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[BTS] Evaluating Public Mental Well-Being Should Be Taken Seriously.

Updated: Nov 3, 2021

What means and how would we go about creating a method to help us find out where the public lies with their mental well-being? We look into the research literature to find out what works and what doesn't work when surveying people.


Evaluating public mental well-being should be taken seriously. The Warwick Edinburgh mental well-being scale (WEMWBS) was created to monitor the well-being of the general population. This scale consists of a 14 item scale to see how each respondent scores in five categories. We aim to find what barriers may be found in international uses of the WEMWBS scale. To make sure the population is being well monitored, it would be in the best interest of those in charge to find a suitable testing scale. When we determine who the "public" is, what adjustments would we have to make in terms of the testing scale?

There are many scales that help monitor different aspects of mental health. The Warwick Edinburgh mental well-being scale (WEMWBS) was created in order to monitor the well-being of the general population having a 14 item scale with 5 response categories. All the items are positively worded to “cover both the feeling and functioning aspects of mental wellbeing ("Warwick Medical School").” There is also a shortened version called the Short Warwick Edinburgh mental well-being scale (SWEMWBS) that only has half the questions and is compatible with RASCH data analysis. This literature review aims to point out if the WEMWBS and SWEMWBS posed predictable barriers in international uses. The various papers information from research articles has been gathered from the United Kingdom, Norway, Pakistan, Singapore, and England. Three of the articles focus on a randomized group of the general public, two focused on medical professionals, and the last focused on a select few with mental illnesses (depression, anxiety, and schizophrenia). In this analysis, we will determine if this scale is transitional across various cultures and language barriers or is it limited to the country that it was created in as well as the top two issues that came up during the process.

Each article articulated an agreed-upon factor which was the definition for what the Warwick Edinburgh Mental Well-being Scale (WEMWBS) was. Some sticking to the bare basics while some, like Tennant et al. (2007), point out that the 14 items cover “both hedonic and eudaimonic aspects of mental health including positive affect satisfying interpersonal relationships and positive functioning”. Only one article that used the short version (SWEMWBS), also used the Rasch analysis with this shortened scale. “Rasch Analysis (RA) is a unique approach of mathematical modeling based upon a latent trait and accomplishes stochastic (probabilistic) conjoint additivity (conjoint means measurement of persons and items on the same scale and additivity is the equal-interval property of the scale) (n.d.).” Fat et al. (2016) furthers the separation between the two scales by reasoning such as five of the items removed from the original version to help fit the data into the Rasch model; then they removed two more due to the local dependency of the reference or understanding. “The items in SWEMWBS present a picture of mental wellbeing in which psychological functioning dominates subjective feeling states, but the superior scaling properties and reduced participant burden have made it the instrument of choice in some studies (Fat et al., 2016).”

Many methods were used in these articles to collect the information resulting in both Quantitative and Qualitative data. Taggart F. et al. (2013) collected information from a sample size of 100 participants that would give a 95% confidence interval for their correlation coefficient. They only selected participants within Coventry and Birmingham that selected their ethnicity as Pakistani or Chinese. Both Qualitative and Quantitative methods were used to first generally select participants then meet them face to face for interviews. Fat N. L., et al., (2016) used information from The Health Survey for England to collect participants. They decided to use only the short version of WEMWBS meaning that out of the 1841 people registered to participate, 512 participants had completed the SWEMWBS. There was no indication for how many completed the full 14-item scale even though they implied there had been some that completed the full test. Tennant R., et al. (2007), gathered information through nine focus groups consisting of eight people in each totaling 56 participants. Three of these groups were held in England while six were in Scotland to cover a range of attributes that are known to be associated with mental health such as age, socio-economic status, and sex. Smith R. F. O., et al., (2017) selected patients from those who had received treatment at PMHC in Norway between October 2014 and February 2016 at 14 different locations. Of these, 1189 opted in to participate in the study. Waqas A., et al., (2015) did a cross-sectional survey with 1271 Pakistani HCPS (Health Care Providers) in Pakistan covering seven different cities within the Punjab province. They included pharmacists, dentists, nurses, doctors, physiotherapists currently practicing within the seven districts- Faisalabad, Gujrat, Lahore, Sheikhupura, Multan, Islamabad, Rawalpindi to represent the Punjab population. Vaingankar A. J., et al., (2017) completed a cross-sectional study covering 350 service users who have schizophrenia, depression, or anxiety spectrum disorders. They had to be permanent residents, Singapore citizens, and who are of Chinese, Malay, or Indian ethnicity. All had to be literate in English before seeing if they fit into the quota sampling plan to get adequate representation.

There was a common theme in what issues may arise as was predicted. The first main hurdle was the language barrier that may skew the understanding and ultimately the purpose of the test. Taggart et al. (2013) pointed out that one of the items listed was greatly misunderstood “by several young and middle-aged Pakistani men and one Chinese man who saw a sexual interpretation for this question”. The statement that reads “I’ve been feeling interested in other people” could be read in different ways implying that the structure of each item should carefully reflect a cultural or situational understanding if there are language barriers. Waqas et al. (2015) realized that their test would not represent the population of Pakistan as they did not have a translated version in Urdu (their national language). Those that took their test were fluent in English being high-standing health care professionals. Smith et al. (2017), actually took five stages in translating the original language of the scale into the native tongue of their target population. This did become the final version of the Norwegian WEMB=WBS.

The second hurdle seen was the general differences in what was agreed upon as “mental well-being” and what core components these would contain. In the research study by Tennant et al. (2007), items were removed due to an assumption of what was considered ‘well-being’ in the general UK population. Spirituality was not included and it was suggested that some instruction for the general population’s knowledge could help them understand what mental well-being encompasses. This was similar to the groups Taggart et al. (2013), identified between Pashtun speakers and the Chinese group. Fal et al. (2016), just pointed out that “Measuring mental wellbeing as a single construct may mask its multidimensionality”. Recommendations for reviewing and adjusting the scale to fit language or cultural barriers would be in place before using these scales.


Ahmed Waqas, Waqas Ahmad, Mark Haddad, Frances M. Taggart, Zerwah Muhammad, Muhammad Hamza Bukhari, … Sumbul Ejaz. (2015). Measuring the well-being of health care professionals in the Punjab: a psychometric evaluation of the Warwick–Edinburgh Mental Well-being Scale in a Pakistani population. PeerJ, Vol 3, p E1264 (2015), e1264.

Janhavi Ajit Vaingankar, Edimansyah Abdin, Siow Ann Chong, Rajeswari Sambasivam, Esmond Seow, Anitha Jeyagurunathan, … Mythily Subramaniam. (2017). Psychometric properties of the short Warwick Edinburgh mental well-being scale (SWEMWBS) in service users with schizophrenia, depression and anxiety spectrum disorders. Health and Quality of Life Outcomes, Vol 15, Iss 1, Pp 1-11 (2017), (1), 1.

Linda Ng Fat, Scholes, S., Boniface, S., Mindell, J., Stewart-Brown, S., & Ng Fat, L. (2017). Evaluating and establishing national norms for mental wellbeing using the short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS): findings from the Health Survey for England. Quality of Life Research, 26(5), 1129–1144.

Otto R. F. Smith, Daniele E. Alves, Marit Knapstad, Ellen Haug, & Leif E. Aarø. (2017). Measuring mental well-being in Norway: validation of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS). BMC Psychiatry, Vol 17, Iss 1, Pp 1-9 (2017), (1), 1.

Taggart, F., Friede, T., Weich, S., Clarke, A., Johnson, M., & Stewart-Brown, S. (2013). Cross cultural evaluation of the Warwick- Edinburgh mental well-being scale (WEMWBS) -a mixed methods study. Health & Quality of Life Outcomes, 11(1), 1–12.

Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Weich, S., … Stewart-Brown, S. (2007). The Warwick-Edinburgh Mental Well-being Scale (WEMWBS):development and UK validation. Health & Quality of Life Outcomes, 5, 63–75.

Warwick Medical School. (n.d.). Retrieved from




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