Arthritis & Rheumatism (Arthritis Care & Research)

Vol. 49, No. 5S, October 15, 2003, pp S165–S174

DOI 10.1002/art.11408
© 2003, American College of Rheumatology
MEASURES OF PSYCHOLOGICAL STATUS AND WELL-BEING

Other Measures of Psychological Well-Being

The Affect Balance Scale (ABS), General Health Questionnaire (GHQ-12), Life
Satisfaction Index-A (LSI-A), Rosenberg Self-Esteem Scale, Satisfaction with Life
Scale (SWLS), and State-Trait Anxiety Index (STAI)

Kathleen M. Schiaffino

AFFECT BALANCE SCALE (ABS) Other uses. None.

General Description WHO ICF Components. Not applicable.
Purpose. To assess positive and negative affect
as indicators of life satisfaction and/or well-being
(1,2). Administration
Method. Self-report.
Content. Five positive affect questions and 5
negative affect questions. Training. None.

Developer/contact information. Norman M. Time to administer/complete. Brief.

Bradburn. Studies conducted by the National
Organization for Research (NORC) at the University
of Chicago in the 1960s resulted in the publication
The Structure of Psychological Well-Being by
Bradburn (1), which contains a description of the
Affect Balance Scale. Available at
http://cloud9.norc.uchicago.edu.
Versions. The ABS has been translated into
many languages, including Cantonese, Vietnamese,
and Laotian; cultural equivalence was found (3).
Equipment needed. None.
Cost/availability. Not copyrighted. The measure
is available at http://cloud9.norc.uchicagoedu/dlib/
spwb/summary.htm. Full-text chapters of The
Structure of Psychological Well-Being (1) are
available as PDF files at http://cloud9.norc.uchicago.
edu/dlib/spwb/index.htm. The ABS is discussed at
length in Chapter 4.

Number of items in scale. There are 10 items. Scoring

Subscales. Positive affect, Negative Affect, and
Affect Balance, which is the difference between
Positive Affect and Negative Affect and is
sometimes used as an indicator of overall
happiness.
Populations. Developmental/target. General
Population.
Kathleen M. Schiaffino, PhD: Fordham University, Bronx
Fordham University, Bronx, New York.
Address correspondence to Kathleen Schiaffino, PhD,
Bronx Fordham University, Bronx, NY 10458. E-mail:
schiaffino@fordham.edu.
Submitted for publication April 23, 2003; accepted April
24, 2003.
Responses. Scale. Yes or no.
Score range. The range is 0 –5 for positive and
for negative affect.
Interpretation of scores. Higher scores indicate
higher positive and higher negative affect.
Method of scoring. Positive and negative
questions summed separately, with a score of 1 for
a “yes” response and a score of 0 for a “no”
response. Affect Balance is computed as the
difference between Positive Affect and Negative
Affect.
Time to score. Brief.
Training to score. None.

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S166
Training to interpret. None.
Norms available. Typical responses for specific
populations can be drawn from existing literature
(3–10).
Psychometric Information
Reliability. Generally strong reliability. Bradburn
(1) reported test-retest reliability on a sample of
200 over a 3-day period for Positive Affect,
Negative Affect, and Affect Balance to be 0.83,
0.81. and 0.76, respectively. Internal consistency
reliabilities for Positive Affect range between 0.55
and 0.73; for Negative Affect scores range between
0.61 and 0.73.
Bassett et al (4) evaluated the agreement
between self-report and rater versions of 4 mental
health measures, including ABS, in a sample of
538 individuals. Results indicated a strong
association. This association was found even for
respondents classified as depressed or cognitively
impaired. Although there was evidence of rater
bias, with raters underrating affective status and
overrating cognitive status, the magnitude of the
bias proved small.
Validity. Bradburn (1) showed that positive
affect correlated with single-item indicators of
happiness from 0.34 to 0.38 and with
corresponding values for negative affect at ⫺0.33
and ⫺0.38. He hypothesized that positive and
negative affect were distinct dimensions; this was
supported by small associations between the scales
(0.04 – 0.15). Factor analyses have also indicated
distinct orthogonal dimensions
Others have also found positive and negative
affect to be orthogonal dimensions, with negligible
or weak negative associations, supporting the two-
factor theory which “maintains that positive and
negative affect represent statistically independent
dimensions of subjective well-being, with positive
affect more related to situational factors and
negative affect more related to dispositional
factors” (5).
Sensitivity/responsiveness to change. For people
at all ages, negative affect appears to decrease over
time. “Looking at all three age groups together,
negative affect decreased steadily until around age
60, at which time the rate slowed significantly.
Unlike the hypothesized upturn in very old age,
the decline continued even in very old age” (6).
Maitland et al (7) have found stability in positive
and negative affect factors over 3 years in a
Victoria sample aged 54 – 87. Factor loadings
remained largely invariant over time. Some
differences in sex loadings emerged.
Schiaffino
Comments and Critique
A model of subjective well-being has been
proposed and tested by Liang which integrates the
ABS and the Life Satisfaction Index–Version A
(LSIA). The proposed model employs 8 ABS items
and 7 LSIA items and is presumed to measure 4
dimensions: congruence, happiness, positive affect,
and negative affect. Liang (8) successfully
replicated this model across 4 randomly divided
subsamples; Lawrence and Liang (9) reported
further evidence for the stability of the model
structure across age and sex, but noted some
variability when comparing African American and
White samples and conclude that the meaning of
subjective well-being may differ for these two
groups.
Evidence seems to suggest that positive and
negative affect are independent of each other and
that they have different etiologies with positive
affect being influenced by environmental factors,
and negative affect deriving more from stable,
perhaps genetic, factors. “There is a heritable basis
of negative affect, perhaps stemming from
genetically influenced personality characteristics.
Situational variables that family members share are
of greater importance for explaining family
resemblance for positive affect” (5). This emphasis
on the independence of the 2 factors makes the use
of a difference score to obtain an indication of
“Affect Balance” conceptually problematic.
Moreover, fundamental weaknesses in the ABS
have been argued, including the fact that affect
items more strongly reflect arousal content; items
include non-affect content; intensity/frequency of
affect is not assessed; response bias may lead to
ceiling or floor effects (10).
References
1. (Original) Bradburn NM. The structure of
psychological well-being. Chicago: Aldine; 1969.
2. Bradburn NM, Caplovitz D. Reports on happiness.
Chicago: Aldine; 1965.
3. Devins GM, Beiser M, Dion R. Cross-cultural
measurements of psychological well-being: the
psychometric equivalence of Cantonese, Vietnamese,
and Laotian translations of the Affect Balance Scale.
Am J Public Health 1997;87:794 –9.
4. Bassett SS, Magaziner J, Hebel JR. Reliability of
proxy response on mental health indices for aged,
community-dwelling women. Psychol Aging 1990;5:
127–32.
5. Baker LA, Cesa IL, Gatz M, Mellins C. Genetic and
environmental influences on positive and negative
affect: support for a two-factor theory. Psychol Aging
1992;7:158 – 63.
6. Charles ST, Reynolds CA, Gatz M. Age-related
differences and change in positive and negative
Psychological Well-Being
affect over 23 years. J Pers Soc Psychol 2001;80:136 –
51.
7. Maitland SB, Dixon RA, Hultsch DF, Hertzog D.
Well-being as a moving target: measurement
equivalence of the Bradburn Affect Balance Scale. J
Gerontol 2001;56:P69 –77.
8. Liang J. A structural integration of the Affect Balance
Scale and the Life Satisfaction Index A. J Gerontol
1985;40:552– 61.
9. Lawrence RH, Liang J. Structural integration of the
Affect Balance Scale and the Life Satisfaction Index
A: race, sex, and age differences. Psychol Aging
1988;3:375– 84.
10. Diener E. Subjective well-being. Psychol Bull 1984;
95:542–75.
Additional Reference
McDowell I, Newell C. Measuring health: a guide to
rating scales and questionnaires, Second Edition.
Oxford (UK): Oxford University Press; 1996. pp.
191–194.
GENERAL HEALTH QUESTIONNAIRE
(GHQ-12)
General Description
Purpose. To screen for minor psychiatric
(nonpsychotic) disorders in community and
nonpsychiatric clinical settings (1).
Content. The items of the GHQ-12 were selected
from the pool of 60 items comprising the original
questionnaire, GHQ-60. Items focus on the inability
to carry out normal activities and the appearance
of new and distressing symptoms, i.e., depression,
anxiety, observable behaviors, and
hypochondriasis.
Developer/contact information. D. P. Goldberg,
University of Manchester, UK. Copies of the GHQ-
12 can be obtained from National Foundation for
Educational Research–Nelson Publishing Company
Ltd., Darville House, Oxford Road East, Windsor,
Berkshire SL4 1DF, UK or
http://www.nfer-nelson.co.uk/default.asp.
Versions. GHQ-12, GHQ-20, GHQ-28, GHQ-30,
and GHQ-60.
Number of items in scale. There are 12, 20, 28,
30, and 60 items, respectively. Items for the
various versions can be found in McDowell and
Newell (2).
Subscales. Studies have suggested the presence
of 2 factors: depression and social dysfunction (3)
and 3 factors: self-esteem, stress, and successful
S167
coping (4) in the GHQ-12. Factor structures vary in
the larger versions.
Populations. Developmental/target. Community
and non-psychiatric clinical samples.
Other uses. None.
WHO ICF Components. Not applicable.
Administration
Method. Self-report.
Training. None.
Time to administer/complete. Brief.
Equipment needed. None.
Cost/availability. Packets of 100 can be obtained
via the website indicated above at approximately
£30.50 (English pounds) plus tax.
Scoring
Responses. Scale GHQ-12. Items ask whether a
particular symptom or behavior has been recently
experienced. Responses are indicated using one of
two 4-point scales depending on the nature of the
question: either “Better than usual; Same as usual;
Worse than usual; Much worse than usual” OR
“Not at all; No more than usual; Rather more than
usual; or Much more than usual.”
Score range. The range is 0 – 4 for each item.
There are 2 different scoring options, described
below.
Interpretation of scores. Using receiver-
operating characteristic analysis, threshold cutting
scores of “1 or 2” and “3 or 4” have been identified
in various studies. A cut-off of 1 or 2, indicating a
positive response to 1 or 2 items, is most
commonly used. The higher cut-off has been
recommended for elderly respondents (5).
Method of scoring. Can be scored in 2 ways: the
binary or Likert method. The binary method
identifies individuals reporting sufficient
psychological distress to be probable cases of
minor psychiatric disorder. The first 2-response
categories are scored as 0 and the latter 2 as 1. The
possible scale score is 0 –12. The Likert method
assigns a value of 0, 1, 2, and 3 to each response
category, and takes the mean of all 12 scores.
Time to score. Brief.
S168
Training to score. Brief.
Training to interpre. Minimal.
Norms available. Typical responses for specific
populations can be drawn from existing literature
(2–10).
Psychometric Information
Reliability. The GHQ-12 has alpha coefficients
for the 12 items at mid to high 0.80s. Test-retest
correlations at 2 weeks have been reported at 0.73
(6) and at 6 months between 0.75 and 0.90 (2).
Validity. Correlates highly with the Symptom
Check-List (SCL-90; [7]) and other mental health
measures (such as the Brief Screen for Depression)
and least with a Muscle Fatigue scale, providing
evidence of discriminant validity (6).
Reliable and valid for identifying mental
disorders when used by primary care physicians in
Germany (7) and when used with elderly subjects,
with comparable performance across age groups
and in the presence of mild intellectual
impairment (5).
Validity not affected by variations in factor
structure (3), which may be at least partially
attributable to the reporting of GHQ-12 scores
which have been extracted from one of the larger
versions (embedded) rather than administered as a
distinct scale (8). Variations in factor structure may
also be attributable to cultural differences (9).
Sensitivity/responsiveness to change. The GHQ-
12 has been consistent and reliable with samples
with relatively long (i.e., yearly) intervals between
applications (10).
Comments and Critique
One limitation is the possible insensitivity of
the GHQ-12 in identifying depressive disorder (6).
In addition, the factor structure appears to be
unstable both within and across cultures. Finally,
most evidence for discriminant validity for
psychological disorders is based upon evidence
from clinical interviews and not from standardized
measures.
References
1. (Original) Goldberg DP. The detection of psychiatric
illness by questionnaire (Maudsley Monograph No.
21).Oxford (UK): Oxford University Press; 1972.
2. McDowell I, Newell C. Measuring health: a guide to
rating scales and questionnaires, Second Edition.
Oxford (UK): Oxford University Press; 1996, p. 225–
37.
Schiaffino
3. Werneke U, Goldberg DP, Yalcin I, Ustun BT. The
stability of the factor structure of the General Health
Questionnaire. Psychol Med 2000;30:823–9.
4. Martin AJ. Assessing the multidimensionality of the
12-item General Health Questionnaire. Psychol Rep
1999;84:927–35.
5. Papassotiropoulos A, Heun R, Maier W. Age and
cognitive impairment influence the performance of
the General Health Questionnaire. Compr Psychiatry
1997;38:335– 40.
6. Hardy GE, Shapiro DA, Haynes CE, Rick, JE.
Validation of the General Health Questionnaire-12
using a sample of employees from England’s Health
Care Services. Psychol Assess 1999;11:159 – 65.
7. Schmitz N, Kruse J, Heckrath C, Alberti L, Tress W.
Diagnosing mental disorders in primary care: The
General Health Questionnaire (GHQ) and the
Symptom Checklist (SCL-90-R) as screening
instruments. Soc Psychiatry Psychiatr Epidemiol
1999;34:360 – 6.
8. Van Hemert AM, den Heijer M, Vorstenbosch M,
Bolk JH. Detecting psychiatric disorders in medical
practice using the General Health Questionnaire:
why do cut-off scores vary? Psychol Med 1995;25:
165–70.
9. Aderibigbe YA, Riley W, Lewin T, Gureje O. Factor
structure of the 28-item General Health
Questionnaire in a sample of antenatal women. Int
J Psychiatry Med 1996;26:263–9.
10. Pevalin DJ. Multiple applications of the GHQ-12 in a
general population sample: An investigation of long-
term retest effects. Soc Psychiatry Psychiatr
Epidemiol 2000;35:508 –12.
LIFE SATISFACTION INDEX A (LSI-A)
General Description
Purpose. To assess life satisfaction in older
adults.
Content. Items assess 5 components: zest (versus
apathy), resolution and fortitude, congruence
between desired and achieved goals, positive self-
concept, and mood tone.
Developer/contact information. Neugarten BI,
Havighurst RJ, Tobin SS. The measurement of life
satisfaction. (1). Available at www.medal.org.
Versions. Life Satisfaction Index–A and Life
Satisfaction Index–B. The most commonly used
measure is Life Satisfaction Index–A (LSI-A) that
will be described here. Various translations exist.
Number of items in scale. There are 20 items.
Subscales. None.
Populations. Developmental/target. Older adults.
Psychological Well-Being
Other uses. None.
WHO ICF Components. Not applicable.
Administration
Method. Self-report.
Training. None.
Time to administer/complete. Brief.
Equipment needed. None.
Cost/availability. No cost; not copyrighted.
Scoring
Responses. Scale. There are 3 responses:
“agree,” “disagree,” or “I don’t know.”
Score range. Range is 0 – 40.
Interpretation of scores. Higher scores indicate
greater life satisfaction.
Method of scoring. For positively-worded items,
“Agree” responses are scored 2 points; for
negatively-worded items “Disagree” responses are
scored 2 points. “I don’t know” responses are
scored 1 point. Total scored by summing all points
for the 20 statements.
Time to score. Brief.
Training to score. Minimal.
Training to interpret. Minimal.
Norms available. Typical responses for specific
populations can be drawn from existing literature
(2–7). McDowell and Newell (2) report evidence
for consistent means scores across samples.
Psychometric Information
Reliability. Wallace and Wheeler (3) reviewed
157 journal articles for reliability information
resulting in a review of 34 samples. In this review,
an average reliability of 0.79 was found.
Correlations suggested that LSI-A reliability was
unrelated to sample characteristics such as sample
size, age and sex. “No significant differences in
score reliability were found by language of
administration or sample type. These analyses
provide evidence for adequate reliability of LSI
scores across a variety of sample characteristics. . .”
(3).
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Validity. LSI-A correlated 0.39 with clinical
ratings using the LSR (Life Satisfaction Ratings),
which uses an interview to evaluate the 5
hypothesized components of life satisfaction (1).
The following attitudes have been found to be
associated with life satisfaction: 1) zest for life as
opposed to apathy; 2) resolution and fortitude as
opposed to resignation; 3) congruence between
desired and achieved goals; 4) high physical
psychological and social self-concept; 5) happy
optimistic mood tone.
Sensitivity/responsiveness to change. No
reported information.
Comments and Critique
McDowell and Newell (2) confirmed the
stability of the factor structure, but McCulloch (4)
found the factor structure to be affected by sex and
race. There is a need for conceptual clarity of what
is meant by life satisfaction, morale, and other
terms related to subjective well-being (5).
A model of subjective well-being has been
proposed and tested by Liang that integrates the
Affect Balance Scale (ABS) and the LSIA. The
proposed model employs 8 ABS items and 7 LSIA
items and is presumed to measure 4 dimensions:
congruence, happiness, positive affect, and
negative affect. Liang (6) successfully replicated
this model across four randomly divided
subsamples; Lawrence and Liang (7) reported
further evidence for the stability of the model
structure across age and sex, but note some
variability when comparing African American and
White samples and conclude that the meaning of
subjective well-being may differ for these 2 groups.
References
1. (Original) Neugarten BI, Havighurst RJ, Tobin SS. The
measurement of life satisfaction. J Gerontol 1961;16:
134 – 43.
2. McDowell I, Newell C. Measuring health: a guide to
rating scales and questionnaires, Second Edition.
Oxford (UK): Oxford University Press; 1996. p. 198 –
203.
3. Wallace KA, Wheeler AJ. Reliability generalization of
the life satisfaction index. Educ psychol meas. 2002;
62:674 – 84
4. McCulloch BJ. Gender and race: an interaction
affecting the replicability of well-being across groups.
Women Health 1992;19:65– 89.
5. Thomas LE, Chambers KO. Phenomenology of life
satisfaction among elderly men quantitative and
qualitative views. Psychol Aging 1989;4:284 –289
6. Liang, J. A structural integration of the Affect Balance
Scale and the Life Satisfaction Index A. J Gerontol
1985;40:552– 61.
S170
7. Lawrence RH, Liang J. Structural integration of the
Affect Balance Scale and the Life Satisfaction Index
A: race, sex, and age differences. Psychol Aging 1988;
3:375– 84.
Additional References
Adams DL. Analysis of a life satisfaction index. J
Gerontol 1969;24:470 – 4.
Fountoulakis K, Iakovides B, Iakovides A, Christofides
A, Ierodiakonou C. The validation of the life
satisfaction index (LSI) in the Greek population.
Psychiatriki. 1997;8:292–304
Maddox G L, Wiley J. Scope, concepts, and methods in
the study of aging. In: Binstock R, Shanas E,
editors. Handbook of aging and the social sciences.
New York: Van Nostrand Reinhold; 1976. p. 3–34.
Sauer W J, Warland R. Morale and life satisfaction. In:
Mangen DA, Peterson WA, editors. Research
instruments in social gerontology: clinical and
social psychology. Minneapolis: University of
Minnesota Press; 1982. p. 195–240.
Wood V, Wylie ML, Sheafor B. An analysis of a short
self-report measure of life satisfaction: correlation
with rater judgments. J Gerontol 1969;24:465–9.
ROSENBERG SELF-ESTEEM SCALE
General Description
Purpose. To assess self-esteem, defined as self-
acceptance or a positive or negative orientation
toward self (1).
Content. Ten items reflecting thoughts and
feelings about oneself as an object.
Developer/contact information. Morris
Rosenberg. Not copyrighted. Information available
at www.bsos.umd.edu/socy/grad/rosenberg.doc.
Versions. None The scale has been translated
into a variety of languages.
Number of items in scale. There are 10 items.
Subscales. None. Some studies have identified a
2-factor structure (self-confidence and self-
deprecation) although it is widely argued that
these factors are an artifactual separation of
positive and negative items (2).
Populations developmental/target. Originally
developed for adolescent samples.
Other uses. Has been used with the full range of
adolescent and adult populations.
WHO ICF Components. Not applicable.
Schiaffino
Administration
Method. Self-report.
Training. None.
Time to administer/complete. Brief.
Equipment needed. None.
Cost/availability. No cost. See contact
information.
Scoring
Responses. Scale. The scale ranges from
“Strongly agree” to “strongly disagree.”
Score range. Items score from 0 to 3; scale
range ⫽ 0 to 30.
Interpretation of scores. Higher scores indicate
higher self-esteem.
Method of scoring. For items 1, 2, 4, 6, 7
“strongly agree” ⫽ 3 and “strongly disagree” ⫽ 0.
For items 3, 5, 8, 9, 10 a “strongly agree” ⫽ 0 and
“strongly disagree” ⫽ 3.
Time to score. Brief.
Training to score. Brief.
Training to interpret. Brief.
Norms available. It is the most widely used
global self-esteem measure available. Normative
information best obtained by reviewing previous
research uses with comparable populations.
Psychometric Information
Reliability. Test-retest correlations range from
0.82 to 0.88; internal consistency reliabilities tend
to range from 0.77 to 0.88 (3). Rosenberg reported a
test-retest coefficient of 0.92 and an alpha
coefficient of 0.72 (1).
Validity. Significant correlations between self-
esteem and clinical ratings of depression. The
Rosenberg Self-Esteem Scale is the standard against
which other measures of self-esteem, self-efficacy,
mastery, self-concept, etc. are tested (4 –7).
Coleman et al (8) note that Rosenberg has
presented good evidence for the convergent and
predictive validity of the scale.The evidence for
discriminant validity is less strong.
Psychological Well-Being S171

Sensitivity/responsiveness to change. Rosenberg Content. Five items: life close to ideal;

conceived of self-esteem as a stable characteristic conditions of life excellent; satisfied with life;
of adults (1). gotten things I want; would change almost nothing.

Developer/contact information. Diener et al (1).

References Available at www.psych.uiuc.edu/⬃ediener.
1. (Original) Rosenberg M. Society and the adolescent
self-image. Princeton (NJ): Princeton University Press; Versions. The SWLS is available in many
1965. (Chapter 2 discusses construct validity.) languages, including French, Dutch, Russian,
2. Marsh HW. Positive and negative global self-esteem: a Korean, Hebrew, and Mandarin Chinese.
substantively meaningful distinction or artifactors? J
Pers Soc Psychol 1996;70:810 –9. Number of items in scale. There are 5 items.
3. Blascovich J, Tomaka J. Measures of self-esteem. In:
Robinson JP, Shaver PR, Wrightsman LS, editors. Subscales. None.
Measures of personality and social psychological
attitudes. Third Edition. Ann Arbor (MI): Institute for Populations. Developmental/target. General
Social Research; 1993. p. 115– 60.
population.
4. Lorr M, Wunderlich RA. Two objective measures of
self-esteem. J Pers Assess 1986;50:18 –23.
5. Diener E, Emmons RA, Larson RJ, Griffin S. The Other uses. None.
satisfaction with life scale. J Pers Assess 1985;49:71–
5. WHO ICF Components. Not applicable.
6. Linton KE, Marriott RG. Self-esteem in adolescents:
validation of the State Self-esteem scale. Person
Individual Diff 1996;21:85–90. Administration
7. Robins RW, Hendin HM, Trzesniewski KH. Measuring Method. Self-report.
global self-esteem: construct validation of a single-
item measure and the Rosenberg Self-Esteem Scale. Training. None.
Personality Soc Psychol Bull 2001;27:151– 61.
8. Coleman PG, Aubin A, Robinson M, Ivani-Chalian C, Time to administer/complete. Brief.
Briggs R. Predictors of depressive symptoms and low
self-esteem in a follow-up study of elderly people
Equipment needed. None.
over 10 years. Int J Geriatric Psychol 1993;8:343–9.
Cost/availability. No cost, not copyrighted.
Available at http://s.psych.uiuc.edu/⬃ediener/
Additional References hottopic/hottopic.html.
Owens TJ. Two dimensions of self-esteem: reciprocal
effects of positive self-worth and self-deprecation
on adolescent problems. Am Sociol Rev 1994;59: Scoring
391– 407. Responses. Scale. There is a 7-point scale from
Owens TJ. Accentuate the positive and the negative:
“strongly disagree” to “strongly agree.”
rethinking the use of self-esteem, self-deprecation,
and self-confidence. Social Psychol Q 1993;56:288 –
99. Score range. Range is 5–35.
Silber E, Tippett J. Self-esteem: Clinical assessment and
measurement validation. Psychol Rep 1965;16: Interpretation of scores. Scores can be
1017–71. interpreted in terms of absolute as well as relative
Wells LE, Marwell G. Self-esteem: its conceptualization life satisfaction. A score of 20 represents the
and measurement. Beverly Hills (CA): Sage; 1976. neutral point on the scale. Scores between 31 and
Wylie RC. The self-concept. Lincoln, (NE): University of 35 indicate extremely satisfied, 26 –30 indicates
Nebraska Press; 1974. p. 180 –9. satisfied, 21–25 indicates slightly satisfied, 15–19
indicates slightly dissatisfied, 10 –14 dissatisfied,
and 5–9 extremely dissatisfied.
SATISFACTION WITH LIFE SCALE
(SWLS) Method of scoring. Sum indicated values for
each item.
General Description
Purpose. To assess global judgment of life Time to score. Brief.
satisfaction, rather than satisfaction with specific
domains. Training to score. Minimal.
S172
Training to interpret. None.
Norms available. Typical responses for specific
populations can be drawn from existing literature
(see additional references).
Psychometric Information
Reliability. Strong internal reliability and
moderate temporal stability. Diener et al (1) report
coefficient alphas of 0.79 to 0.89 and a 2-month
test—retest stability coefficient of 0.64 to 0.82.
Validity. Validity indicated by groups scoring
lowest on the SWLS: psychiatric patients,
prisoners, students in poor and turbulent
countries, and abused women. The SWLS has
negatively correlated with clinical measures of
distress and with neuroticism and positively
correlated with extraversion. Diener and Diener (2)
found SWLS to be significantly correlated with
satisfaction with the self in most nations. However,
covariation between self-esteem and life
satisfaction was lower in collectivistic nations.
Sensitivity/responsiveness to change.
Test—retest stability decreases to 0.50 – 0.54 over
time, suggesting changes in life satisfaction may
occur over time (1).
Comments and Critique
Research has suggested two broad aspects of
subjective well-being: an affective component,
which is usually further divided into pleasant
affect and unpleasant affect, and a cognitive
component which is referred to as life satisfaction.
References
1. (Original) Diener E, Emmons RA, Larsen RJ Griffin S.
The satisfaction with life scale. J Person Assess 1985;
49:71–5.
2. Diener E, Diener C. Most people are happy. Psychol
Sci 1996;7:181—5.
Additional References
Diener E, Diener M. Cross-cultural correlates of life
satisfaction and self-esteem. J Pers Soc Psychol
1995;68:653– 63.
Diener E, Emmons RA. The independence of positive
and negative affect. J Pers Soc Psychol 1984;47:
1105–-17.
Diener E, Larsen RJ. The subjective experience of
emotional well-being. In: Lewis M, Haviland JM,
editors. Handbook of emotions. New York: Guilford
Press; 1993. p. 405–15.
Diener E. Subjective well-being. Psychol Bull 1984;95:
542–75.
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Diener E, Diener M, Diener C. Factors predicting the
subjective well-being of nations. J Pers Soc Psychol
1995;69:851– 64.
Diener E, Sandvik E, Pavot W, Gallaher D. Response
artifacts in the measurement of subjective well-
being. Soc Indicators Res 1991;24:36 –56.
Pavot W, Diener E. Review of the satisfaction with life
scale. Psychol Assess 1993;5:164 –72.
STATE-TRAIT ANXIETY INVENTORY
(STAI)
General Description
Purpose. The STAI assesses separate dimensions
of state and trait anxiety. “State anxiety refers to
anxious affect, situationally provoked. . .” Trait
anxiety is “. . . a person’s general disposition to be
anxious.” (1).
Content. Twenty items assess tension,
apprehension, and nervousness. For state anxiety
the response is in terms of feelings at the moment;
for trait anxiety the response is in terms of how
one generally feels.
Developer/contact information. Spielberger (2,3);
Psychological Assessment Resources, Inc., 16204
North Florida Avenue, Lutz, FL 33549.
http://www.parinc.com).
Versions. STAI is available in more than 40
languages. Form Y is the latest refinement of the
English version.
Number of items in scale. There are 20 items.
Subscales. STAI was developed as a
unidimensional measure.
Populations. Developmental/target. General
adult population.
Other uses. None.
WHO ICF Components. Not applicable.
Administration
Method. Self-report measure; 10 items are
positively worded, and 10 items are negatively
worded.
Training. None.
Time to administer/complete. Brief.
Equipment needed. None.
Psychological Well-Being
Cost/availability. Copyrighted; contact:
Psychological Assessment Resources, Inc. 16204 N.
Florida Avenue, Lutz, FL 33549. Available at
http://www.parinc.com.
Scoring
Responses. Scale. 4 point scale. For state
anxiety, responses are “not at all,” “somewhat,”
“moderately so,” or “very much so.” For trait
anxiety, responses are “almost never,”
“sometimes,” “often,” or “almost always.”
Score range. Range is 20 – 80.
Interpretation of scores. Higher scores indicate
greater levels of anxiety.
Method of scoring. Positively worded items are
reversed and then summed.
Time to score. Brief.
Training to score. None.
Training to interpret. Brief.
Norms available. Norms provided for college
freshman, graduate students, college graduates,
psychiatric patients and general medical patients.
In addition, extensive literature exists involving
the use of this measure.
Psychometric Information
Reliability. Test-retest reliability tends to be
high for Trait and low for State, as expected. Test-
retest for STAI Trait ranges from 0.73 to 0.86 over
periods of 1 hour to 104 days. Alpha coefficients
for both tests range from 0.83 to 0.95.
Validity. STAI State and STAI Trait correlate
between 0.59 and 0.75. Evidence for convergent
validity has been observed in correlations with the
Taylor Manifest Anxiety Scale (TMAS) and the
Institute for Personality and Ability Testing’s
Anxiety Scale (IPAT) of 0.73– 0.85.
Sensitivity/responsiveness to change. The State
Anxiety Scale is intended to measure transient
levels of anxiety and, as such, is not expected to
have high test-retest relationships. The Trait
S173
Anxiety Scale measures dispositional anxiety and
has been shown to be relatively stable over time.
Comments and Critique
The STAI is the most widely used measure of
anxiety. It has been used cross-culturally with
good success. Some researchers have suggested
that the STAI and measures of depression like the
Beck Depression Inventory may simply measure
“general psychological distress” and that anxiety
and depression may be impossible to accurately
differentiate using existing self-report measures
(4 – 6). Endler et al (6) developed measures of state
and trait anxiety (EMAS) with which anxiety has
been differentiated from depression. However, the
EMAS-State has 20 items and the EMAS-Trait has
60 items.
References
1. Spielberger CD. Theory and research on anxiety. In:
Spielberger CD, editor. Anxiety and behavior. San
Diego (CA): Academic Press; 1966. p. 3–20.
2. Spielberger CD. Manual for the State-Trait Anxiety
Inventory (Form V). Palo Alto (CA): Consulting
Psychologists Press; 1983.
3. Spielberger CD. Anxiety as an emotional state. In:
Spielberger CD, editor. Anxiety: current trends in
theory and research. San Diego (CA): Academic Press;
1972. p. 24 – 49.
4. Gotlib IH. Depression and general psychopathology in
university students. J Abnorm Psychol 1984;93:19 –30.
5. Dobson KS. The relationship between anxiety and
depression. Clin Psychol Rev 1985;5:307–24.
6. Endler NS, Cox BJ, Parker JD, Bagby RM. Self-reports
of depression and state-trait anxiety: evidence for
differential assessment. J Pers Soc Psychol 1992;63:
832– 8.
Additional References
Gotlib IH, Cane DB. Self-report assessment of depression
and anxiety. In: Kendall PC, Watson D, editors.
Anxiety and depression: distinctive and
overlapping features. San Diego (CA): Academic
Press 1989; p. 131– 69.
Hishinuma ES, Miyamoto RH, Nishimura ST, Nahulu
LB. Differences in state-trait anxiety inventory
scores for ethnically diverse adolescents in Hawaii.
Cult Divers Ethnic Minor Psychol 2000;6:73– 83.
Novy DM, Nelson DV, Goodwin J, Rowzee RD.
Psychometric comparability of the State-Trait
Anxiety Inventory for Different Ethnic
Subpopulations. Psychol Assess 1993;5:343–9.
 S174

Summary Table for Other Measures of Psychological Well-Being

Psychometric properties
No. of Method of Time for Validated
Measure/scale Content Measure outputs items Response format administration administration populations Reliability Validity Responsiveness

Affect Balance Positive and Positive Affect, 10 Yes or no Self 10 minutes Adults Good Adequate Good
Scale (ABS) negative Negative Affect,
affect as and Affect
indicators Balance
of life
satisfaction
General Health Ability to do Cut-off score of 1 or 12 4 point scale Self 10 minutes Various age groups, Excellent Good Good
Questionnaire normal 2 indicating including elderly;
(GHQ12) activities; distress primary care
distressing patients
symptoms
Life Satisfaction Zest, Total score ranging 20 Agree, Disagree, Don’t Self 15–20 minutes Older adults Adequate Adequate Not reported
Index A (LSI-A) resolution, from 0 to 40 Know
goal
congruence,
self-
concept,
mood
Rosenberg Self- Self- Total score ranging 10 4-point scale Self 10 minutes Adolescents and Excellent Good Good
Esteem Scale acceptance from 0 to 30 adults
Satisfaction with Global Total score ranging 5 7-point scale Self 5 minutes Adolescents and Excellent Excellent Excellent
Life Scale judgment from 5 to 35 adults
(SWLS) of life
satisfaction
State-Trait Anxiety at the Separate scores for 20 4-point scale Self 15–20 minutes College students, Good Adequate Good
Anxiety Index moment State and Trait graduates,
(STAI) and usual psychiatric
anxiety patients; general
medical patients
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