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Psychological General Wellbeing Index

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P 5152
Psychological General Well-Being
Index (PGWB)
Enzo Grossi1 and Angelo Compare2
1
Medical, Bracco, San Donato Milanese, Italy
2
Department of Human Sciences, University of
Bergamo, Bergamo, Italy
Synonyms
PGWB; PGWB-6 items; PGWBI; Psychological
General Well-Being (22 items) Index; Psycho-
logical General Well-Being (6 items) Index;
Short Form PGWBI
Definition
The Psychological General Well-Being Index
(PGWBI) is a measure of the level of subjective
psychological well-being. In detail, it assesses
self-representations of intrapersonal affective or
emotional states reflecting a sense of subjective
well-being or distress and thus captures what we
could call a subjective perception of well-being.
Consisting of 22 standardized items (6 items for
the short form), the tool produces a single mea-
sure of psychological well-being. The full mea-
sure also provides subscales to assess the
following domains: anxiety, depression, positive
well-being, self-control, general health, and
vitality.
Description
The original PGWBI consists of 22 self-
administered items, rated on a 6-point scale,
which assess the psychological and general
well-being of respondents in six HRQoL
domains: ▶ anxiety, depression, positive well-
being, self-control, general health, and vitality.
Each item has six possible scores (from 0 to 5),
referring to the last 4 weeks of the subject’s
Psychological General Well-Being Index (PGWB)
lifetime. Each domain is defined by a minimum
of 3 to a maximum of 5 items. The scores for all
domains can be summarized into a global sum-
mary score, which reaches a theoretical maxi-
mum of 110 points, representing the best
achievable level of well-being (Dupuy, 1990),
a sort of “state of bliss.” The short form of the
PGWBI (Grossi et al., 2006), subsequently devel-
oped, consists of a subset of six items that gener-
ally explain more than 92 % of the global
variance of the full questionnaire.
Brief History of PGWBI
In the 1960s, Harold Dupuy, psychologist at the
National Center for Health Statistics, developed
his Psychological General Well-Being (PGWB)
Schedule, a questionnaire of 68 items to measure
the psychological distress of the American popu-
lation. In those years, the National Institutes of
Health (NIH), which were planning the first
large-scale survey of the physical health of the
American population known as the National
Health and Nutrition Examination Survey
(NHANES), felt the need for a meter that was
simple but valid and reliable for the assessment of
the physical and mental health and welfare of the
population. It should, however, be noted that the
PGWB was originally developed to measure
emotional distress “physiologically,” unlike
many tools designed to investigate the psycho-
logical effects of specific mental disorders. As
a result, there was a drastic reduction in the num-
ber of items to ensure applicability and accept-
ability of the questionnaire on a large scale, and
only 18 items were chosen to be effectively used
in the NHANES in 1971. Subsequently, the col-
laboration between Harold Dupuy and the RAND
Corporation led to a revision, adaptation, and
validation of the final PGWB Schedule and its
transformation to its final form, the PGWB Index.
The original version of 18 items of the schedule
was increased to 22 items, and response catego-
ries for all items were simplified and standardized
according to a ▶ Likert scale with 6 points, with
values ranging between “0” and “5.” About 10
years later, the instrument was also introduced in
Europe. The PGWBI was adapted in many lan-
guages and cross-culturally validated for the use
Psychological General Well-Being Index (PGWB) 5153 P
Psychological General Well-Being Index (PGWB), response, using a simple form that is easy to
Table 1 The six domains of the PGWBI understand.
Domains No. Items The PGWBI also allows the calculation of an
Anxiety 5 overall index, which can reach a maximum of 110
Depression 3 points, i.e., the sum of unweighted responses to
Positive well-being 4 individual items of all domains.
Self-control 3 The main strengths of the PGWB question-
General health 3 naire can be summarized as follows:
Vitality 4 • The instrument is capable of measuring the
balance between negative and positive affec-
tive states.
• It avoids references to physical symptoms of
in several countries under the coordination of the emotional distress.
MAPI Research Institute. As a result, different • It is suitable as a generic tool to measure the
language versions of the PGWBI are available on psychological distress caused by different
the MAPI website (www.mapi-research-inst. diseases.
com). • It is not only oriented to discriminate psychi-
atric cases.
Structural Characteristics of the • It correlates well with other instruments for
Questionnaire PGWBI the mental sphere.
The questionnaire PGWB consists of 22 items, • Although not particularly short, these are 22
investigating six different domains: anxiety, questions with a rather complex pattern of
depression, positive and well-being, self-control, responses, which can be used in combination
general health, and vitality (Table 1). with modern short and generic tools, such as
With regard to structural and functional the SF-12.
aspects of a questionnaire, the PGWBI has sev- The comparison between the PGWBI and the
eral interesting characteristics: ▶ SF-36 allows us to appreciate the degree of
• It examines psychological well-being across complementarity between the two scales, which
six domains. partially overlap in the aspects of general health
• Different types of presentation of items, such and vitality (Fig. 1). P
as statements or questions, are used (16 ques-
tions, 6 statements). Psychometric Features of Long Version
• Response options differ with regard to their PGWBI
scoring direction (from positive to negative A number of studies have conducted cross-
sequence, from first to last response, or vice sectional and longitudinal psychometric valida-
versa). tion research in different contexts (communities,
• Several types of frequency–intensity matrices institutions, hospitals) and correlated the PGWBI
are used in the responses (response options with a large number of other indices of physical
were constructed to describe the frequency and mental health (e.g., Boman, Bryman,
and/or intensity of the phenomenon under Halling, & Moller, 2001; Havelund et al., 1999;
investigation). Omvik et al., 1993; Wiklund, & Karlberg, 1991).
The items belonging to the same domain have The RAND Health Insurance Survey offers the
a balanced alternation of the orientation of the US standard of reference: 71 % of adults are
responses of both the frequency-intensity pattern placed in the category of scores of “being posi-
within each domain so as to render a repetition by tive” (73–110), 15.5 % show moderate psycho-
the subject in the response to the 6-point scale logical distress (scores between 61 and 72), while
virtually impossible. In this way, the respondent 13.5 % are classified as experiencing severe psy-
is forced to read the contents of both item and chological distress (scores between 0 and 60).
P 5154 Psychological General Well-Being Index (PGWB)

Psychological General
Well-Being Index PGWB and SF-36
(PGWB), comparison
Fig. 1 Comparison of the
PGWBI and the SF-36
PGWB-22 SF-36

• Physical activity
• Role and physicalhealth
• Positive well-being • General Health • Pain
• Self control • Vitality • Socialactivties
• Role and emotional
status
• Anxiety
• Depression • Mental health

The mean PGWBI total score reported in studies Psychological General Well-Being Index (PGWB),
with US population samples ranged between 80 Table 2 Intercorrelations of the PGWBI with measures
assessing mental disorders
and 81 points.
Scales Correlation with PGWBI
Internal Consistency Beck depression inventory 0.68
In all studies, the internal consistency of the Zung depression inventory 0.75
Minnesota multiphasic 0.55
American PGWBI was high, with ▶ Cronbach’s
personality inventory
alpha values ranging between 0.90 and 0.94. The
Personal feelings depression 0.78
intrasubjective reproducibility expressed by test- inventory
retest coefficients ranged around a median value Hopkins symptom checklist 0.77
of 0.80.

Validity
The validity of the PGWBI was evaluated in
a large number of studies. In the 1971 NHANES,
the PGWB Schedule was significantly correlated
with the items that assessed the needs and utili-
zation of mental health services, with the
sociodemographic variables and the items of
medical history. Correlations of the PGWB
index with some mental disorders as assessed
with standardized instruments are shown in
Table 2.
Short Version of PGWBI
The six-item short version of the PGWBI was
developed in 2000 as part of the MiOS project,
a multidisciplinary initiative to study in depth
different kinds of subjective outcome measures
for health assessment, on a representative sample
of 1,129 Italian citizens above 15 years of age.
The main objective of this study was to reduce the
number of items of the original 22-item PGWBI
while keeping adequate validity of the instru-
ment. The purpose of the item reduction was to
increase the compliance of the questionnaire so
that it could be administered in a relatively short
time and by phone. Based on these data, the 22
items of the questionnaire were analyzed in
a linear multiple regression model with the objec-
tive to find the combination of items most rele-
vant for the description of the summary measure.
The items were identified by a stepwise selection
starting with the item that would explain alone
the highest degree of variance of the original
PGWBI and in combination at least 90 % of
the variance. In the model, the items were
matched to find out which of their combination
would best reproduce the average score for the
Psychological General Well-Being Index (PGWB) 5155 P
Psychological General Well-Being Index (PGWB), summary measure. The most predictive items
Table 3 Items of the PGWB-S were selected to be part of the new structure of
Position in the questionnaire PGWB-S (Table 3).
Items the 22 items
PGWB-S Dimension questionnaire Content
Psychometric Features
Item 1 Anxiety 5 Have you been
bothered by
Once the structure of the PGWB-S had been iden-
nervousness or tified, it was administered in three different settings
your “nerves” in Italy for the purpose of its validation. All studies
during the past took place during the year 2004, and their charac-
month?
teristics are summarized in Table 4. The accept-
Item 2 Vitality 6 How much
energy, pep, or ability was evaluated using patients’ response
vitality did you rates and indicators of questionnaire completeness
have or feel during at item and summary level. Completeness was
the past month? defined in terms of the proportion of items for
Item 3 Depressed 7 I felt downhearted
which patients failed to provide an answer (i.e.,
mood and blue during
the past month completeness ¼ proportion of missing values).
Item 4 Self- 18 I was emotionally
control stable and sure of Validity and Reliability
myself during the Through a stepwise selection process, six items
past month
were identified to predict 90 % variance of the
Item 5 Positive 20 I felt cheerful,
well-being lighthearted
summary measure when the original question-
during the past naire was applied to an Italian population. Item
month 20 alone reached 60 %, whereas items 7, 21, 5, 6,
Item 6 Vitality 21 I felt tired, worn 18, and 2 added an additional 15 %, 8 %, 3 %,
out, used up, or 3 %, and 2 %, respectively. These items were
exhausted during
the past month confirmed to become part of the new six-item
structure of the questionnaire. The internal

P
Psychological General Well-Being Index (PGWB), Table 4 Summary of studies on the PGWBI and PGWB-S
Development
Study study Study 1 Study 2 Study 3
Organization DOXA DOXA Catholic University University Hospital SACCO
Location Milan Milan Milan Milan
Year 2000 2004 2004 2004
# cases 1129 1015 400 28
Questionnaire PGWBI PGWB-S PGWBI, PGWB-S PGWBI, PGWB-S
administered
Sampling Random Random Random Random
method
Population General General University students, in second year In-patients with diagnosis of chronic
population population of Psychology and others inflammatory bowel disease
Mode of Person-to- Person-to- Self-administered** Self-administered**
administration person* person*
Male % 48.1 49.5 11.4 39.3
Age, mean yrs 47.4 51.3 21.5 50.1
*Self-administration in a structured interview
**Self-administration of both questionnaires one hour apart (cross-over design)
P 5156 Psychological Pain

consistency measuring the extent to which the

items are interrelated, expressed by the coeffi- Psychological Pain
cient Cronbach’s alpha, was calculated for each
study. The smallest value was 0.80 and the ▶ Psychological Distress and Chronic
highest 0.92, indicating that the summary mea- Obstructive Pulmonary Disease (COPD)
sure showed good internal reliability. The coeffi-
cients Cronbach’s alpha were all above 0.80
showing acceptable reliability, also when com-
pared to the one (0.94) of the original instrument Psychological Quality of Life Among
in full length (22 items). Breast Cancer Patients

Helena Moreira
Cross-References
Faculty of Psychology and Educational Sciences,
University of Coimbra, Coimbra, Portugal
▶ Anxiety
▶ Cronbach’s Alpha
▶ Distress
▶ Internal Consistency
Synonyms
▶ Likert Scale
▶ Quality of Life Biomedical model of qol and breast cancer;
Biopsychosocial model of quality of life
▶ SF-36
▶ Test-Retest Reliability
Definition
References
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