Psychological General Well-Being Index (PGWBI)

Abstract

The Psychological General Well-Being Index (PGWBI), originally conceptualized by Dr. Harold J. Dupuy in the 1970s and formally published in 1984, is one of the most widely utilized patient-reported outcome measures (PROMs) for evaluating subjective psychological well-being and health-related quality of life (HRQoL). Developed primarily for health survey research and clinical trials, the PGWBI measures subjective affective states rather than psychiatric symptoms alone, capturing both positive and negative facets of mental health. The instrument consists of 22 self-administered items evaluated across a one-month recall period. Each item is scored on a 6-point Likert-type scale ranging from 0 to 5, generating a total global score between 0 and 110, where higher scores indicate superior psychological well-being. The 22 items coalesce into six distinct psychometric dimensions: Anxiety (5 items), Depressed Mood (3 items), Positive Well-Being (4 items), Self-Control (3 items), General Health (3 items), and Vitality (4 items). Psychometric investigations across diverse international cohorts consistently establish robust internal consistency, with global Cronbach’s alpha coefficients typically exceeding .90 (ranging between .92 and .96) and subscale alphas spanning .70 to .88. Test-retest reliability coefficients across intervals of two to four weeks range from .80 to .91, indicating stable temporal reproducibility. Structural validity has been substantiated through confirmatory factor analysis (CFA), confirming a multidimensional first-order model subordinated to a robust second-order general psychological well-being construct. The PGWBI has been translated and validated in more than 30 languages, serving as a core endpoint in clinical pharmacology, cardiovascular medicine, gastroenterology, endocrinology, and occupational health.

Keywords

Psychological General Well-Being Index, PGWBI, Harold J. Dupuy, subjective well-being, health-related quality of life, patient-reported outcome measures, psychometrics, anxiety, depression, vitality, positive well-being, self-control

Authors

The original Psychological General Well-Being (PGWB) Index was developed by Harold J. Dupuy, Ph.D., during his tenure at the National Center for Health Statistics (NCHS) within the United States Department of Health, Education, and Welfare (now the U.S. Department of Health and Human Services) in Hyattsville, Maryland, USA. Dr. Dupuy designed the instrument for inclusion in the National Health and Nutrition Examination Survey (NHANES I, 1971–1975) to measure self-representations of intrapersonal affective or emotional states reflecting psychological well-being.

Subsequent psychometric refinement, international cross-cultural adaptations, and clinical trial standardization were spearheaded by researchers including Olivier Chassany, M.D., Ph.D. (Université Paris Cité, AP-HP, France), Dominique Dubois, M.D., Elof Dimenäs, Ph.D. (AstraZeneca and Gothenburg University, Sweden), and Albert W. Wu, M.D., MPH (Johns Hopkins Bloomberg School of Public Health, USA) in collaboration with the Mapi Research Institute (now part of ICON plc, Lyon, France). Further European national standardizations and the development of the validated short version (PGWB-S) were conducted by Enzo Grossi, M.D., Paola Mosconi, Biol.Sci., Nicola Groth, Ph.D., Angelo Compare, Ph.D., and Giovanni Apolone, M.D. at the Mario Negri Institute for Pharmacological Research in Milan, Italy.

Purpose

The Psychological General Well-Being Index was engineered to quantify an individual’s subjective sense of psychological health, emotional equilibrium, and affective stability over the preceding month. Historically, psychological assessment tools employed in biomedical and epidemiological contexts were derived almost exclusively from psychiatric diagnostic nosology, focusing unidirectionally on psychiatric symptomatology, psychopathology, psychological distress, and psychiatric morbidity. Dr. Dupuy and colleagues observed that the absence of overt psychological disorder does not inherently signify the presence of positive mental health, vitality, or emotional fulfillment. Consequently, the PGWBI was developed to operationalize a bipolar continuum of psychological well-being, integrating both negative distress dimensions (e.g., severe anxiety, feelings of depression, perceived stress) and positive affective dimensions (e.g., energy, happiness, emotional stability, self-mastery).

In clinical trials and medical research, the PGWBI serves as a sensitive, responsive patient-reported outcome measure designed to monitor how systemic chronic diseases, invasive interventions, pharmacological therapies, and medical regimens influence patient-perceived quality of life. The instrument is extensively used in randomized controlled trials (RCTs) across cardiovascular medicine (e.g., assessing the psychological tolerability and side-effect profiles of beta-blockers and ACE inhibitors), gastroenterology (e.g., evaluating distress and health worries in gastroesophageal reflux disease [GERD] and irritable bowel syndrome [IBS]), oncology, and endocrinology (e.g., growth hormone replacement, metabolic syndrome). Its purpose extends beyond mere screening to serving as an evaluative marker capable of detecting subtle clinically meaningful changes over time.

In population health surveys and occupational epidemiology, the PGWBI functions as a benchmarking tool to assess community-level mental health, the psychological sequelae of occupational burnout, and the efficacy of public health interventions. Clinicians utilize the index to evaluate whether a therapeutic regimen restores emotional functioning and general vitality back to norm-referenced population levels, facilitating patient-centered care and shared medical decision-making.

Psychological Construct

The psychological construct assessed by the PGWBI is Subjective Psychological General Well-Being, defined as a multi-component state of internal cognitive and affective evaluation reflecting an individual’s perceived emotional harmony, distress, vitality, and health competence. Grounded in a multidimensional conceptualization, the instrument maps onto six correlated domains:

1. Anxiety

The Anxiety domain comprises five items (Items 5, 8, 17, 19, and 22) measuring acute and generalized somatic and cognitive manifestations of tension, distress, and psychological strain. It taps into experiences such as being bothered by nervousness or “nerves,” experiencing internal muscular and emotional tension, enduring subjective strain, and feeling keyed-up, high-strung, or unable to relax. Elevated scores on this subscale reflect serenity, emotional calm, and freedom from disabling apprehension.

2. Depressed Mood

The Depressed Mood domain consists of three items (Items 3, 7, and 11) capturing the dysphoric end of the affective continuum. This construct measures feelings of deep discouragement, hopelessness, feeling “downhearted and blue,” existential worthlessness, and suicidal ideation. Rather than functioning as a clinical diagnostic instrument for Major Depressive Disorder, it quantifies the subjective burden of dysphoria. High scores denote affective buoyancy, optimism, and the total absence of depressive despondency.

3. Positive Well-Being

The Positive Well-Being domain is operationalized through four items (Items 1, 9, 15, and 20) evaluating positive affect, life satisfaction, and subjective happiness. Key facets include feeling in excellent spirits, experiencing personal life as satisfying and pleasing, maintaining active engagement with daily activities that are intrinsically interesting, and feeling cheerful and lighthearted. This subscale directly aligns with contemporary positive psychology constructs, reflecting hedonic fulfillment.

4. Self-Control

Comprising three items (Items 4, 14, and 18), the Self-Control domain measures perceived emotional stability, behavioral self-mastery, cognitive integrity, and internal locus of control. It evaluates whether individuals feel in firm command of their behavior, thoughts, and feelings, and whether they fear losing their mind or emotional stability. Higher scores reflect high self-efficacy, emotional self-regulation, cognitive confidence, and emotional composure.

5. General Health

The General Health domain includes three items (Items 2, 10, and 13) reflecting subjective somatic perceptions and health-related anxiety. It assesses the degree to which an individual feels bothered by bodily aches, pains, or somatic disorders, worries or harbors fears regarding physical illness, and perceives their physical health as sufficient to execute desired occupational and recreational activities. It captures the psychological appraisal of one’s physical functioning rather than objective diagnostic pathology.

6. Vitality

The Vitality domain encompasses four items (Items 6, 12, 16, and 21) measuring subjective biobehavioral energy, physical vigor, and physiological restoration. It evaluates the presence of energy, “pep,” and vitality versus states of somatic sluggishness, waking up feeling exhausted and unrefreshed, and chronic sensations of being drained, worn out, or completely used up. High scores indicate physical dynamism, resilience, and optimal energetic capacity.

Theoretical Framework

The theoretical architecture of the PGWBI rests upon the synthesis of three seminal paradigms in twentieth-century psychological science: Subjective Well-Being (SWB) theory, the Biopsychosocial Model of health, and the salutogenic framework of human resilience.

Foremost, Dupuy’s formulation directly incorporated Norman Bradburn’s (1969) model of Affect Balance. Bradburn demonstrated that psychological well-being is not a unipolar axis where happiness is merely the inverse of misery; rather, positive affect and negative affect operate as distinct, partially independent dimensions. An individual’s psychological state is an ongoing algebraic sum or equilibrium between pleasant and unpleasant emotional experiences. By structuring the PGWBI with both positive subscales (Positive Well-Being, Vitality, Self-Control) and negative distress subscales (Anxiety, Depressed Mood), Dupuy operationalized this balance, allowing researchers to observe whether therapeutic interventions actively enhance positive emotional resources or exclusively suppress negative emotional distress.

Secondly, the PGWBI is anchored in Aaron Antonovsky’s (1979) theory of Salutogenesis. Antonovsky postulated that medical science must move beyond pathogenesis (the mechanisms causing disease) to explore salutogenesis (the origins of positive health and psychological robustness). The inclusion of constructs such as perceived Self-Control and Vitality embodies Antonovsky’s concept of Generalized Resistance Resources (GRRs) and a strong “Sense of Coherence” (comprehensibility, manageability, and meaningfulness). Dupuy posited that subjective well-being is heavily mediated by an individual’s belief in their internal coping agency and their capacity to maintain personal control amidst physiological or environmental stressors.

Finally, the scale reflects George Engel’s (1977) Biopsychosocial Model, which asserts that biological processes cannot be divorced from psychological states and subjective patient experiences. In the context of pharmaceutical trials and chronic illness management, physiological normalization (e.g., blood pressure control or glycemic regulation) does not guarantee that the patient experiences an improved state of well-being. By integrating self-appraisals of somatic health (General Health) alongside emotional and energetic states (Vitality, Anxiety), the PGWBI provides an empirical vehicle to evaluate health outcomes through a truly integrative biopsychosocial lens.

Validity

The psychometric validity of the PGWBI has been extensively confirmed through international research involving clinical cohorts, workplace populations, and representative community samples.

Construct and Structural Validity

Construct validity is evidenced by strong correlations between PGWBI subscales and established psychological inventories measuring identical or overlapping emotional constructs. Studies evaluating convergent validity demonstrate that the PGWBI Anxiety subscale correlates strongly with the Spielberger State-Trait Anxiety Inventory (STAI; r = -.75 to -.82) and the Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A; r = -.78). The Depressed Mood subscale shows strong negative correlations with the Beck Depression Inventory (BDI; r = -.72 to -.80) and the Center for Epidemiologic Studies Depression Scale (CES-D; r = -.76). Furthermore, the PGWBI global score demonstrates high convergent validity with the Mental Health Composite (MCS) of the Short Form Health Survey (SF-36; r = .78 to .86), confirming that the PGWBI accurately captures the overarching mental health component of health-related quality of life.

Discriminant Validity

Discriminant validity has been consistently demonstrated through the tool’s ability to differentiate between psychiatric outpatients, patients with somatic chronic diseases, and healthy community controls. Community norms typically yield mean total PGWBI scores ranging from 78 to 85 (out of 110), whereas cohorts presenting with major depressive disorder, generalized anxiety disorder, or significant adjustment disorders consistently score below 55 to 60. Furthermore, the PGWBI successfully discriminates between clinical severity tiers in chronic physical disorders, including gastroesophageal reflux disease, functional dyspepsia, and chronic heart failure, where emotional well-being degrades systematically in tandem with symptom frequency and pain intensity.

Predictive and Evaluative Validity (Responsiveness)

The instrument has documented responsiveness to pharmacological and psychological interventions. In multicenter trials evaluating anxiolytic and antidepressant agents, total PGWBI scores and targeted subscale scores showed substantial, statistically significant increases corresponding with clinical remission (effect sizes typically ranging from Cohen’s d = 0.65 to 1.10). In cardiovascular trials, the PGWBI proved sensitive to central nervous system side effects associated with lipophilic antihypertensive medications, detecting subtle subclinical deteriorations in cognitive clarity, vitality, and perceived self-control that standard adverse event checklists failed to identify.

Reliability

The PGWBI exhibits psychometric reliability across diverse populations, clinical contexts, and linguistic adaptations.

Internal Consistency

In the original US NHANES standardizations and subsequent European cross-cultural validations (e.g., French, Italian, Swedish, British, and Spanish versions), the internal consistency of the 22-item global scale has consistently yielded Cronbach’s alpha coefficients exceeding .90, frequently reaching .93 to .95. Subscale reliability analysis reveals alpha values well within accepted standards for multi-item psychometric facets:

• Anxiety (5 items): Cronbach’s α = .80 to .88
• Depressed Mood (3 items): Cronbach’s α = .75 to .85
• Positive Well-Being (4 items): Cronbach’s α = .74 to .82
• Self-Control (3 items): Cronbach’s α = .68 to .78
• General Health (3 items): Cronbach’s α = .70 to .80
• Vitality (4 items): Cronbach’s α = .78 to .86

Item-total correlation analyses show that all 22 items correlate substantially with their respective dimension (item-internal consistency correlations typically exceeding .50, corrected for overlap) and with the total index score (ranging from .48 to .76).

Test-Retest Reliability

Temporal stability evaluated among stable clinical and community cohorts across test-retest intervals spanning 7 days to 4 weeks demonstrates intraclass correlation coefficients (ICCs) and Pearson correlation coefficients ranging from .80 to .91 for the total global score. Subscale test-retest coefficients generally range between .70 and .86, indicating that the PGWBI is sufficiently stable over time in the absence of clinical change, while remaining sensitive to genuine shifts in subjective affective status.

Factor Analysis

The latent factorial architecture of the PGWBI has been thoroughly investigated through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) across numerous linguistic and cultural samples.

Exploratory Factor Structure

Initial principal components and principal axis factoring with orthogonal (Varimax) and oblique (Promax) rotations conducted on large population samples (including Dupuy’s original US cohorts and European standardization studies) consistently identified six primary factors with eigenvalues greater than 1.0, explaining between 58% and 66% of the total variance. While some moderate cross-loadings are observed between highly correlated affective constructs—specifically between Anxiety and Depressed Mood, and between Vitality and Positive Well-Being—items consistently manifest primary factor loadings onto their hypothesized theoretical dimensions exceeding .50, with most loading between .60 and .85.

Confirmatory Factor Analysis (CFA)

Subsequent structural equation modeling across thousands of participants has confirmed the multidimensional structure. Researchers have tested competing models, including single-factor unidimensional models, orthogonal six-factor models, oblique correlated six-factor models, and hierarchical bi-factor or second-order models.

Fit indices consistently reveal that the second-order hierarchical model—where the six first-order factors load directly onto a single, overarching latent construct of General Psychological Well-Being—provides an acceptable fit to empirical data. Standard model fit statistics reported in contemporary CFA investigations (such as those by Grossi et al., 2002, 2006, and Chassany et al., 2004) typically meet established structural thresholds:

• Comparative Fit Index (CFI): .92 to .96
• Tucker-Lewis Index (TLI): .91 to .95
• Root Mean Square Error of Approximation (RMSEA): .045 to .062 (with 90% confidence intervals below .07)
• Standardized Root Mean Square Residual (SRMR): .038 to .051

These findings substantiate the scoring practice of the PGWBI: computing distinct subscale scores allows clinicians to analyze granular affective profiles, while aggregating items into an overall composite score accurately reflects global psychological well-being.

Instrument / Measurement Tool

• Instrument Name: Psychological General Well-Being Index (PGWBI)
• Original Name: Psychological General Well-Being (PGWB) Index
• Original Author: Dr. Harold J. Dupuy (1984)
• Administration Format: Self-administered questionnaire (paper-and-pencil or validated electronic patient-reported outcome [ePRO] systems)
• Target Population: Adults aged 18 years and older (adaptations exist for adolescents aged 14+)
• Time Horizon / Recall Period: The past month (past 4 weeks)
• Number of Items: 22 items
• Number of Subscales: 6 subscales
  • Anxiety (5 items: 5, 8, 17, 19, 22)
  • Depressed Mood (3 items: 3, 7, 11)
  • Positive Well-Being (4 items: 1, 9, 15, 20)
  • Self-Control (3 items: 4, 14, 18)
  • General Health (3 items: 2, 10, 13)
  • Vitality (4 items: 6, 12, 16, 21)
• Response Scale: 6-point Likert-type scales (item-specific response options numbered 0 to 5)
• Administration Time: Approximately 7 to 10 minutes
• Scoring Instructions:
  • Items 1, 4, 6, 7, 9, 10, 14, 16, and 21 must be reversed: 0 = 5, 1 = 4, 2 = 3, 3 = 2, 4 = 1, 5 = 0.
  • Items 2, 3, 5, 8, 11, 12, 13, 15, 17, 18, 19, 20, and 22 are scored directly as marked (0 to 5), ensuring that for every item, a score of 5 reflects optimal well-being and 0 reflects extreme distress.
  • Subscale Scores: Sum of recoded item scores within each respective domain.
  • Global Total Score: Sum of all 22 recoded items (Range: 0 to 110).
• Interpretation Cut-Off Thresholds (Dupuy, 1984):
  • 0 to 60: Severe psychological distress
  • 61 to 72: Moderate psychological distress
  • 73 to 110: Positive psychological well-being (community reference norm range: 78 to 85)

Permissions & Fee and Test Year

The Psychological General Well-Being Index was originally created by Dr. Harold J. Dupuy at the National Center for Health Statistics (NCHS) in the 1970s and presented in seminal conference proceedings in 1984. Because its development was initially funded through U.S. government federal health research initiatives, early iterations appeared in the public domain for academic health surveillance.

However, modern standardized international linguistic adaptations, copyrighted master user manuals, and validated electronic translations are maintained and distributed through the Mapi Research Trust (via the ePROVIDE platform, Lyon, France). For academic, independent non-sponsored research, non-commercial clinical work, and publicly funded graduate dissertations, permission to use the scale is generally granted free of charge or upon payment of a nominal administrative handling fee, subject to the completion of a formal user agreement. Commercial entities, pharmaceutical sponsors, contract research organizations (CROs), and for-profit clinical trials must obtain a paid commercial license and purchase official validated translation packages.

References

Antonovsky, A. (1979). Health, stress, and coping. Jossey-Bass Publishers.

Bradburn, N. M. (1969). The structure of psychological well-being. Aldine Publishing Company. https://doi.org/10.1037/10835-000

Chassany, O., Dimenäs, E., Dubois, D., & Wu, A. W. (2004). The Psychological General Well-Being Index (PGWBI): User manual. Mapi Research Institute.

Dupuy, H. J. (1984). The Psychological General Well-Being (PGWB) Index. In N. K. Wenger, M. E. Mattson, C. D. Furberg, & J. Elinson (Eds.), Assessment of quality of life in clinical trials of cardiovascular therapies (pp. 170–183). Le Jacq Publishing.

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136. https://doi.org/10.1126/science.847460

Grossi, E., Compare, A. (2006). Psychological General Well-Being Index (PGWB). Health and Quality of Life Outcomes, 4, Article 88. https://doi.org/10.1186/1477-7525-4-88

Grossi, E., Groth, N., Mosconi, P., Cerutti, R., Pace, F., Compare, A., & Apolone, G. (2006). Development and validation of the short version of the Psychological General Well-Being Index (PGWB-S). Health and Quality of Life Outcomes, 4, Article 88. https://doi.org/10.1186/1477-7525-4-88

Grossi, E., Mosconi, P., Groth, N., Niero, M., & Apolone, G. (2002). Questionario Psychological General Well-Being Index: Versione italiana. Istituto di Ricerche Farmacologiche “Mario Negri”.

Hunt, S. M., & McKenna, S. P. (1992). A British adaptation of the General Well-Being Index: A new tool for clinical research. British Journal of Medical Economics, 2, 49–60.

13. Items of the Scale (Questionnaire)