscotland,com/
understanding/population/mental-health-indicators.aspx)
9
10
16
If you have compelling reasons to believe that existing scales do not suit your
purpose, then you could be justified in developing your own scale. Just bear in mind
that perhaps the greatest disadvantage in doing so would be the lost opportunity to
make comparisons with the results of other studies i.e. it could be more difficult to
prove your intervention was a success compared with other interventions. If you were
to develop your own scale, it is important to include one or more existing scales in
your data collection so that you can investigate how your new scale compares with
other widely used scales. More information on the characteristics of good scales is
provided in Section 4.3.
Points for reflection
When planning your intervention, consider the pros and cons of using scales
versus other methods of data collection:
scales provide information about the quantity of impact of your intervention
i.e. they allow you to measure differences in scores between groups or before
and after an intervention. Scales provide very limited information about the
quality of impact of your intervention. Consider whether interviews and/or
focus groups would be useful to explore the participants experiences
consider collecting objective data as well as subjective data
be aware of the sensitivity of different types of response
be aware of the advantages (e.g. comparable responses, low-cost) and
disadvantages (e.g. missing data, misunderstandings due to poorly worded
questions, low response rates) of using scales
Finally, be aware of the pitfalls of designing your own scale. It is much better to
use a scale that has been well developed and tested elsewhere, as this adds to
the validity of your results. There are many scales available to assess the impact
of your intervention (see Section 7).
17
How to select a scale

The key steps to selecting and using scales are:
What are the aims and objectives of your intervention?
What does your intervention seek to improve?

What are the expected outcomes/indicators of success?
Aspects of mental wellbeing
General mental
wellbeing
Emotional wellbeing
Self-esteem
Social functioning
Life satisfaction
Resilience & coping
Optimism & hope

Spirituality
Would one or more scales be useful to measure these outcomes?

See Section 3: Why use a scale?
What issues need to be considered in choosing a scale?

See also Section 5: Some questions to ask before selecting a scale.
Select an appropriate
general mental
wellbeing scale
(pages 30-54)
Select an appropriate aspect of mental wellbeing scale

Emotional wellbeing
Life satisfaction
Optimism & Hope
Self-esteem
Resilience & coping
Spirituality
Social functioning
(page 30)
(page 39)
(page 47)
(page 35)
(page 41)
(page 37)
(page 44)
(page 52)
Pilot scale(s) with target group
Administer scale(s) with target group
Use results to inform evaluation

18
4.1 Start by defining the questions you want to answer

The first priority when choosing a scale is to determine the extent to which it fits with
the aims and objectives of your intervention (previous guides in this series provide
useful advice on this). So, planning your evaluation is crucial. Evaluating an intervention
is not only about proving its success (see Guide 2: Measuring success and Guide 3:
Getting results). A good evaluation can also tell us about how and why an intervention
worked, or did not work, which can be useful when developing a service or rolling out
an intervention (see Guide 4: Making an impact).
People often mistakenly believe that it is important to collect as much information
as possible, so that any question about the intervention can be answered. This is
not the case. The most successful evaluations are those where the researcher has
carefully considered the aims and objectives of the intervention and then constructed
hypotheses (i.e. specific questions to test). Generating hypotheses about your
intervention before you begin an intervention means you have a clear idea of what you
need to measure. Thus, when it comes to choosing a scale, you need to understand
how your intervention is expected to work and then select a scale that is suitable for
demonstrating that (see below).
EXAMPLE Matching your scale to the objectives of your intervention
If your intervention is designed to improve self-esteem, you would definitely want to
include a measure of self-esteem in your evaluation. But what else might you want
to include? If you believe that increasing self-esteem improves mental wellbeing,
you will also need to test this idea. To do this, you would need to include a scale
capable of measuring overall MWB. By doing all of this, you will then be able to
determine:
(a) the extent to which self-esteem has improved following your intervention
(b) the extent to which overall MWB has improved following your intervention, and
(c) the extent to which any improvement in MWB is due to the improvement in self-
esteem.
Some people may then choose to include other scales in the hope that they find
some other interesting or useful results. This is commonly known as a fishing exercise.
However, this is not necessary or beneficial. Most importantly, the more scales
you include in your evaluation, the greater the burden on your participants time
and enthusiasm. This increases the chance of participants missing out data or not
responding at all. It can also be considered unethical to ask for data when you have no
clear plan for analysing it. However, if you have the hypothesis (i.e. a testable theory),
for example, that social functioning is the mediating factor between self-esteem and
MWB (i.e. that higher levels of self-esteem lead to more positive relations with others,
which then increases MWB), then it would be necessary and justifiable to include a social
functioning scale in order to test that theory.
19
4.2 Why can it be difficult to select a scale?

In Section 7, you will see that there are several scales from which to choose within
any single aspect of MWB. Selecting the most appropriate one for your purposes will
require careful consideration.
This guide will help you to think about what is relevant when trying to make
your choice of scale but for a more detailed description of the key issues in the
appropriate selection of scales, see Review of Scales of Positive Mental Health
Validated for Use with Adults in the UK: Technical report11.
We have grouped the characteristics (or properties) of the scales under three major
headings (essential, desirable and practical properties) see Section 4.3. Before
discussing these properties there are three issues to consider that are extremely
important when selecting a scale:
Can you take a scale from one country/population and use it in another?
While it may be unlikely that you will find a scale that was developed in another
language and want to translate it for use in the UK, you may well find a scale that
was developed in another English-speaking country (e.g. USA, Australia) and want
to use that in your evaluation. It is important to realise that a scale developed
in one country/culture is unlikely to be suitable for use in another without first
undergoing some adaptation. This process is called linguistic validation.
Following this adaptation, the scale will need to be tested statistically (known
as psychometric validation) to make sure that it still works in the way that was
originally intended. Both linguistic and psychometric validation are complex
processes, requiring specific expertise. They are also very time-consuming, so it is
recommended that you use only those measures that have been developed in the
UK or have already been subjected to this testing. The scales included in this guide
have been developed and/or tested in this way and are suitable for use in the UK12.
How easy is the scale to read?
Many of the scales have been developed using student samples. Thus, although
these scales are designed for use with the general population, the selection and
wording of items (e.g. trust of others and use of social support) is likely to have
been influenced by student perceptions, which may vary greatly from the general
population. When choosing a scale, you therefore need to consider carefully the
item wording to ensure that it is appropriate for your population.
Available from: http://www.healthscotland.com/understanding/population/mental-health-indicators.aspx

It should be noted, however, that even where research has been conducted in the UK, the extent of the validation
was rarely evident. For example, where a US scale was used for the first time in the UK, almost no publications
mentioned cross-cultural linguistic validation of the scale and few provided full psychometric validation. In view of
these issues, for scales that were developed in countries other than the UK the term UK validation has been used in
the technical review to mean that evidence of reliability and validity (including scale structure) has been established
using a UK dataset.
11
12
20
Readability is rarely assessed formally or documented. It is highly likely that your target
population will include some people who have difficulty reading written English (either
because of low literacy levels or because English is not their first language). Some scales
are more difficult to read than others, with long words and complex sentence structures.
The only way to make sure that the scale you select is appropriate for your target
population is for you to assess the readability/suitability of the scale (see below). If you
find problems with the scale you have chosen, e.g. some questions are poorly worded
and/or irrelevant, you would be well-advised to consider choosing another scale.
If there are no other more suitable scales, then you may want to contact the scale
developer to discuss the possibility of modifying some of the items. It is important to
contact the developer at this point because they will know how and why the questions
have been worded in that particular way. It is likely that the scale developer will be able
to advise you what to do in this situation.
Will the questions you ask cause distress to your participants?

Some questions (e.g. issues concerning friendship networks or emotional relationships)
may cause the participant to question aspects of their lives in ways that may distress
them. Before you select a scale (particularly if it will be completed by the participant
with no follow-up support), please consider the potential issues that certain scales
may raise. This is not to suggest that all MWB scales will have adverse effects, but just
that you need to think about the impact of asking certain types of questions. Ethics
committees are aware of these issues and you will need to have considered them prior
to seeking approval.
Pilot testing your scale

You will learn a great deal by completing the scale yourself, and then asking a few
people from your target population (i.e. the sort of people among whom you intend
to use the scale) to complete it. Then answer (and ask your participants to answer) the
following questions:
how long did it take to complete the scale?
did each of the questions make sense to you?
were there any questions (or particular words) that were difficult to understand?
did any questions cause you distress?
did the response options fit well with the questions asked?
were all the questions relevant to what the scale is supposed to measure?
what, if anything, is missing from the scale that you think is important? Consider
whether another scale might be more suitable, or if an additional scale might be
required to fill the gaps.
and finally, did the task of completing the scale feel like an engaging, worthwhile
and satisfying experience (by contrast, perhaps, to being irritating, boring, or overdemanding).
21
4.3 Properties of scales

To identify the most appropriate scale it is important to have an understanding of
what makes a good scale. The following properties have been used to appraise the
scales included in this guide (see Section 7) and an explanation of each is provided
here. The properties have been categorised as essential, desirable and practical (see
below). For further information on the appropriate selection of scales, see Review
of Scales of Positive Mental Health Validated for Use with Adults in the UK: Technical
report13.
Use the traffic lights
Essential properties must be satisfactory before you start.
Desirable properties are helpful but not always necessary or available.
Practical properties are important but can only be judged by you, the
individual practitioner, in terms of the extent to which they fit with your
requirements.
Essential properties
Content validity
Does the scale measure what it claims to measure? This is a subjective judgement
of the extent to which the items in the scale adequately cover the construct
being assessed (e.g. whether it measures self-esteem or optimism or trust).
This judgement is not based on statistical analysis but draws on the researchers
understanding of the underlying construct and, if possible, the views of your target
group should also be obtained. Ideally, this work will have been done by the scale
developer and documented in a published paper but many scales are published
without this information. Therefore, it is important that you make an assessment
for yourself of the extent to which the items (i.e. questions) in the scale appear to
match with what you want to measure.
Structure
Do the items fit together? To justify the summing of individual scores into one
total or composite score, the scales structure must be explored using statistical
analysis to ensure that all items group together as expected. This is known as
factor analysis.
Reliability
Does the scale produce similar results under similar conditions? This is assessed
as test-retest reliability (i.e. the correlation between scale scores obtained from
the same people on two separate occasions). Another form of reliability is internal
consistency (i.e. a statistical procedure that indicates the extent to which items
are homogenous).
13
Available from: http://www.healthscotland.com/understanding/population/mental-health-indicators.aspx.
22
Desirable properties
Construct validity
Does the scale relate to other variables in a meaningful way? This is usually
assessed by including additional scales in your study that you expect either to
relate well to your scale because they are intended to measure similar constructs
(e.g. two scales designed to measure optimism) or to be completely unrelated to
your scale (e.g. optimism and IQ).
Responsiveness14
Does the scale detect changes following an intervention? This can be assessed in
a number of ways, though it is typically (if not ideally) reported as a statistically
significant difference between pre- and post-intervention scores, thus indicating
that some change has occurred.
Normative data
How does the general population score on this scale? In practice, this information
is available for very few scales of MWB because it requires very large sample sizes
(which unfortunately are rare in the social sciences). However, if available, this
information can be useful in determining the extent to which your sample is similar
to the general population.
Practical properties
How many items are included in the scale? It would be counter-productive to
administer a scale that includes 40 items if you know that your participants have
short attention spans or if you are also including several other scales in your
evaluation. Participant fatigue or boredom will probably result in ill-considered
answers, missing data and/or low response rates.
How much time do participants take to complete the scale? In addition to the
number of items, the complexity and wording of items can greatly influence how
long it takes a participant to complete the scale, or even whether or not he/she
completes it at all.
How easy is it to access a copy of the scale? While many scales are freely available
on the internet or directly from the scale developer/copyright holder, there are
many others that require the user to sign an agreement relating to its use. There
are several benefits to accessing a legitimate copy directly from the copyright
holder (see overleaf), but it is worth finding out early on how long the process of
setting up an agreement will take.
How much does the scale cost? While many scales are free of charge (and many
more are free to those working on non-commercially funded projects), there are
some that require a fee to be paid. This can be as a one-time payment for use in
a given study or programme of research or it can be a cost per participant, which
may limit the number of people you can afford to include in your evaluation.
14
23
Responsiveness is often used interchangeable with sensitivity to change, but the latter term does not imply the
change is clinically meaningful
COPYRIGHT The benefits of obtaining a legitimate copy

Copies of most scales included in this guide are available in the accompanying
Technical report. The copyright of published scales is usually owned by the
developer of the scale or by the publishers. Readers are asked to respect any
conditions of use stipulated by the developer and/or copyright holder. In many
cases, users will need to obtain a licence to use the scale from the developer or
copyright holder. The good news is, for many non-commercial purposes, scales
are frequently obtainable free of charge, and permission to use the scale may be
easily sought through a simple e-mail or letter. Sometimes, however, users will be
required to pay a license or administrative fee for use and/or be willing to provide
the developer with access to their data. The advantages of obtaining permission to
use a scale (aside from the most obvious, i.e. not breaking copyright laws), include:
ensuring that you are using the latest version (earlier versions may have been
superseded and may no longer be recommended)
avoiding errors that are common in pirate copies (i.e. introduced when scales are
copy typed), which may affect the validity of data collected
accessing the latest scoring guidance so you can do a proper job of it
providing feedback to the developer and contributing to the validation of the
scale.
Please note: Unless indicated otherwise, scales may not be copied or used
without express permission of the copyright holder. Do not let this put you off
using a particular scale as permission may be easily obtained.
24
Points for reflection

When planning an intervention, you need to define the questions you want your
evaluation to answer, make sure that the scale you choose is capable of providing
the data you need and think about the practicalities involved:
consider the objectives of your intervention and make sure you choose scales
that match them
ensure that the scale you have chosen is suitable for use in your country/culture
check whether or not the participants in your intervention will be able to
understand the questions in the scale you have chosen. Are there any language
barriers? Is the wording overly complex or otherwise unsuitable?
will the questions you ask cause your participants any distress?
consider pilot-testing your chosen scale(s)
do the questions in the scale you have chosen actually measure what the
developers say it will measure (i.e. is it valid)?
does the scale you have chosen produce similar results under similar conditions
(i.e. is it reliable)?
consider the burden on your participants and avoid asking them to answer more
questions than you need
are there any conditions of use that you need to consider, e.g. obtaining
permission from the copyright holder or paying a license fee?
25
Some questions to ask before selecting a scale
Some questions to ask before you select a scale

The previous section provided some useful information about what to look for
when selecting a scale. What follows is a checklist for those about to embark on the
evaluation of mental health. When selecting a scale to measure mental wellbeing
(MWB), you may find it useful to consider the following questions. Some issues may not
be relevant to your purposes and/or you might find that when considering some of the
issues, you then think of other issues that are very specific to your evaluation but not
mentioned here. Thus, this checklist is intended to serve as a catalyst for considering
some of the general issues that arise when planning an evaluation. The checklist is not
exhaustive because all evaluations are different.
Are you conducting an intervention, or do you just want to measure some
aspect of MWB, perhaps comparing two groups at a particular point in time?
If you are conducting an intervention, what exactly do you want to know as a
result of the evaluation?
Does the scale you are considering fit with your project aims (and your specific
hypotheses, see Section 4.1)?
In addition to your selected scale(s), have you considered other ways you might
gather important information, such as interviews or observation (see Guide 3:
Getting results)?
If you are conducting an intervention, which aspects of MWB (see Section 2) fit
best with what you are hoping to improve?
If the particular aspect of MWB that you hope to improve does, indeed, show
benefit, will this necessarily mean that overall mental wellbeing has improved? If
not, have you considered selecting a more general scale (see Section 7.1) as well
as the one that measures the particular MWB aspect of interest?
From whom will you collect the data, and why that particular group? Will you
be administering your scale to participants, or participants families, carers or
perhaps health professionals?
When is the information needed? What resources (e.g. time, money, and staff)
do you have available for collecting the information?
Is the scale attractive to participants (e.g. layout, appearance, font size)?
Have you made arrangements to pilot the scale to make sure that the scale is
easily understood and easy to complete? Are your participants likely to have
limited literacy skills which might interfere with completing the items?
26
Have you considered respondent burden (i.e. the difficulty and number of
questions you are expecting the participant to complete)? Are you planning
on including additional scales or other questions (such as age, race, gender,
education, employment and physical health history), which may add to the
respondent burden?
Does the scale developer provide any guidance about scoring the items? This
should include what to do about missing data.
Will you need to repeat your data collection (e.g. before and after the
intervention)? If so, what would be an appropriate follow-up period (e.g. three,
six or 12 months)?
Will participants complete the scale while you are present or some time
later, perhaps at home, returning it by post? What implications could such
arrangements have for the quality of the data you get back?
Have you considered whether the scale, and/or the setting for completing it,
may have any potential adverse effects? Is it possible that some questions might
upset some participants (e.g. questions about the number of people they are
emotionally close to). If so, is an appropriately qualified professional going to be
available to deal with any distress caused?
27
Measuring mental wellbeing
Measuring mental wellbeing

One of the greatest challenges for demonstrating improvements in mental health is
to identify indicators of mental wellbeing (MWB) as opposed to indicators of mental
illness. This is further discussed in Guide 2: Measuring success.
6.1 Why not use scales that measure mental health problems?
Reducing mental illness is important for improving mental health. When researching
mental illness or mental health problems, a typical strategy has been to use scales
that are problem-focused (e.g. measures of anxiety and depression). In the general
population, where only a minority will be clinically anxious or depressed, such scales
often display ceiling or floor effects. This means that such scales are unable to detect
improvements in people without mental health problems, because the participants
score cannot be improved upon at follow-up. So the scales provide little if any
information about whether MWB has increased (Stewart-Brown, 2002).
During the 1980s, as a result of the increasing focus on health promotion, the search
for indicators of positive health intensified (Bowling, 2005). There is now a wealth of
scales that measure subjective indicators of MWB. These include scales about life
satisfaction, self-esteem, social support, resilience and other distinctly positive aspects.
But with such choice, how does the researcher/practitioner choose between them?
Section 7 provides brief details and an appraisal of various scales that measure eight
selected aspects of MWB in adults. These scales were selected for inclusion according
to the criteria described in Section 6.2 (see also Appendix C).
6.2 Caveats regarding the scales recommended in this guide
At this point, a few words of caution. This guide is primarily aimed at practitioners and
researchers in Scotland and the rest of the UK15. Readers (especially those outside the
UK) are advised to consider the limitations of the inclusion criteria16 when using this
guide, which necessitated inclusion of only those scales that:
measure the chosen aspects of MWB. The selection of eight aspects was
developed largely from the work of Health Scotlands Mental Health Indicators
Project Advisory Group17. These aspects of MWB are not definitive and nor are they
universally agreed. There was a pragmatic need for the aspects to be compatible
with this extensive programme of work, and this meant some compromises were
made regarding the choice and naming of aspects
focus on mental wellbeing i.e. the balance of items is in favour of mental wellbeing
rather than mental health problems. This priority objective has meant that some
well-known measures of mental distress (e.g. General Health Questionnaire) or
health status (e.g. SF-36) were excluded
The review (which has informed this Guide) served the specific purposes of Health Scotland.
See Review of Scales of Positive Mental Health Validated for Use with Adults in the UK: Technical report, available from:
http://www.healthscotland.com/understanding/population/mental-health-indicators.aspx
17
See Parkinson J (2006) Indicators of Mental Health and Wellbeing Constructs consultation paper (http://www.
healthscotland.com/documents/1465.aspx)
15
16
28
are suitable for use with the general adult population. This review excludes scales
designed specifically for other age groups (e.g. children, adolescents), sub-sections
of the adult population (e.g. elderly people) or target populations (e.g. specific
diseases or conditions, health-related behaviours, hospital or occupational settings)
have been validated for use in the UK. This review excludes many scales that have
been used widely in other countries (most frequently the USA), but for which no
evidence could be found of UK validation
do not require the user to undergo specialist training or have qualifications in
psychometric testing. This was a practical issue taking account of the fact that
practitioners would be unlikely to be qualified in psychometric testing or have the
resources available to facilitate specialist training
have been psychometrically validated. The scales have undergone statistical
testing to demonstrate the properties described in Section 3. In the course of this
review, some newly designed scales were identified that have not yet undergone
this level of validation.
To exclude those scales that did not meet our inclusion criteria entirely would be to do
a disservice both to the scales (many of which have been used widely outside the UK
and/or for purposes other than assessing MWB) and to future researchers, who may be
interested in conducting the necessary validation. Therefore, further details about the
excluded scales is included in the Technical report18 (including copies where permission
to reproduce was obtained).
With these caveats in mind, it is hoped that you will find the description and appraisal
of scales (see Section 7) useful when planning your evaluation.
6.3 How will you know if overall mental wellbeing has improved?
This guide has been structured to provide advice on measuring specific aspects of
MWB e.g. life satisfaction, social functioning, and spirituality (see Section 7). Whilst
scales measuring specific aspects of MWB may well be useful for evaluating specific
interventions, they will not be able to indicate whether or not overall MWB has
improved (see Section 4.1). If you want to find out whether overall MWB has improved
as a result of your intervention, you are most likely to find a suitable scale in Section 7.1.
In particular the Affectometer 2 (Kammann & Flett, 1983; Stewart-Brown, 2006) has
been highlighted as a useful scale for this purpose19.

Since completion of the review, further work on the validation of Affectometer 2 has been undertaken for Health Scotland
This indicated that the Affectometer 2 could be improved upon. A new and superior scale the Warwick-Edinburgh Mental
Wellbeing Scales (WEMWBS) has subsequently been developed from Affectometer 2. For information on all this work see
www.healthscotland.com/understanding/population/mental-health-indicators.aspx
18
19
29
Scales of mental wellbeing

Each of the scales has been appraised by the authors of this guide according to
the following criteria (see Section 4.3 for more information):
Content validity (or does the scale measure what it claims to measure?)
Structure (or do the items fit together?)
Reliability (or does the scale produce similar results under similar conditions?)
Construct validity (or does the scale relate to other variables in a meaningful
way?)
Responsiveness (or does the scale detect changes following an intervention?)
Normative data (or how does the general population score on this scale?)
The ratings for the essential and desirable properties have then been averaged
into one overall rating, to provide a general indicator of the relative merits of
each scale. Please note that this overall rating is a subjective assessment, so it
is important that you consider the properties of each scale in respect of your
particular requirements, and that you bear in mind the practicalities of each scale
(see below) in relation to your situation, when choosing between scales with
similar ratings. For instance, do you need a particularly brief scale and/or one that
is free to use?
Practical properties
How many items are included in the scale?
How much time do participants take to complete the scale?
How much does the scale cost?
How easy is it to access a copy of the scale?
Further details about the scales (e.g. content, psychometric evidence, conditions
of use) can be found in the accompanying Technical report20.
7.1
Emotional wellbeing
7.1.1 Description of scales

Several scales of emotional wellbeing exist and these differ substantially in
terms of their focus and length. Self-report measures of emotional wellbeing
usually require the participant to indicate how frequently they experience
20
30
various emotional states. Please note that the psychological term affect means
emotional feeling or emotional experience. Timeframe is perhaps the most
important feature of these scales. With shorter timeframes (e.g. referring to
right now, today, at the current time), the scale is more likely to capture an
emotional response, whilst with longer timeframes (e.g. the past week, past few
weeks, past month), the scale is more likely to capture mood or personality traits.
Practitioners are advised to consider which aspect of emotional wellbeing they
wish to evaluate, and to select a scale that fits their needs.
The following scales of emotional wellbeing are recommended:
Affect Balance Scale (ABS) (Bradburn, 1969) measures the concept of
emotional wellbeing, seen as a function of two independent dimensions
positive and negative affect meaning pleasurable and unpleasurable
experience
Affectometer 2 (Affect 2) (Kammann and Flett, 1983) measures MWB using a
balance of positive and negative feelings and thoughts
Depression-Happiness Scale (DHS) (McGreal and Joseph, 1993) measures
positive and negative affect, in terms of positive and negative thoughts,
feelings and bodily experiences. Note that the DHS remains unique in its
dual measurement of depression and happiness as opposite ends of a single
continuum
Oxford Happiness Questionnaire (OHQ) (Hills and Argyle, 2002) provides a
broad measure of happiness in three domains (life satisfaction, positive affect
and negative affect)
Oxford Happiness Questionnaire - Short-Form (OHQ-SF) (Hills and Argyle,
2002) is a brief (8-item) version of the above OHQ
Positive And Negative Affect Schedule (PANAS) (Watson et al, 1988)
measures positive and negative affect, identified in research as the dominant
dimensions of emotional experience. Consists of single word items describing
various feelings and emotions
Psychological General Wellbeing Index (PGWBI) (Dupuy, 1984) provides a
detailed assessment of positive wellbeing, self-control and vitality as well as
aspects of mental health problems
Short Depression-Happiness Scale (SDHS) (Joseph et al, 2004) is a brief
(6-item) version of the above DHS
Wellbeing Questionnaire 12 (WBQ12) (Bradley, 1994; 2000) provides a
brief (12-item) measure of positive wellbeing, energy and negative wellbeing
(avoiding the use of somatic items, so as to be particularly suitable for use in
patient populations).
31
Most scales included here measure positive affect (with or without a measure
of negative affect). They typically include several statements (or single words)
to describe a range of emotional states. There appears to be little attempt with
the current instruments to measure in detail the different types of positive affect
i.e. happiness, elation, calmness, momentary satisfaction. Rather, it is the case
that items can generally be summed (or otherwise aggregated) to form a scale
that measures positive affect or positive wellbeing rather than more specific
elements of the construct.
The Affectometer 2 take a much broader perspective of MWB, including not
only hedonic (i.e. pleasure) but also eudaimonic (i.e. function) dimensions. The
Wellbeing Questionnaire (W-BQ12) and the Psychological General Wellbeing
Index (PGWBI) both provide measures of positive wellbeing but they also include
measures of energy/vitality.
32
7.1.2 Appraisal of the above scales

If researchers are looking for a scale to measure overall MWB, they are most
likely to find a useful instrument amongst this selection. With the exception of
the Affectometer 2, none of these scales includes the eudaimonic dimension of
MWB (which is generally accepted by most specialists to be important for MWB).
That said, the scales included in this section are most likely to provide an indicator
of what most lay people would mean by MWB (i.e. feeling good).
Thus, if an overall scale of MWB is required, the Affectometer 2 appears to be a
very promising instrument. Despite being first published more than twenty years
ago, there has been surprisingly little use of the Affectometer 2 (particularly
in the UK). However, it has recently undergone substantial psychometric
development, and the preliminary evidence indicates that it is a valid, reliable,
acceptable and brief measure of MWB21.
The PANAS is a valid and reliable, detailed measure of positive and negative
affect, for which normative data are available (i.e. information on how a general
population tends to score on it), but there is comparatively little evidence of its
responsiveness (i.e. how sensitively it can measure change in MWB). The PANAS
may well be useful for use in national surveys.
The WBQ12 is also valid and reliable, providing a brief overview of positive
wellbeing, negative wellbeing, and energy. Whilst no normative data are available
and it has not been used widely in the general population, there is strong
evidence for its responsiveness, which makes it a strong contender for the
purposes of evaluating interventions.
If a particularly brief measure of emotional wellbeing is required, the Short
Depression-Happiness Scale (6 items) offers good content validity, reliability and
structural evidence (i.e. its different elements appear to be consistent with each
other), though its responsiveness has yet to be fully established.
A short and substantially revised form of the Affectometer 2 (the Warwick-Edinburgh Mental Wellbeing
Scale (WEMWBS)) is currently under development. Validation on WEMWBS to date is favourable see http://
www.healthscotland.com/understanding/population/mental-health-indicators.aspx for information
21
33
34
(510 mins)
29 items
(Unknown)
8 items
(5 mins)
20 items
(510 mins)
(1015 mins)
6 items
(<5 mins)
**
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** (*)
*
*
** (*)

***
*
*
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*
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*** (*)

*
* (*)
** (*)
* (*)
*
*
* (*)

**
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****
*** (*)
*
*** (*)
***

**
***
***
** (*)
** (*)
*
** (*)

***
*
*
** (*)
**
*** (*)
*** (*)

***
****
****
*** (*)
*** (*)
*
*** (*)

DepressionHappiness Scale
Oxford Happiness
Questionnaire
Oxford Happiness
Questionnaire
Short form
Positive and Negative

Affect Schedule
Psychological
General Wellbeing
Index
Short DepressionHappiness Scale
Wellbeing
Questionnaire-12
Yes
No
Yes
Yes
Unknown
Unknown
No
No
Yes
Permission
needed
No fee
No fee
No fee
No fee
Unknown
Unknown
No fee
No fee
Fee
Fee to use
scale
Free for non-commercial use
Overall rating = mean score of the essential and desirable properties (e.g. 24 stars / 6 properties = *****).
Scales are given a maximum 5-star rating for each of the six psychometric properties reflecting both quantity and quality of evidence, where: ***** = excellent evidence, **** = very good evidence, *** = good evidence, ** = moderate evidence, * = lack of evidence.
Further information about obtaining permission to use scales and details of license fees are provided in the summary reports for each scale, which can be found in the Review of Scales of Positive Mental Health Validated for Use with Adults in the UK: Technical report .
Where information is unknown, contact the developer and/or copyright holder (contact information provided in the Technical report). It should be noted, however, that the authors of this guide have made every effort to obtain as much information as possible.
Summaries of each scale as well as copies (and details of how to obtain permission to use, where necessary) can be found in the Review of Scales of Positive Mental Health Validated for Use with Adults in the UK: Technical report (http://www.healthscotland.com/
understanding/population/mental-health-indicators.aspx for information) which accompanies this guide.
12 items
(510 mins)
22 items
25 items
40 items
(5 mins)
***
****
****
***
*
*
***

10 items
(5 mins)
Items (time)
Practicalities
Affectometer 2
Normative
data
Overall rating
*
**
*
* (*)
*
*
*

Responsiveness
Construct
validity
Reliability
Content
validity
Structure
Affect Balance Scale
Scale
Appraisal of scales of emotional wellbeing
7.2
Life satisfaction

Several scales of life satisfaction exist, which differ in terms of their length and,
therefore, the level of detail measured. The following scales of life satisfaction are
recommended for use:
The Delighted-Terrible Scale (DTS) (Andrews and Withey, 1976) measures
satisfaction with life in general, or satisfaction with more specific topics such as
health
The Global Quality of Life Scale (GQOL) (Hyland and Sodergren, 1996)
provides a measure of a participants overall judgement of their quality of life/
life satisfaction
Satisfaction with Life Scale (SWLS) (Diener et al, 1985) designed to assess a
persons global judgement of life satisfaction
World Health Organisation Quality of Life Bref (WHOQOL-BREF) (The
WHOQOL Group, 1998) provides a brief measure of quality of life in terms of
various dimensions (e.g. physical health, social relationships, environment) and
is valid for cross-cultural assessments.
7.2.2 Appraisal of scales
Life satisfaction is one of the few constructs that has been reliably measured on
a single rating scale (e.g. How satisfied are you with your life?) with a number
of possible answers to choose from on 5-, 7- or 10-point response scales. Note
that the greater the number of points in the response scale, the more sensitive
the question is likely to be at measuring changes (see Section 3.2). Where an
extremely brief scale is required, the single-item measures show equivalence,
with the DTS having greater reliability whereas the GQOL shows greater
responsiveness. When response burden is a major concern, the single-item scales
may well provide a useful measure of life satisfaction.
The Satisfaction With Life Scale (SWLS) is also brief, with five items designed
to assess various perspectives on life satisfaction. However, it has much better
psychometric properties than single-item scales and is the favoured choice, with
the added benefit of normative data being available.
The WHOQOL-BREF has similar psychometric properties to the SWLS and can
be recommended where a more detailed scale is required or where completion
time/ respondent burden is not an issue. It has a much more general focus than
other scales and may be suitable for those interested in assessing wide-ranging
factors that could influence life satisfaction. It also includes a global item (How
would you rate your quality of life?) rated on a 5-point response scale.
35
36
Normative
data
26 items
(1520 mins)
(5 mins)
5 items
1 items
(< 5 mins)
1 items
(< 5 mins)
Items (time)
Practicalities
Yes
No
No
Yes
Permission
needed
No feec
No fee
No fee
Unknown
Fee to use
scale
Further information about obtaining permission to use scales and details of license fees are provided in the summary reports for each scale, which can be found in the Review of Scales of Positive Mental Health Validated for Use with Adults in the UK: Technical report.
a
***
***
*****
*****
***
***
****
****

Satisfaction With Life

Scale
***
***
*
***
*****
*****

**
N/A
*
**
**
*
**

Global Quality of Life
World Health
Organisation Quality
of Life BREF
**
N/A
**

Overall rating
**
*
*
**

Responsiveness
Construct
validity
Reliability
Content
validity
Structure
Delighted-Terrible
Scale
Scale
Appraisal of scales of life satisfaction
36
7.3
Optimism and hope

Various scales exist that are designed to assess an individuals outlook on life. The
scales differ in their emphasis but, generally-speaking, share the same underlying
concept. The following scales of optimism and hope are recommended for use:
Generalised Expectancy Scale for Success Revised (GESS-R) (Hale et al,
1992) assesses optimism by presenting participants with particular situations
and evaluating their expectations of success in those situations
Life Orientation Test (LOT) (Scheier and Carver, 1985) assesses dispositional
optimism (or generalised expectancies) for positive versus negative outcomes
Life Orientation Test Revised (LOT-R) (Scheier et al, 1994) is a brief (ten
item) version of the LOT (above)
Positive and Negative Expectancy Questionnaire (PANEQ) (Olason and Roger,
2001) measures optimism, pessimism and fighting spirit
Trait (Dispositional) Hope Scale (T(D)HS) (Snyder et al, 1991) measures the
degree to which an individual has the perceived motivation to move towards
his or her goals (agency) and the perceived ability to generate workable routes
to goals (pathways).
When selecting scales of optimism and hope, it is important to consider the
population to be studied, and the cultural context. Scales differ in how difficult
they are for participants to complete, which means that you need to consider
the characteristics of your population and whether one scale rather than another
would be more suitable (e.g. as regards reading age, life stage). In particular,
while optimism and hope are universal constructs, their meanings and the value
placed on them differs widely from culture to culture. Thus, when selecting a
scale for use, readers are advised to consider carefully the aspect of optimism
and hope that they wish to assess, the psychometric properties and, importantly,
the practicalities of each scale.
Given the similarities in overall ratings between the scales, it is difficult to
recommend one scale over another. However, where a very brief measure is
required, the LOT-R appears to be a good choice.
37
38
**
**

****
***
**
*
** (*)

**
***
****
***
*
*
** (*)

(12 items)
(<5 mins)
48 items
(510 mins)
(5 mins)
10 items
***
****

****
*** (*)
*
*
***

12 items
(510 mins)
*
* (*)
** (*)
*** (*)
*
*
**

Items (time)
25 items
(510 mins)
Normative
data
Overall rating Practicalities
**
*
****
** (*)
*
*
**

Responsiveness
Construct
validity
Reliability
Content
validity
Structure
No
Yes
Yes
Yes
Yes
Permission
needed
No fee
NZ$1
No feec
No fee
No fee
Fee to use
scale
Trait (Dispositional)
Hope Scale
Positive and
Negative Expectancy
Questionnaire
Life Orientation
TestRevised
Life Orientation Test
Generalised
Expectancy Scale for
Success
Scale
Appraisal of scales of optimism and hope
38
7.4
Scales of Self-esteem

Several scales of self-esteem exist and these differ in terms of their complexity
and length. The following scales of self-esteem are recommended for use:
Basic Self-Esteem Scale (BSES) (Forsman and Johnson, 1996) is designed to
assess the persons fundamental self-love
Coopersmith Self-Esteem Inventory (CSEI) (Coopersmith, 1981; original
work published in 1967) assesses personal judgement of worthiness that is
expressed in the attitudes the individual holds towards him/herself
Robson Self-Concept Questionnaire (RSCQ) (Robson, 1989) assesses the
sense of contentment/self-acceptance that results from a persons appraisal
of self-worth, significance, attractiveness, competence and ability to satisfy
aspirations
Rosenberg Self-Esteem Scale (RSES) (Rosenberg, 1965) provides a measure of
global attitudes about the self. Self-esteem is a positive or negative orientation
towards oneself, and an overall evaluation of ones worth or value. High selfesteem indicates positive self-regard, not egotism
Visual Analogue Self-Esteem Scale (VASES) (Brumfitt and Sheeran, 1999)
is a non-verbal measure of self-esteem, which includes ten pictorial items
depicting various aspects of self-esteem, i.e. cheerful, trapped, optimistic,
confident, frustrated, confused, misunderstood, outgoing, intelligent, angry.
The most widely used, and arguably the best measure of general self-esteem, is
Rosenbergs Self-Esteem Scale (RSES), which has been in use for over 40 years. It is
a relatively brief measure, which includes 10 short and simple statements about a
persons feelings towards him/herself.
For a more detailed assessment, there is good evidence for Robsons Self-Concept
Questionnaire (RSCQ). It has 30 items but can still be completed by most
respondents in 510 minutes.
More recently, the Visual Analogue Self-Esteem Scale (VASES) has been developed
which includes pictures instead of items. Although it has not been used widely,
there is good preliminary evidence for the VASES and it has the added benefit of
being particularly suitable for use with language-impaired people or those people
suffering from with what we might call questionnaire fatigue.
39
40
***
** (*)
*
*
**

**
**
*
** (*)
**

***
****
****
*
** (*)

* (*)

**

**
* (*)

**
* (*)

****
****

***
***
****
*** (*)
**
*
***

Coopersmith SelfEsteem Inventory
Robson Self-Concept
Questionnaire
Rosenberg SelfEsteem Scale
Visual Analogue SelfEsteem Scale
Normative
data
Basic Self-Esteem
Scale
****
****
**
****
****

(10 items)
(Unknown)
(5 mins)
10 items
(510 mins)
30 items
25 items
(510 mins)
20 items
(unknown)
Items (time)
Unknown
No
No
Yes
Unknown
Permission
needed
Unknown
No fee
No fee
Fee
Unknown
Fee to use
scale
Scales are given a maximum 5-star rating for each of the six psychometric properties reflecting both quantity and quality of evidence, where: ***** = excellent evidence, **** = very good evidence, *** = good evidence, ** = moderate evidence, * = lack of
evidence.
Further information about obtaining permission to use scales and details of license fees are provided in the summary reports for each scale, which can be found in the Review of Scales of Positive Mental Health Validated for Use with Adults in the UK: Technical
report. Where information is unknown, contact the developer and/or copyright holder (contact information provided in the Technical report). It should be noted, however, that the authors of this guide have made every effort to obtain as much information as
possible.
Scale
Responsiveness
Construct
validity
Reliability
Structure
Content
validity
Appraisal of scales of self-esteem
40
7.5

Several scales of resilience and coping exist and the following are recommended
for use:
Attributional Style Questionnaire (ASQ) (Peterson et al, 1982; Seligman et al,
1979) measures explanatory style for good and bad events using three causal
dimensions: internal versus external, stable versus unstable, and global versus
specific causes
Brief COPE Scale (BCOPE) (Carver, 1997) is a 28-item short-form of the original
COPE scale (see below), designed to assess 14 conceptually distinct methods
of coping (e.g. active, positive reframing, denial, acceptance, humour, selfblame)
The COPE (Carver et al, 1989) is a 60-item multidimensional coping scale
designed to assess 15 conceptually distinct methods of coping (e.g. active,
positive reinterpretation and growth, denial, seeking of social support for
emotional reasons)
Coping Styles Questionnaire (CSQ) (Roger et al, 1993) measures four styles
of coping. Rational coping and detached coping are considered to be
adaptive styles, while emotional coping and avoidance coping are considered
maladaptive
Functional Dimensions of Coping (FDC) (Ferguson and Cox, 1997) measures
what an individual believes a coping style (or styles) will achieve for them
psychologically, e.g. an individual may cry (style of emotional release) believing
that this will alleviate emotional distress (function)
General Self-Efficacy Scale (GSE) (Schwarzer and Jerusalem, 1995) assesses a
general sense of perceived self-efficacy with the aim of predicting coping with
daily hassles as well as adaptation after experiencing all kinds of stressful life
events
Sense of Coherence Scale (SOC) (Antonovsky, 1987a; Antonovsky, 1987b)
measures ones general orientation to life. A core element in the concept is
that SOC is a global orientation, a way of looking at the world, a dispositional
orientation rather than a response to a specific situation
Ways of Coping (WAYS) (Folkman and Lazarus, 1985) measures coping as
a process taking place within a particular context, rather than coping as a
disposition or style. WAYS can assess and identify thoughts and actions that
individuals use to cope with the stressful encounters of everyday living.
41
The scales can be categorised broadly into two measurement approaches:

Resilience Scales in this category (i.e. GSE, SOC) focus on the capacity of the
individual to cope in times of stress, that is, his/her sense of self-efficacy or self
perception of his/her ability to cope (in a demanding situation)
Coping style Scales in this category (i.e. BCOPE, COPE, CSQ, WAYS) assess
the strategy that individuals use to deal with stressful/demanding situations.
Related to this, the Attributional Style Questionnaire assesses how an individual
explains good and bad events (which provides a quasi-measure of the way in
which they cope with negative events). Finally, the FDC goes one step further
to assess what the individual expects a coping style (e.g. crying) will achieve
for them (e.g. relieve of emotional distress).
For scales that provide a measure of resilience (or capacity for coping), the
General Self-Efficacy Scale (GSE) and the Sense of Coherence Scale (SOC) can
be distinguished more in terms of their approach to measurement, with each
having equivalent and reasonable evidence for their psychometric properties.
The construct of perceived self-efficacy reflects an optimistic self-belief that one
can cope with adversity or perform novel or difficult tasks. With only ten items
(and reportedly taking less than five minutes to complete), the GSE is a brief and
widely used scale. The SOC, on the other hand, offers a similar approach in its
domain of manageability, i.e. the extent to which the individual feels able to
cope with demands, but also offers domains that assess comprehensibility, i.e.
the extent to which events make sense to the individual, and meaningfulness,
i.e. the feeling that life is challenging and has purpose. However, with 29 items,
the SOC is likely to take longer to complete and may be more burdensome for
the respondent.
For scales of coping style, it is difficult to differentiate between the scales
available with respect to psychometric properties. In order to assess several
different styles of coping reliably (which requires several items for each style),
most scales include 40-70 items and even the Brief COPE includes 28 items. The
ASQ includes only 12 items but has been criticised for the use of hypothetical
scenarios.
42
43
Reliability
Responsiveness
Construct
validity
Normative
data
Structure
Appraisal of scales of resilience and coping

a
Scale
Content
validity
Permission
needed
$20 US
Fee to use
scale
Items (time)
Yes
12 items
(20 mins)
* (*)
* (*)
**
**
*
*
* (*)

No fee
Attributional Style
Questionnaire
No
Brief COPE Scale
28 items
(Unknown)
**
** (*)
*
*
**

**
**

(Unknown)
Yes
No fee
** (*)
** (*)
*
*
**

48 items
(Unknown)
No
No
**
**

**
*
*
**
*** (*)

16 items
(Unknown)
No fee
60 items
COPE Scale
***
** (*)

*** (*)
***
*
*
**

No
No fee
$1NZ
Coping Styles
Questionnaire
** (*)
** (*)

10 items
(<5 mins)
No fee
Functional Dimensions
of Coping
****
***
*
***
***

No
** (*)
****

General Self-Efficacy
Scale
Unknown
66 items
(Unknown)
(1015 mins)
Yes
*** (*)
** (*)

29 items
Sense of Coherence
Scale
*** (*)
***
*
* (*)
** (*)

Ways of Coping
** (*)
*
*
**
** (*)
**

**
a
understanding/population/mental-health-indicators.aspx
for information) which accompanies this guide.

Permission required for commercial use.
b
c
43
7.6
Spirituality

Several scales of spirituality exist and these differ substantially in terms of their
focus and length. The following scales of spirituality are recommended for use:
Life Attitude Profile Revised (LAP-R) (Reker, 1992) measures discovered
meaning, purpose in life, and the motivation to find meaning and purpose
in life. It includes several subscales, which measure purpose, coherence,
death acceptance, choice/responsibleness, existential vacuum and goalseeking. From these, composite scores (Personal Meaning Index and Existential
Transcendence) can be obtained
Meaning in Life Questionnaire (MLQ) (Steger et al, 2006) measures the
presence of and search for meaning in life, defined in the scale as the
sense made of and significance felt regarding the nature of ones being and
existence
Purpose in Life Test (PIL) (Crumbaugh & Maholick, 1964) measures the extent
to which meaning in life has already been found, as opposed to the selfmotivation to find purpose in life
Spiritual Wellbeing Scale (SWBS) (Paloutzian and Ellison, 1982) provides an
overall measure of the perception of spiritual quality of life, as well as subscale
scores for religious wellbeing (self-assessment of ones relationship with God)
and existential wellbeing (self-assessment of ones sense of life purpose and
life satisfaction).
The selection of a scale of spirituality will require a decision about the relative
importance of detail versus brevity.
The LAP-R is a lengthy measure (at 48 items) which includes several subscales
designed to measure various aspects of spirituality. The 16-item Personal Meaning
Index (derived by summing the Purpose and Coherence subscales) has been used
most widely. The LAP-R has reasonable psychometric properties and offers the
advantage of providing detailed measurement of spirituality.
The Purpose in Life Test (PIL) and the Spiritual Wellbeing Scale (SWBS) are both
20-item measures of spirituality but differ slightly in completion times, due to the
PILs unorthodox response scale. Each item of the PIL uses different anchors for
44
the response scale, so it takes a little more time to complete and may be more
confusing to participants than a similar measure that uses the same response
scale throughout. A further concern with the PIL is that its content is somewhat
confounded with depression (e.g. If I could choose, I would: prefer never to
have been born live nine more lives just like this one). This is likely to artificially
increase correlations with other aspects of mental health.
The SWBS is a relatively brief measure of spirituality, which focuses on spiritual
wellbeing, both religious (i.e. relationship with God) and existential (i.e. ones
sense of life purpose and life satisfaction). Thus, it offers a slightly different focus
from other scales reviewed here. The SWBS has been reported to be prone to
ceiling effects in some religious samples, which may limit its usefulness for some
purposes. However, for use in the general population, this criticism may not be
relevant and the scale has been found to be particularly useful for identifying
those experiencing spiritual distress or lack of wellbeing.
With only 10 items (five of which concern the presence of purpose and five of
which concern the search for purpose), the Meaning in Life Questionnaire (MLQ)
offers the most concise measure of spirituality. As it takes less than 10 minutes to
complete and is available free of charge for non-commercial use, the MLQ offers
distinct practical advantages over the other scales included here. The MLQ also
offers good content validity, as well as superior evidence for its scale structure
and reliability. As the MLQ has been developed very recently, the lack of evidence
regarding responsiveness and normative data is not a major concern.
45
Normative
data
***
Spiritual Wellbeing
Scale
20 items
(1015 mins)
Yes
Unknown
Yes
Yes
Permission
needed
Free for non-commercial use, may not be used in commercial research.
46
$20 US
Unknown
No fee
$40 US
Fee to use
scale
***
*
**
** (*)
** (*)
*** (*)

20 items
* (*)
***
** (*)
*
** (*)
**

Purpose In Life Test
(15 mins)
10 items
(510 mins)
****
****
***
*
*
***

***

48 items
(15 mins)
Items (time)
Practicalities
Meaning in Life
Questionnaire
**

Overall rating
**

**
***
***
*
*

Responsiveness
Construct
validity
Reliability
Content
validity
Structure
Life Attitude Profile

Revised
Scale
Appraisal of scales of spirituality
46
7.7
Social functioning

Numerous scales of social functioning exist and these differ substantially in terms
of their approach to measurement and length (see Section 7.7.2). The following
scales of social functioning are recommended for use:
Duke-UNC Functional Social Support Questionnaire (DUFSS) (Broadhead et
al, 1988) measures the amount of social support an individual believes they
receive from and give to others
Interpersonal Support Evaluation List (ISEL) (Cohen et al, 1985) measures
the perceived availability of social resources, in terms of obtaining material aid
(tangible), social support (appraisal), perceived positive comparison of self with
others (self-esteem), and perceived availability of other people one can do
things with (belonging)
Interpersonal Trust Questionnaire (ITQ) (Forbes and Roger, 1999) assesses
the ability to use social support by estimating the capacity to self-disclose and
express emotion in an adaptive manner in the context of social support
Interpersonal Trust Scale (ITS) (Rotter, 1967) measures the trust a person
has for a variety of individuals in society (such as parents, teachers, doctors,
politicians, friends, etc) and measures the general level of optimism the person
has for society
Inventory of Socially Supportive Behaviours (ISSB) (Barrera Jr et al, 1981)
measures how often assistance (e.g. sharing tasks, giving advice, teaching
skills, providing material aid) was received from others in the past four weeks
MOS Social Support Survey (MOS-SSS) (Sherbourne and Stewart, 1991)
measures perceived availability of functional social support (if needed),
in terms of received affection, emotional/informational support, tangible
(practical) support, and positive social interactions
Multidimensional Scale of Perceived Social Support (MSPSS) (Zimet et al,
1988) measures the perceived level of support an individual receives from
three sources: family, friends and a significant other (i.e. a partner or spouse)
Oslo 3-item Social Support Scale (03SS) (Dalgard, 1996) provides a brief
overall assessment of social support as a function of the number of people the
participant reports being close to, interest and concern shown by others, and
ease of obtaining social practical help
47
Perceived Social Support from Family and Friends (PSSFF) (Procidano and Heller,
1983) measures the extent to which an individual perceives that his/her needs for
support, information and feedback are fulfilled by friends (PSS-Fr) and by family (PSSFa)
Social Support Questionnaire (SSQ) (Sarason et al, 1983) measures the perceived
availability of social support, i.e. the number of people likely to provide support
(number) and satisfaction with the support received (satisfaction)
Social Support Questionnaire Brief (SSQ-B) (Sarason et al, 1987) a brief measure
of perceived availability of (Number) and Satisfaction with social support.
The scales can be categorised (broadly) into four approaches to the measurement
of social functioning:
Interpersonal trust Scales in this category (i.e. ITQ, ITS) focus on the capacity or
willingness of the individual to engage in social interaction, e.g. the expectancy
held by an individual or a group that the word, promise, verbal or written statement
of another individual or group can be relied upon (Rotter, 1967, pp 651) or the
ability to self-disclose and express emotion in an adaptive manner in the context of
social support (Forbes and Roger, 1999, pp168)
Perceived sources of social support Scales in this category include the MSPSS
and the PSSFF. Like the scales of functional social support (below), they focus
on perceptions of the availability of social support (rather than objective
assessment). Where they differ from functional measures is in their emphasis on
the importance of the source of social support, e.g. friends, family or significant
other. The importance of this focus is based on the notion that different
populations may rely on or benefit from friend or family support to different
extents (and at different times in their lives)
Functional social support Scales in this category include the DUFSS, ISEL, ISSB,
MOS-SSS and 03SS. They include subscales that measure the degree to which
interpersonal relationships serve particular functions (Sherbourne and Stewart,
1991, pp705) (e.g. emotion/information sharing for problem-solving, practical
assistance, companionship)
Social networks i.e. the number of people an individual can turn to for help
(sometimes referred to as objective measurement of social support). Scales
that include some objective measurement include: 03SS, SSQ, SSQ-B. The SSQ
and SSQ-B also include an assessment of the individuals satisfaction with the
support received. It should be noted, however, that most researchers have found
functional or perceived social support and satisfaction with social support to be
a better predictor of mental health than objectively measured social support
(Barrera Jr et al, 1981; Cohen et al, 1985; Sarason et al, 1987; Sarason et al, 1983;
Zimet et al, 1988).
48

Practitioners wishing to evaluate social functioning will need to bear in mind the
various approaches taken in each of the above measures.
Interpersonal trust
If researchers are looking for a scale to measure interpersonal trust i.e. the
extent to which an individual has the capacity or willingness to engage in their
community or society, then the ITQ is recommended because it has reasonable
psychometric properties and provides general measures of trust (labeled fear of
disclosure), the extent to which an individual turns to others when he/she has a
problem (social coping), and is prepared to express emotions (social intimacy).
On the other hand, the evidence for the ITS is less strong and it focuses on
trust in specific individuals in society e.g. parents, doctors, politicians. However,
at more than 40 items each, both are lengthy scales and researchers need to
consider the practicalities of using them.
Perceived sources of social support
If a scale is needed to measure perceived sources of social support, there is
greater evidence in support of the MSPSS. With 12 items, it is a relatively brief
measure, reported to take less than five minutes to complete. It includes an
assessment of support received from family, friends and significant others. The
PSS-FF measures the support received from family (20 items) and friends (20
items). Each scale can be used in isolation if the research and/or time available
warrant a specific focus.
Functional social support
If a scale to measure functional social support is required, two scales (i.e.
MOS-SSS and ISEL) are adequate for the task and indistinguishable in terms
of psychometric properties. Thus, decisions about which scale to use need
to be made on the basis of content/focus (including content validity) and
practicalities. The MOS-SSS appears to be marginally better than others in this
respect, largely because it has been used more widely and, thus, the evidence
for its psychometric properties is quite strong. With fewer than 20 items, it is
relatively short and is reported to take 57 minutes to complete. The ISEL is a
more lengthy measure (at 40 items), with 10 each measuring tangible support,
social support, self-esteem and belonging. Thus, the ISEL provides a wellbalanced scale and is arguably more carefully designed than the MOS-SSS.
49
Social networks
The SSQ and its short-form (SSQ-B) both provide objective measures of
the availability of social support (in terms of numbers of people) as well as
satisfaction with that support. Thus, if a scale is required that includes both
objective and subjective assessment of social support, then the long-form
can be recommended for a detailed assessment and the brief-form can be
recommended if respondent burden or time is an issue.
Finally, if a particularly brief measure of social functioning is required, the O3SS
includes just three items, which are designed to provide an objective measure
of the number of people the respondent feels close to, as well as interest and
concern shown by others and ease of obtaining practical help. Unfortunately,
the structure and reliability of the O3SS have not been well-documented despite
widespread use in several European countries. The O3SS is the only scale for
which normative data (i.e. scores from the general population) from several
countries are available. In future, the brevity of this scale and the availability of
normative data with may well be influential in decisions regarding which scale of
social functioning to choose.
50
** (*)
48 items
** (*)
*
** (*)
**
*
*
* (*)

****
***
***
*** (*)
*
*
** (*)

Perceived Social
Support from Family
and Friends
Social Support
Questionnaire
*** (*)
*
*
** (*)
****
** (*)

(10-12 mins)
12 items
(15-20 mins)
(<1 mins)
3 items
No
No
Yes
No
No
No
No
Yes
Yes
No
Unknown
Permission
needed
No fee
No fee
No fee
No fee
No Fee
No fee
No fee
No fee
No fee
No fee
Unknown
Fee to use
scale
Permission for commercial use
****

27 items
* (*)

Oslo 3-item Social

Support Scale
Social Support
Questionnaire - Brief
40 items
(Unknown)
**** (*)
** (*)
**** (*)
** (*)
*(*)
*
***

Multidimensional
Scale of Perceived
Social Support
*
* (*)
*
*** (*)
* (*)

12 items
**** (*)
**** (*)
** (*)
***
*
*
***

MOS Social Support

Survey
19 items
(57 mins)
**
*
** (*)
**
*
*
* (*)

Inventory of
Socially Supportive
Behaviours
(<5 mins)
40 items
(10 mins)
**
40 items
(1520mins)
** (*)
** (*)
*
*
* (*)
*
** (*)

*** (*)
(15 mins)
****
***
40 items
(Unknown)
8 items
(Unknown)
Items (time)
Interpersonal Trust
Scale
Interpersonal Trust
Questionnaire
***
** (*)
*** (*)
***
*
*
** (*)

Interpersonal
Support Evaluation
List
Normative
data
Overall rating Practicalitiesb
***
**
**

** (*)
*
*
**

Responsiveness
Construct
validity
Reliability
Content
validity
Structure
Duke-UNC Functional
Social Support
Scale
Appraisal of scales of social functioning
51
7.8

The validity of the construct of emotional intelligence (EI) is fiercely debated
and this, perhaps, is the most controversial of the eight components of mental
wellbeing described in this review. It is described by some as an ability (Salovey et
al, 2005; Schutte et al, 1998), while others view it as a personality trait (Furnham
& Petrides, 2003; Petrides & Furnham, 2000; Petrides and Furnham, 2001).
Several scales of emotional intelligence exist and the following are recommended
for use:
Emotional Intelligence Scale (EIS) (Schutte et al, 1998) draws on the ability
model, conceptualising emotional intelligence in terms of potential for
intellectual and emotional growth. Thus, the EIS assesses the ability to process
information about ones own and others emotions
Trait Emotional Intelligence Questionnaire (TEIQue) (Petrides and
Furnham, 2003) measures trait emotional intelligence (or emotional selfefficacy), defined as self-perceptions concerning ones general tendencies. It
includes 144 items measuring assertiveness, emotion perception, empathy,
impulsiveness, optimism, relationship skills, self-motivation, and stress
management
Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF)
(Petrides and Furnham, 2006) is a shorter (30-item) version of the TEIQue,
intended to measure global trait intelligence only, i.e. the TEIQue-SF produces
a scale score only rather than the numerous subscale scores of the parent
scale.
Despite the distinctions made between trait EI and ability EI, the scales
recommended here do not differ substantially in content. It is argued that ability
EI is measured more appropriately using a series of practical tests rather than by
self-report, in which the respondent can indicate only how they usually behave,
thus drawing on traits rather than actual ability (Davey, 2005).
52
Of the three recommended scales, each can be considered adequate for

the task of assessing emotional intelligence. However, none of the scales is
particularly strong in terms of psychometric properties and they cannot really be
distinguished in this way, except perhaps that the TEIQue-SF appears to be less
reliable than its long form or the EIS. Thus, decisions about which scale to use
need to be made on the basis of content/focus (including content validity) and
practicalities.
The EIS has arguably more evidence for its content and construct validity than the
TEIQue or its short-form. With only 33 items (compared with 144 for the TEIQue),
it is likely to take less time for respondents to complete and can offer a global
assessment of emotional intelligence.
If researchers are interested in assessing specific components of emotional
intelligence (e.g. assertiveness, social competence, emotion regulation), then
the TEIQue is the only scale (in this selection) that offers a multi-dimensional
assessment. However, at 144 items, and a reported completion time of 1520 minutes, it will not be suitable for those with low literacy skills or where
respondent burden is an issue.
53
*(*)

**

**
** (*)
** (*)
*
*
**

Normative
data
** (*)

**
*
**
*
*
* (*)

*
** (*)
* (*)
*
*

* (*)

Responsiveness
Construct
validity
Reliability
Structure
Content
validity
Overall rating
(510 mins)
30 items
114 items v1
153 items v1.5
(1520 mins)
33 items
(Unknown)
Items (time)
Practicalities
No fee
No feec
Nod
Permission needed if research not by University staff or students
No fee
Fee to use
scale
No
No
Permission
needed
Trait Emotional
Intelligence
Questionnaire
Short Form
Trait Emotional
Intelligence
Questionnaire
Emotional
Intelligence Scale
Scale
Appraisal of scales of emotional intelligence
54
54
Concluding comments
We hope that this guide to selecting scales for evaluating the mental health of
adults in the UK will encourage you to do so in your day-to-day work, whether in
a community project, an inpatient or outpatient clinic or a whole range of other
settings.
Although we have tried to make our explanations straightforward, we appreciate
that this can be a difficult area for practitioners who are not familiar with
research and/or the concept of mental wellbeing. Many of the issues covered
in this guide are discussed in greater detail in other guides in the series or
in the accompanying technical report: Review of Scales of Positive Mental
Health Validated for Use with Adults in the UK: Technical report (http://www.
healthscotland.com/understanding/population/mental-health-indicators aspx).
Our intention has been to create a guide that will be a useful resource, enabling
you to make informed decisions about which scales of mental wellbeing to use to
demonstrate:
the needs of the adults you are working with, and
the effectiveness of your activities, by collecting data about mental wellbeing
both before and after your service or other intervention has been provided.
55
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60
Appendix A Glossary
61
Affect
Emotional feeling or emotional experience.
Aspect of mental
wellbeing
The term used in the report to cover elements of

mental wellbeing; factors which influence mental
wellbeing and the consequences of mental wellbeing.
Categorical data
Data at the nominal level of measurement (e.g.

religious denomination, or yes or no responses).
Ceiling effect
Occurs where item wording restricts the possibility of

respondents indicating a higher level of response. If
there is a ceiling effect at baseline (i.e. the initial preintervention measurement) a scale may not be able to
detect improvements following an intervention.
Construct
A theoretical or hypothetical entity (e.g. optimism,

self-esteem, depression) that cannot be directly
observed.
Construct validity
An indication that there is evidence that supports

the existence of a hypothetical construct that a scale
purports to be measuring but which cannot be directly
observed.
Content validity
An indication of the degree to which a construct is

measured by items in a scale. It is a judgement by both
experts and members of the target population for
which a scale has been developed.
Continuous data
Data measured on scales where values change

smoothly rather than in steps, e.g. a visual analogue
scale (see box on p14).
Correlation
The relationship between two variables.
Eudaimonic
Eudaimonic components of mental wellbeing relate

to functioning and growth, at both a personal and a
social level (e.g. self-esteem, resilience).
Factor analysis
Factor analysis is a statistical method used to simplify

complex sets of data in order to identify ways in which
items cluster together.
Floor effect
Occurs where the wording of an item (and/or response

scale) restricts the possibility of respondents indicating
a lower level of response. Thus, if there is a floor effect
pre-intervention, the scale may not be able to detect
worsening in a variable following an intervention.
Appendices
Hedonic
Hedonic elements of mental wellbeing are

characterised by a sense of pleasure (e.g. life
satisfaction, positive affect).
Hypothesis
A prediction based on theory i.e. prediction of what

should or should not be the case if a theory is true.
Indicator
Something that helps us to understand where we are,

where we are going and how far we are from the goal.
Internal consistency
Internal consistency is an indicator of the reliability

or the homogeneity of items within the scale i.e. the
degree to which scores on each item correlate with the
scores on all the other items in its scale. The internal
consistency reliability is the average of the correlations
among all the scale items.
Item
A statement or question on a scale to which an

individual is invited to respond.
Linguistic validation
Linguistic validation is a multi-stage process to ensure

that the translated version of a scale is equivalent
to the original version, and is clear and easy to
understand. It includes forward translations into
the new target language, back translations into the
original language with comparison of the two versions,
and finally checking the translation is acceptable to
respondents.
Mental wellbeing
Mental wellbeing implies completeness and full

functioning. It is defined in this guide as covering both
hedonic and eudaimonic dimensions. It is more than
the absence of mental illness or pathology. The term
mental wellbeing is often used interchangeably with
positive mental health.
Normative data
Data that characterise what is usual (the norm) in a

defined population (e.g. general UK population), at a
specific point or period of time.
Objective
Not influenced by ones own perceptions or emotions

and thus the same data can be gathered by all
observers.
Psychometric
validation
A scale undergoes psychometric validation (or

evaluation) when respondent data are collected in one
or more studies, and analyses conducted to ascertain
that the scales reliability and validity are at acceptable
levels.
62
63
Qualitative data
Includes virtually any information that can be captured

that is not numerical in nature, e.g. interviews, focus
groups, observation, and written materials such as
diaries.
Quantitative data
Any data that is numerical in nature, typically collected

using a questionnaire/scale and analysed using
statistics.
Rating scale
Multiple (three or more) response options for an

item on a scale. A visual analogue scale would also
constitute a rating scale.
Reliability
Indicates whether a scale is measuring an attribute in a

way that is reproducible and consistent.
Response options
The way in which the response to an item is worded

and the number of options available.
Responsiveness
Indicates whether a scale can detect changes that

matter to respondents across time. The terms
responsiveness and sensitivity to change are often used
interchangeably.
Scale
A series of self-report questions, ratings or items used

to measure a concept. The response categories of the
items are all in the same format so that they can be
summed, and they may be weighted.
Self-report
Subjective judgements by participants as the basis

of responses to items (rather than assessments by
investigators).
Sensitivity (to change)
Indicates whether a scale can detect expected

differences (e.g. between groups, or changes postintervention). The terms responsiveness and sensitivity
to change are often used interchangeably, though
responsiveness is usually confined to changes within
participants over time.
Somatic
Refers to the body e.g. physical symptoms.
Structure
Structure can be determined by factor analysis, a

statistical procedure that shows whether items fit
or cluster together in the expected pattern. For
example, in a scale measuring wellbeing, whether
items measuring positive wellbeing cluster together
on a different factor from those measuring negative
wellbeing. If so, this would indicate two subscales: one
of positive and one of negative wellbeing.
Appendices
Subjective
Existing in ones own consciousness or mind and

therefore not perceived by other people.
Test-retest reliability
Indicates whether a scale yields similar results on two

or more administrations, assuming that there has been
no actual change in participants on the attribute being
measured during the intervening period.
Validity
The extent to which a scale accurately reflects the

concept that it is intended to measure.
Variable
A characteristic or factor that is liable to change or vary

between individuals (e.g. ethnicity) or within individuals
over time (e.g. age).
Visual analogue scale
A rating scale in the form of a single straight line,

usually 10 cm long, with descriptive anchors at each
end (e.g. very satisfied very dissatisfied). Participants
mark a cross on the line to indicate their response.
64
Appendix B Abbreviations of scale names
65
ABS
Affect Balance Scale
Affect-2
Affectometer 2
ASQ
Attributional Style Questionnaire
BCOPE
Brief COPE
BSES
Basic Self-Esteem Scale
COPE
COPE Scale
CSEI
Coopersmith Self-Esteem Inventory
CSQ
Coping Styles Questionnaire
DHS
DepressionHappiness Scale
D-T Scale
DelightedTerrible Scale
DUFFS
Duke-UNC Functional Social Support Questionnaire
EIS
Emotional Intelligence Scale (33-item)
FDC
Functional Dimensions of Coping Scale
GESS-R
Generalized Expectancy for Success Scale Revised
GQOL
Global Quality of Life Scale
GSE
General Self-Efficacy Scale
ISEL
Interpersonal Support Evaluation List
ISSB
Inventory of Socially Supportive Behaviors
ITQ
Interpersonal Trust Questionnaire
ITS
Interpersonal Trust Scale
LAP-R
Life Attitude Profile Revised
LOT
Life Orientation Test
LOT-R
Life Orientation Test Revised
MLQ
Meaning in Life Questionnaire
MOS-SSS
MOS Social Support Survey
MSPSS
Multidimensional Scale of Perceived Social Support
Appendices
O3SS
Oslo 3-item Social Support Scale
OHQ
Oxford Happiness Questionnaire
OHQ-SF
Oxford Happiness Questionnaire Short Form
PANAS
Positive And Negative Affect Schedule
PANEQ
Positive And Negative Expectancy Questionnaire
PGWBI
Psychological General Wellbeing Index
PIL Test
Purpose in Life Test
PSSFF
Perceived Social Support from Family and Friends
RSCQ
Robson Self Concept Questionnaire
RSES
Rosenberg Self-Esteem Scales
SDHS
Short DepressionHappiness Scale
SOC
Sense of Coherence Scale
SSQ
Social Support Questionnaire
SSQ-B
Social Support Questionnaire - Brief
SWB
Spiritual Wellbeing Scale
SWLS
Satisfaction With Life Scale
T(D)HS
Trait (Dispositional) Hope Scale
TEIQue
Trait Emotional Intelligence Questionnaire
TEIQue-SF
Trait Emotional Intelligence Questionnaire Short Form
VASES
Visual Analogue Self-Esteem Scale
WAYS
Ways of Coping
W-BQ12
Wellbeing Questionnaire 12
WHOQoL-BREF
World Health Organisation Quality of Life BREF
66
Appendix C How this review of scales was conducted

The purpose of this review was to inform decisions to be made by Health
Scotland regarding which scales are the most appropriate to capture data
either (a) in national surveys to inform the mental health indicator set, or (b) by
practitioners to assess the impact on mental health of local interventions.
A targeted, structured review of the published literature was conducted to
identify relevant scales for key aspects of mental wellbeing, and assess their
properties. The criteria for selection of scales were that they:
measure one or more key aspects of mental wellbeing (see Section 2)
focussed more on mental wellbeing than mental ill-health
are suitable for use with the general adult population
have been formally tested for use in the UK
do not require the user to undergo specialist training.
In addition, the team consulted with 18 specialists in the field of mental
wellbeing. Interviews included discussion of the selected aspects as well as
specialists views on various scales. Twenty-three experts and practitioners,
including five of the initial interviewees, later reviewed and commented on drafts
of the technical report.
Forty-nine scales were selected as suitable for inclusion in the review: emotional
wellbeing (9), life satisfaction (4, including one generic quality of life measure),
optimism and hope (5), self-esteem (5), resilience and coping (8), spirituality (4),
social functioning (11), and emotional intelligence (3).
For a full account of the review methods (including search terms, databases,
inclusion criteria) and details of the expert consultation (including interview
schedules), see Review of Scales of Positive Mental Health Validated for Use with
Adults in the UK: Technical report22.
22
67
Available from http://www.healthscotland.com/understanding/population/mental-health-indicators.aspx
Appendices
Appendix D Further reading

Selecting and using scales
Boynton PM (2005). The Research Companion: A Practical Guide for the Social
and Health Sciences. Psychology Press, Hove.
Gillham W (2000). Developing a Questionnaire. Continuum, London.
Loewenthal KM (2001). An Introduction to Psychological Tests and Scales.
Psychology Press, London.
Mental wellbeing
Carr A (2004). Positive Psychology: The Science of Happiness and Human
Strengths. Brunner-Routledge, New York (* see also selected chapters below).
Stewart-Brown SL (2002). Measuring the Parts Most Measures Do Not Reach: A
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Emotional Intelligence
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69
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Guide 5: Selecting scales to assess mental wellbeing in adults

Mental Health Improvement:

Guide 5: Selecting scales to

Published by Health Scotland

Mental Health Improvement: Evidence and Practice

Dr Elizabeth Austin, Department of

Prof Felicia Huppert, Department of

Dr Nick Baylis, Co-Director of the

Dr Corey Keyes, Department of

Dr Sandra Boersma, Faculty of Social

Amanda Knight, Centre for Applied

Dr Anne Stiggelbout, Leiden

Dr Ken Pakenham, School of

Dr Veronica Vigan, Ambulatory

Michael Rainsford, HSE Western

Prof Joar Vitterso, Dept of Psychology,

Prof Sarah Stewart-Brown, University

Available from http://www.healthscotland.com/understanding/population/mental-health-indicators.aspx

2 What is mental wellbeing?

3 Why use a scale?

4 How to select a scale

5 Some questions to ask before you select a scale

6 Measuring mental wellbeing

7 Scales of mental wellbeing

Appendix B Abbreviations of scale names

Appendix C How this review of scales was conducted

Appendix D Further reading

Guide 5: Selecting scales to assess mental wellbeing in adults

The Guides are available from http://www.healthscotland.com/mental-health-publications.aspx

Guide 5: Selecting scales to assess mental wellbeing in adults. How do we

Terms in bold appear in the glossary in Appendix A

Guide 5: Selecting scales to assess mental wellbeing in adults

The guides have been compiled as part of Health Scotlands work to

Strengthening evidence-based practice involves:

Guide 5: Selecting scales to assess mental wellbeing in adults

1.2 Who are the guides for?

report, available from http://www.healthscotland.com/understanding/population/mental-health-indicators.aspx.

1.4 What does this guide include?

Terms in bold are defined in the Glossary (see Appendix A)

with Adults in the UK: Technical report, available from: http://www.healthscotland.com/understanding/population/

Guide 5: Selecting scales to assess mental wellbeing in adults

The Evaluation Process

Using Evidence to inform

Getting Results: Analysis and

Designing and Implementing an Evaluation

Guide 5: Selecting scales to assess mental wellbeing in adults

What is mental wellbeing?

more than the absence of mental illness or pathology. It implies

What is mental wellbeing?

Working definition for this guide

More than the absence of psychological

This includes, but is

Overall assessment of ones life, or a comparison

Optimism and hope

Positive expectations of the future; a tendency

A belief or evaluation that one is a person

Resilience and coping

Resistance to mental illness in the face of

Guide 5: Selecting scales to assess mental wellbeing in adults