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TCPXXX10.1177/0011000016633507The Counseling PsychologistCooke et al.

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The Counseling Psychologist
2016, Vol. 44(5) 730­–757
Measuring Well-Being: © The Author(s) 2016
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DOI: 10.1177/0011000016633507
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Philip J. Cooke1, Timothy P. Melchert1,

and Korey Connor1

Abstract
Interest in the study of psychological health and well-being has increased
significantly in recent decades. A variety of conceptualizations of psychological
health have been proposed including hedonic and eudaimonic well-being,
quality-of-life, and wellness approaches. Although instruments for measuring
constructs associated with each of these approaches have been developed,
there has been no comprehensive review of well-being measures. The
present literature review was undertaken to identify self-report instruments
measuring well-being or closely related constructs (i.e., quality of life and
wellness) and critically evaluate them with regard to their conceptual basis
and psychometric properties. Through a literature search, we identified 42
instruments that varied significantly in length, psychometric properties, and
their conceptualization and operationalization of well-being. Results suggest
that there is considerable disagreement regarding how to properly understand
and measure well-being. Research and clinical implications are discussed.

Keywords
well-being, happiness, assessment, instruments, measurements

In recent years, interest in positive conceptualizations of health and well-being

has grown steadily in the behavioral sciences as well as in society more gener-
ally. It is possible that human beings have always contemplated the nature of

1Marquette University, Milwaukee, WI, USA

Corresponding Author:
Timothy P. Melchert, Department of Counselor Education and Counseling Psychology,
Marquette University, 168F Schroeder Complex, Milwaukee, WI 53201-1881, USA.
Email: [email protected]

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Cooke et al. 731

well-being, health, happiness, and the “good life”; psychological theorizing

has explored these questions across the history of the discipline (Lent, 2004).
However, little sustained empirical attention has been given to these topics
until the past few decades, when several different conceptualizations of health
and well-being have been advanced, “positive psychology” has grown into a
recognized specialization, empirical research has increased significantly, and
theoretical disagreements have been debated vigorously (Jayawickreme,
Forgeard, & Seligman, 2012; Lent, 2004; Ryan & Deci, 2001).
There has been a long running and still unresolved debate in the literature
about how to properly conceptualize and measure health and well-being. Some
of this debate dates back to the ancient Greeks (e.g., Aristotle was an active
early participant), and lively disagreements continue on how best to measure
the essential aspects of well-being and optimal life functioning (Jayawickreme
et al., 2012; Lent, 2004). Clarifying the strengths and limitations of these vari-
ous approaches will be important to advancing research on this subject. A
search of the literature, however, found no comprehensive review of the instru-
ments that have been developed to measure these constructs. Therefore, the
present review was undertaken to identify and critically evaluate all the pub-
lished well-being instruments that include a psychological component. To clar-
ify the scope of the project, next we describe the primary theoretical approaches
used in developing the instruments included in this review.

Primary Approaches to Conceptualizing

Well-Being
Prior to World War II, most conceptualizations of health were focused on the
absence of disease and disability. In 1948, however, the World Health
Organization (WHO) proposed a definition that viewed health as “a state of
complete physical, mental, and social well-being and not merely the absence
of disease and infirmity” (WHO, 1948). Nonetheless, most health care
research and practice continued to rely on the traditional medical model that
focused on reducing disease and disability, with little attention given to the
nature of health and well-being. The medical model was very useful for devel-
oping effective treatments for many illnesses but fell short in addressing the
growing body of research that suggested that the absence of pathology does
not necessarily correlate with positive dimensions of health and well-being
(e.g., Keyes, 2002). A variety of different conceptualizations of well-being
were also being promoted during this time, and the proliferation of these
approaches led to confusion as to how to properly define and measure positive
health and functioning (Lent, 2004). These varying conceptualizations can be
categorized into four broad approaches. The two most influential approaches

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732 The Counseling Psychologist 44(5)

in psychology have been the hedonic and eudaimonic schools (Lent, 2004;
Ryan & Deci, 2001). Approaches emphasizing quality of life and wellness
also have been influential in psychology, although not as much as they have
been in medicine and counseling, respectively (Lent, 2004; Roscoe, 2009).
Additional theoretical models have been proposed to explain relationships
among components of well-being and explain the processes involved in devel-
oping and maintaining well-being (e.g., Jayawickreme et al., 2012; Lent,
2004). However, instruments for measuring new conceptualizations of well-
being associated with these models have not been proposed.
The hedonic approaches to conceptualizing well-being focus on pleasure
and happiness (Ryan & Deci, 2001). The most prominent hedonic model is
known as subjective well-being, a tripartite model consisting of satisfaction
with life, the absence of negative affect, and the presence of positive affect
(Diener, Emmons, Larsen, & Griffin, 1985). Proponents of this perspective
tend to conceptualize well-being in terms of all three of these constructs,
although many researchers focus on life satisfaction alone when assessing
well-being from this perspective.
The eudaimonic approaches to conceptualizing well-being suggest that
psychological health is achieved by fulfilling one’s potential, functioning at
an optimal level, or realizing one’s true nature (Lent, 2004). In contrast to the
focus on affect and life satisfaction in the hedonic models, eudaimonic mod-
els tend to focus on a larger number of life domains, although they vary sig-
nificantly regarding the fundamental elements that determine well-being. For
example, one of the more prominent eudaimonic models is the psychological
well-being model (Ryff, 1989; Ryff & Keyes, 1995), which suggests that
well-being consists of six elements: self-acceptance, positive relations with
others, autonomy, environmental mastery, purpose in life, and personal
growth. The eudaimonic model proposed by Ryan and Deci (2001), however,
suggests that well-being is found in the fulfillment of three basic psychologi-
cal needs: autonomy, competence, and relatedness. Clearly these two models
overlap, but they also illustrate the variation found within the eudaimonic
approaches to understanding well-being.
A third category of approaches to conceptualizing well-being focuses on
quality of life (QoL). The term QoL is often used interchangeably with well-
being in the literature. For example, the authors who developed the Quality of
Life Inventory use the terms quality of life, subjective well-being, and life sat-
isfaction interchangeably (Frisch, Cornell, Villanueva, & Retzlaff, 1992).
However, those studying QoL generally conceptualize well-being more broadly
than either the hedonic or eudaimonic models and include physical, psycho-
logical, and social aspects of functioning. This approach has been influenced
by a variety of disciplines including medicine, sociology, and psychology, and

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Cooke et al. 733

is often employed in medical contexts (Lent, 2004). In the area of oncology, for
example, the measurement of QoL for patients with cancer has become highly
developed (Cella & Stone, 2015). The WHO defines QoL as a “broad range
concept affected in a complex way by the persons’ physical health, psychologi-
cal state, level of independence, social relationships and their relationship to
salient features of their environment” (WHOQOL Group, 1998, p. 1570).
A fourth category of conceptualizations of well-being is often referred to
as wellness. Wellness approaches are rooted in the counseling literature and
tend to be broader and less clearly defined than the approaches mentioned
earlier (Roscoe, 2009). Similar to the situation for QoL, some authors use the
term wellness interchangeably with well-being (Harari, Waehler, & Rogers,
2005; Hattie, Myers, & Sweeney, 2004). One early definition of wellness
shares with eudaimonic approaches a focus on optimal functioning and
defines wellness as “an integrated method of functioning which is oriented
toward maximizing the potential of which the individual is capable” (Dunn,
1961, p. 4, as cited in Palombi, 1992). Like well-being and QoL, conceptual-
izations of wellness emphasize that well-being is more than the absence of
illness, although theories of wellness differ in the specific elements included.
Nearly all scholars in this area agree on a multifaceted conceptualization of
wellness as a holistic lifestyle and include multiple areas of health and func-
tioning (e.g., physical or spiritual health, possessing an integrated personal-
ity; Palombi, 1992; Roscoe, 2009).
These four categories of approaches to understanding well-being have
substantial similarities, with the broadest commonality being each construct’s
foundational interest in the positive dimension of human experience and
functioning. Each category attempts to identify what constitutes “the good
life” or optimal functioning for the human person (Ryan & Deci, 2001) even
if they differ on the particular terms used, on the components of well-being,
or the preferred measurement approach to operationalize well-being.
Although there are important theoretical distinctions between these four cat-
egories, it is unclear the degree to which they represent unique phenomena.
In fact, these various theoretical camps may be tapping into a similar, or
perhaps the same, dimension of human experience, resulting in a prolifera-
tion of constructs that may complicate rather than clarify scientific under-
standing. This potential construct proliferation may be due in part to these
different conceptualizations having risen out of different disciplines (i.e.,
hedonic and eudaimonic well-being primarily in psychology and sociology,
QoL primarily in medicine, and wellness primarily in counseling). One of the
purposes of this review is to begin to bridge these differences by examining
the measurement of well-being from a comprehensive perspective that
includes all these schools of thought.

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734 The Counseling Psychologist 44(5)

The Present Study

Measurement instruments have been developed for the multiple models that
fall within each of the four categories of conceptualizations of well-being.
These instruments are used in research and clinical settings as well as in public
polling to assess the level of psychological health or well-being of individuals,
groups, communities, and even whole societies (e.g., Gallup-Healthways,
2014; Huppert & So, 2013). Of course, the results of these polls, research
studies, and individual clinical assessments might vary considerably depend-
ing on the instrument used. It is consequently important that users of these
instruments are aware of the underlying conceptualizations on which particu-
lar instruments are based along with information regarding their psychometric
properties so that they can take a critical approach to interpreting the data
obtained with these instruments.
A literature search found two previous reviews of broadly focused well-
being measures. McDowell (2010) provided an historical and philosophical
overview of conceptualizations of well-being and reviewed nine instru-
ments based primarily on hedonic and eudaimonic approaches. He addressed
the limitations of the instruments, particularly with regard to their clinical
utility and the precision of their item content for measuring the specific
constructs the scales were designed to assess. Roscoe (2009) reviewed six
instruments designed to measure wellness and came to similar conclusions
regarding the difficulties of using existing measures to empirically evaluate
theoretical conceptualizations of wellness. These reviews provided useful
information on select instruments, but they included a small number of
measures and did not cover the full range of approaches to conceptualizing
well-being. In addition, several reviews have been conducted on QoL mea-
sures for patients with particular diseases (e.g., Cella & Tulsky [1990]
reviewed 24 instruments used to measure QoL in cancer patients), but the
applicability of these reviews is focused on specific patient populations. In
the present review, we attempted to address these limitations by evaluating
the full range of published instruments designed to measure well-being
from a psychological perspective.

Method
This review included self-administered instruments that were identified by
their authors as measuring well-being, QoL, or wellness. Instruments were
included if they measured psychological well-being, psychosocial well-
being, or psycho-physical well-being, whereas instruments were excluded if
they addressed either social, economic, or physical well-being alone without

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Cooke et al. 735

including a psychological component. Instruments designed to assess narrow,

domain-specific aspects of well-being (e.g., spiritual well-being; Ellison,
1983) or instruments developed for narrowly defined populations (e.g.,
Hemophilia Well-Being Index; Remor, 2013) were excluded as these mea-
sures were designed specifically for individuals who share a particular char-
acteristic or experience and were not intended to represent a full
conceptualization of well-being for use with the general population. Measures
designed specifically for children were also excluded due to the unique theo-
retical and measurement considerations for this group (for a review of these
issues, see Huebner, 2004). Single-item measures of well-being were included
in this review due to their use in some of the most influential empirical stud-
ies on the topic (e.g., Ryff et al., 2007).
The search for well-being, QoL, and wellness instruments was conducted
using online databases including PsycINFO, Medline, and Google Scholar.
In addition to the terms well-being, quality of life, and wellness, four addi-
tional search terms (flourishing, psychological well-being, life satisfaction,
and happiness) were used in combination with “measurement” in an attempt
to capture all relevant instruments. Reference lists from published reviews of
the psychological well-being literature (e.g., Lent, 2004; McDowell, 2010;
Roscoe, 2009) were also examined to identify any additional instruments.
Use of these procedures yielded 1,519 publications. These publications were
then examined to determine if they actually described a well-being instru-
ment and they met the inclusionary and exclusionary criteria described in the
previous paragraph. In cases where it was unclear whether an instrument
fully met the criteria, the authors discussed the evidence until consensus was
reached. For example, some instruments, such as the Positive Affect and
Negative Affect Schedule (Watson, Clark, & Tellegen, 1988), are often used
along with instruments that are specifically designed to measure well-being,
but were not themselves explicitly designed as stand-alone measures of well-
being; these were consequently excluded from this review. Use of these pro-
cedures resulted in the identification of 42 instruments.
To maintain a uniform approach to presenting information, psychometric
data from the original publication of an instrument are reported. In cases
where an original instrument had been revised, only the revised instrument
was included in this review (e.g., the Psychological General Well-Being
Index–Revised; Revicki, Leidy, & Howland, 1996). Some instruments were
originally presented without psychometric data; in these cases, data reported
are from the Mental Measurements Yearbook (Farmer, 2005; Lonborg, 2007)
or from the earliest publication that reported psychometric data for an instru-
ment (e.g., the Wellness Inventory; Palombi, 1992).

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736 The Counseling Psychologist 44(5)

Results
Overall Observations
A total of 42 instruments were identified as meeting the inclusion criteria for
this review. Most of these instruments were placed into one of the four cat-
egories of well-being approaches (i.e., hedonic, eudaimonic, QoL, or well-
ness) based on the authors’ explicit identification of their instrument with
one of these approaches. All of the wellness and QoL measures were identi-
fied in this way. Most of the hedonic and eudaimonic measures were also
explicitly identified with one of these two approaches. Several were not,
however, although their implicit association with either the hedonic or
eudaimonic approaches was clear, and they were placed into the appropriate
category as a result (i.e., the five single-item measures in the hedonic cate-
gory; the Flourishing Scale and the Social Well-Being Scale in the eudai-
monic category). A fifth category of composite measures was formed
because the authors did not associate them with a particular theoretical
approach to well-being and they combined aspects of hedonic and eudai-
monic approaches along with aspects of QoL and/or wellness approaches.
A variety of authors working over several decades developed the various
instruments included in this review (see Table 1). Diener, Keyes, Cummins,
Myers, Sweeney, and the WHO were the only authors or organizations to
have published two instruments, and no author published three or more
instruments. The publication dates for the instruments suggest that interest in
measuring well-being increased in the late 1980s and has continued to receive
significant attention since that time (the earliest measure was published in
1960 and the most recent measure in 2014).
The instruments varied significantly in length, although most were rela-
tively brief: The number of items across instruments ranged from one to
135; 81% included 36 items or fewer, and the median number of items was
19. Five measures included only a single item, and all of these were
hedonic instruments that measured life satisfaction or happiness. These
single items have often been used in large scale surveys and tend to include
straightforward statements that directly refer to global life satisfaction or
happiness. No reliability or validity evidence was found for any of these
measures.
Most of the reliability coefficients reported for the instruments were
obtained using convenience samples (76%), with the remainder using a ran-
dom sampling technique and/or a nationally or internationally representative
sample. Of the samples, 43% were composed of university students and 38%
included participants from outside the United States.

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 Table 1. Overview of Well-Being Instruments
Reliabilityb

Cronbach’s Test– Validity

Instrument Citationa Scales Items Alpha Retest Evidencec Definitiond

Hedonic
Australian Cummins, Eckersley, 2 10 — — 3 Measures overall life satisfaction and seven domain-specific areas of
Unity Index Pallant, Van Vugt, satisfaction (standard of living, health, achievement in life, personal
of Subjective & Misajon, 2003 relationships, how safe you feel, community connectedness, and
Well-Being future security).
Delighted- Andrews & Crandall, 1 6 — .70–.80e 1 Measures feelings regarding domain specific and global life satisfaction
Terrible Scale 1976 over the past year on Likert-type scale ranging from delighted to
terrible.
European European Social — 1 — — 0 “Taking all things together, how happy would you say you are with
Social Survey Survey, 2014 your life?” (p. 14).
Happiness Item
Happiness Fordyce, 1988 1 2 — .59–.98 3 Measures level of happiness and average percentage of time when one
Measures feels happy, unhappy, or neutral.
Ladder of Life Cantril, 1965 — 1 — — 0 “Please imagine a ladder with steps numbered from zero at the
Scale bottom to ten at the top. The top of the ladder represents the best
possible life for you and the bottom of the ladder represents the
worst possible life for you. On which step of the ladder would you
personally say you stand?”
Life Satisfaction Hagedorn, 1996 1 9 — .56–.64 1 Measures satisfaction with past circumstances, what one made of those

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Research past circumstances, and total satisfaction.
Questionnaire
MIDUS Ryff et al., 2007 — 1 — — 0 “At present, how satisfied are you with your life?” (p. 91).
II–Satisfied
With Life item

(continued)

737
 738
Table 1. (continued)
Reliabilityb

Cronbach’s Test– Validity

Instrument Citationa Scales Items Alpha Retest Evidencec Definitiond

National Survey, Gurin, Veroff, & — 1 — — 0 “Taking all things together, how would you say things are these days—
University Feld, 1960 would you say that you are very happy, pretty happy, or not too
of Michigan– happy?”
Happiness Item
Satisfaction With Diener, Emmons, 1 5 .87 .82 2 “A global assessment of a person’s quality of life according to his own
Life Scale Larsen, & Griffin, chosen criteria” (Shin & Johnson, as cited in Diener et al., 1985,
1985 p. 71).
Short Joseph, Linley, 1 6 .77–.92 .68 3 Measures level of depression and happiness.
Depression- Harwood, Lewis, &
Happiness McCollam, 2004
Scale
Subjective Lyubomirsky & 1 4 .79–.94 .55–.90 3 Measures level of happiness and comparison of level of happiness to
Happiness Lepper, 1999 others.
Scale
World Values World Values — 1 — — 0 “All things considered, how satisfied are you with your life as a whole
Survey Survey, 2012 these days?” (p. 3).
Eudaimonic
Basic Needs Johnston & Finney, 3 21 — — 3 “Needs [for autonomy, competentness, and relatedness] are innate,
Satisfaction in 2010 psychological, and essential for well-being” (p. 280).

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General
Flourishing Scale Diener et al., 2010 1 7 .81–.87 — 1 “Designed to measure social-psychological prosperity” (p. 144) as
defined by positive social relationships, purposeful and meaningful life,
engagement and interest in one’s activities, and feeling competent
and capable in activities that are important to the individual.

(continued)
 Table 1. (continued)
Reliabilityb

Cronbach’s Test– Validity

Instrument Citationa Scales Items Alpha Retest Evidencec Definitiond

Questionnaire Waterman et al., 1 21 .85 — 3 Measures “. . . well-being incorporating both subjective and objective
for Eudaimonic 2010 elements. The subjective elements are experiences of eudaimonia/
Well-Being feelings of personal expressiveness. The objective elements include
those behaviors involved in the pursuit of eudaimonic goals such
as self-realization entailing the identification and development of
personal potentials and their utilization in ways that give purpose and
meaning to life” (p. 43).
Scales of Ryff, 1989 6 120 .86–.93 .81–.88 1 Measures self-acceptance, positive relations with others, autonomy,
Psychological environmental mastery, purpose in life, and personal growth.
Well-Being
Social Well-Being Keyes, 1998 5 14 .41–.73 — 2 Measures social aspects of well-being, including meaningfulness of
Scale society, social integration, acceptance of others, social contribution,
and social actualization.
Quality of life
Assessment Richardson, Iezzi, 10 35 .51–.96 — 3 Measures level of happiness, presence of negative symptoms, coping
of Quality of Khan, & Maxwell, abilities, positive social relationships, sense of self-worth, ability to
Life–8D 2014 live independently, level of pain, and functioning of senses (vision,
hearing, and communication).
Comprehensive Cummins, McCabe, 3 21 .39–.75 — 0 Measures life satisfaction subjectively, objectively, and weighted by

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Quality of Life Romeo, & Gullone, importance according to the respondent.
Scale 1994
Quality of Life Frisch, Cornell, 1 17 .77–.89 .80–.91 2 Measures overall life satisfaction, consisting of the sum of satisfaction in
Inventory Villanueva, & particular areas of life.
Retzlaff, 1992

(continued)

739
 740
Table 1. (continued)
Reliabilityb

Cronbach’s Test– Validity

Instrument Citationa Scales Items Alpha Retest Evidencec Definitiond

WHO Quality of WHOQOL Group, 4 100 .68–.88 — 2 “Individuals’ perception of their position in life in the context of the
Life Scale 1998 culture and value systems in which they live and in relation to their
goals, expectations, standards and concerns. It is a broad ranging
concept affected in a complex way by the persons’ physical health,
psychological state, level of independence, social relationships and
their relationship to salient features of their environment” (p. 1570).
Wellness
Five Factor Lonborg, 2007f 23 73 .89–.98 — 3 Measures five second-order factors identified as the creative self, the
Wellness (Myers & Sweeney) coping self, the social self, the essential self, and the physical self.
Evaluation of
Lifestyle
Life Assessment Palombi, 1992f 11 100 .64–.93 — 2 “Designed to help students assess their current level of wellness and
Questionnaire– (Hettler and the the potential risks or hazards that they choose to face at that point
Wellness National Wellness in their life” (p. 221). Measures the 10 dimensions of physical fitness,
Assessment Institute) nutrition, self-care, drugs and driving, social environment, emotional
Questionnaire awareness, emotional control, intellectual, occupational, and spiritual.
Optimal Living Renger et al., 2000 6 135 .78–.95 .53–.86 3 “Wellness represents the optimum state of well-being that each
Profile individual is capable of achieving, given his or her own set of
circumstances . . . . Wellness embodies a way of living that encourages

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individuals to seek a balance in their lifestyle designed to improve the
quality of life” (p. 404). Measures environmental, intellectual, spiritual,
emotional, social, and physical health.

(continued)
 Table 1. (continued)
Reliabilityb

Cronbach’s Test– Validity

Instrument Citationa Scales Items Alpha Retest Evidencec Definitiond

Perceived Adams, Bezner, & 6 36 .64–.81 — 3 “The Perceived Wellness Survey is a slautogenically-oriented, multi-
Wellness Steinhardt, 1997 dimensional measure of perceived wellness perceptions in the
Survey physical, spiritual, psychological, social, emotional, and intellectual
dimensions” (p. 212).
TestWell Owen, 1999 11 100 .56–.92 — 1 “Wellness is the process by which one responsibly identifies areas
of life in need of improvement and subsequently makes choices
conducive to a more satisfying lifestyle . . . . [TestWell] measures the
extent to which lifestyle behaviors reflect potential risks and hazards”
(p. 180).
Wellness Farmer, 2005f 17 131 .60–.89 — 1 Wellness is defined as “a way of life oriented toward optimal health
Evaluation of (Myers, Sweeney, and well-being in which the body, mind, and spirit are integrated
Lifestyle & Witmer) by the individual to live more fully within the human and natural
community” (Myers, Sweeney, & Whitmer, as cited in Farmer, 2005).
Wellness Palombi, 1992f (J. W. 13 120 .52–.93 — 2 “Growth oriented . . . measurement designed to stimulate new ways of
Inventory Travis) approaching personal issues” (p. 221). Measures self-responsibility
and love, breathing, sensing, eating, moving, feeling, thinking, playing
and working, communicating, sex, finding meaning, and transcending.
Composite
12-Item Pouwer, Van der 4 12 .73–.91 .66–.83 3 Measures negative affect, positive affect, and energy.

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Well-Being Ploeg, Ader, Heine,
Questionnaire & Snoek, 1999
Authentic Zabihi, Ketabi, 1 24 .93 — 1 Designed to measure pleasure, engagement, meaning in life, and
Happiness Tavakoli, & interpersonal connectedness as components of happiness.
Inventory Ghadiri, 2014

(continued)

741
 Table 1. (continued)

742
Reliabilityb

Cronbach’s Test– Validity

Instrument Citationa Scales Items Alpha Retest Evidencec Definitiond

COMPAS-W Gatt, Burton, 7 26 .55–.84 .19–.83 3 Measures life satisfaction, mastery, achievement, positivity, composure,
Schofield, Bryant, & and own worth.
Williams, 2014
Gallup- Gallup-Healthways, 5 10 — — 0 Measures purpose, social relationships, financial management and
Healthways 2014 security, satisfaction with community, and physical health.
Well-Being
Index
General Well- Fazio, 1977 1 18 .91–.95 .85 2 “Self representations of subjective well-being and distress . . . designed
Being Schedule to asses an individual’s mental health or quality of life” (p. 1).
Life Satisfaction Neugarten, 1 20 — — 1 Measures the extent to which one takes pleasure from the round of
Index Havighurst, & activities that constitute everyday life; regards life as meaningful and
Tobin, 1961 accepts resolutely that which life has been; feels one has succeeded
in achieving major goals; holds a positive image of self; and maintains
happy and optimistic attitudes and mood.
Medical McHorney, Ware, 8 36 .78–.93 — 3 Measures physical functioning, role limitation due to physical problems,
Outcome Lu, & Sherbourne, bodily pain, general mental health, role limitation due to emotional
Studies Short- 1994; McHorney, problems, social functioning, vitality, and general health perceptions.
Form 36 Health Ware, & Raczek,
Survey 1993
Mental Health Keyes et al., 2008 4 14 .59–.74 — 2 Emotional well-being is defined as positive affect/satisfaction with

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Continuum life; social well-being is defined by Keyes’s five factors of social
Short Form acceptance, social actualization, social contribution, social coherence,
and social integration; psychological well-being is defined by Ryff’s six
factors of self-acceptance, positive relations with others, autonomy,
environmental mastery, purpose in life, and personal growth

(continued)
 Table 1. (continued)
Reliabilityb

Cronbach’s Test– Validity

Instrument Citationa Scales Items Alpha Retest Evidencec Definitiond

Oxford Argyle, Martin, & 1 29 .9 .78 2 A broad measure of personal happiness designed to mirror the Beck
Happiness Crossland, 1989 Depression Inventory in format.
Inventory
Oxford Hills & Argyle, 2002 1 29 .91 — 3 “a broad measure of personal happiness” (p. 1073).
Happiness
Questionnaire
Pemperton Hervás & Vázquez, 3 21 .82–.93 — 3 Covers multiple domains of well-being (i.e., general, hedonic,
Happiness 2013 eudaimonic, and social), assesses overall remembrance of well-being
Index and experience of well-being yesterday, and is validated in multiple
countries and languages.
Psychological Revicki, Leidy, & 7 22 .44–.95 — 1 “Designed to measure self-representations of interpersonal affective
General Howland, 1996 or emotional states reflecting a sense of subjective well-being or
Well-Being distress” (p. 419).
Index–Revised
Warwick- Tennant et al., 2007 1 14 .89–.91 .83 3 “A wide conception of well-being, including affective-emotional aspects,
Edinburgh cognitive-evaluative dimensions and psychological functioning . . . by
Mental Well- focusing wholly on the positive” (p. 64).
Being Scale
WHO-Ten Well- Bech, Gudex, & 1 10 .85 — 3 Measures the absence of negative symptoms (i.e., anxiety, depression)
Being Index Staehr Johansen, and the presence of positive symptoms (e.g., energy).

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1996

Note. Dashes indicate information was not provided in the cited publication or is nonapplicable.
aCitation provided for original publication from which the data are derived, unless otherwise noted. bRanges for reliability coefficients listed when coefficients for multiple
subscales were reported and/or when multiple test–retest coefficients were reported. c0 = no validity evidence present in original study; 1 = one type of validity evidence present in
original study; 2 = two types of validity evidence present in original study; 3 = three or more types of validity evidence present in original study. dDefinitions in quotes are directly quoted
from cited publication; otherwise, the definitions are developed by the authors of this review. eData found in McDowell (2010). fCited publication is from a review of the
instrument; the instruments’ authors are indicated in parentheses.

743
744 The Counseling Psychologist 44(5)

The reliability coefficients reported for the instruments varied widely, and
were frequently at levels too low for many research and clinical purposes
(reliability coefficients of .70 or greater are commonly considered adequate
for research purposes, whereas coefficients of .90 or greater are considered
adequate for many clinical purposes; Nunnally & Bernstein, 1994). Reported
Cronbach’s alpha internal consistency coefficients ranged from .39 to .98.
Only 33% of the reports of instruments included estimates of test–retest reli-
ability, and these ranged from .19 to .98.
Definitions of the constructs assessed by each instrument are provided in
the final column of Table 1. The reports of these instruments varied signifi-
cantly in terms of their explicit operational definitions of the constructs they
were attempting to measure. In some cases, verbatim definitions are pro-
vided, whereas paraphrased definitions are provided when succinct defini-
tions could not be found. In the case of the single-item measures, the item
itself typically provided the clearest definition of the construct measured.
Definitional issues are discussed in more detail in the next section.
There was substantial variability in the amount and types of validity evi-
dence presented regarding the instruments. Tests of validity included exami-
nations of convergent, discriminant, predictive, and content validity as well
as exploratory and confirmatory factor analyses. To illustrate the range in the
types of validity evidence presented across these instruments, reports of
instruments that included no validity evidence were assigned a 0, instruments
with one type of validity evidence reported were assigned a 1, instruments
with two types of validity evidence were assigned a 2, and instruments with
three or more types of validity evidence were assigned a 3 (see Table 1). This
rating illustrates the variability in the ways validity was addressed across
these instruments, but the amount and quality of the validity evidence pre-
sented for these instruments varied greatly and are not reflected in these rat-
ings. Given that most modern psychometricians consider construct validity to
be the overarching concern that subsumes all other types of validity evidence
(Messick, 1995), and given that there is significant lack of clarity about the
nature of the construct or constructs measured by well-being instruments,
reporting more specific information regarding the amount and quality of the
validity evidence regarding these instruments was viewed as premature and
potentially misleading. These issues are discussed more extensively below.
Table S1 (available online at tcp.sagepub.com/supplemental) provides a
listing of the constructs assessed by all the instruments taken as a whole.
Many of the subscales in the instruments had slightly different titles but
appeared to measure very similar constructs; in these cases, the subscales
were placed into the category that most closely matched the item content of
the subscale (e.g., the Social Functioning subscale in the Medical Outcome

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Cooke et al. 745

Studies Short-Form 36 as well as all five subscales in the Social Well-Being

Scale were categorized in the “social well-being” factor). In the interest of
parsimony, subscales that measured different constructs that fell under a
somewhat broader category were also combined (e.g., the Psychological
General Well-Being Index–Revised subscales for Anxiety and Depressed
Mood are placed under the “negative affect” factor). In a small number of
cases, reports of instruments did not include a definition or sample items for
individual subscales (e.g., the Breathing and Sensing subscales of the
Wellness Inventory), and they were not included in the tabulation presented
in Table S1 as a result. Therefore, Table S1 illustrates the general domains
assessed by existing well-being instruments but does not provide an exhaus-
tive account of the specific elements measured across all the instruments. To
further organize the factors identified through this analysis, the individual
factors were also grouped into biological, psychological, or sociocultural
domains of functioning, although it was not always possible to clearly cate-
gorize the subscales (e.g., the Vitality/Energy subscales usually focused on
physical energy but also referred to mental energy in some instruments).
Taken together, the number of factors measured across the instruments
ranged from one to 11, with the Wellness Evaluation of Lifestyle and the
Pemperton Happiness Index assessing 11 factors and the Satisfaction With
Life Scale, the Social Well-Being Scale, and all of the single-item measures
assessing one factor. Positive affect was the most commonly measured factor
(in 21 of the 42 instruments), whereas the factor “social role limitations” was
measured in just one instrument.

Examination of Instruments by General Category

Hedonic instruments. A total of 12 instruments were categorized as falling
into the hedonic approach to conceptualizing well-being; five of these con-
tained a single item. Test–retest reliability was reported for 50% of the instru-
ments (range = .55–.98), and Cronbach’s alpha was reported for 57% of the
multi-item measures (range = .77–.94). No validity evidence was reported for
the single-item measures, whereas 71% of the multi-item instruments
reported at least two types of validity evidence.
All of the instruments in this category included a measure of life satisfaction
or positive/negative affect. All the instruments measuring life satisfaction
assessed global satisfaction, although some also assessed satisfaction in specific
life domains. The Happiness Measures and the Subjective Happiness Scale
measure the positive and negative affective components of subjective well-
being but do not measure life satisfaction. Only one instrument (i.e., the Short
Depression-Happiness Scale) assessed both life satisfaction and positive affect,

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746 The Counseling Psychologist 44(5)

and no instrument was found that measured life satisfaction, positive affect, and
negative affect, the three components that are included in the most prominent
hedonic approach to conceptualizing well-being (Diener et al., 1985).

Eudaimonic instruments. Five instruments were identified as being based on a

eudaimonic conceptualization of well-being. These instruments tend to be
relatively brief with no more than 21 items, except for the Scale of Psycho-
logical Well-Being (120 items). Four of the five instruments reported internal
consistency coefficients (range = .41–.93). Test–retest reliability was reported
only for the Scale of Psychological Well-Being (range = .81–.88 across the
subscales). All of these measures presented some validity evidence, with
60% presenting at least two types.
The eudaimonic instruments are much more heterogeneous in their defini-
tions of well-being compared with the hedonic instruments. All the measures
shared an emphasis on the fulfillment of human potential and/or optimal
functioning, but there was no consensus regarding the critical components of
this conceptualization of well-being (see Table S1). Several of these instru-
ments included factors that would appear to fall outside common conceptual-
izations of eudaimonia. For example, most of the items on the Social
Acceptance and Social Actualization subscales of Keyes’s (1998) Social
Well-Being Scale inquire about respondents’ judgments or attitudes regard-
ing others in society or society as a whole (e.g., beliefs regarding others’
kindness or society’s progress), factors that are not usually included in defini-
tions of eudaimonic well-being or optimal functioning.
No single factor was found in common across the five eudaimonic instru-
ments. Environmental mastery, purpose or meaning in life, and positive rela-
tions with others were the most common factors and were included in three
out of the five scales. Only two factors were measured exclusively in a single
instrument (i.e., self-worth/self-esteem in the Scale of Psychological Well-
Being, and achievement in the Questionnaire for Eudaimonic Well-Being).
Four of the five eudaimonic instruments included at least one socially ori-
ented factor, whereas none included a biologically oriented factor.

Quality-of-life instruments. The four instruments whose authors specifically

identified them as QoL measures varied significantly in length (range = 17–
100 items). Internal consistency coefficients ranged from .39 to .96, and no
data regarding test–retest reliability were reported for any of these instru-
ments. The amount and type of validity evidence reported for these scales
also varied significantly.
All the measures in this category were explicitly identified as measuring
QoL or were specifically based on the literature in this area. The Quality of

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Cooke et al. 747

Life Inventory would also fit in the hedonic category as it only measures life
satisfaction, but it was placed in this category because of its identification
with QoL. Except for this instrument, the other three measures are more com-
prehensive than most of the instruments in other categories. Three of the four
instruments include at least two factors in each of the three biopsychosocial
categories, and all of them measure positive affect, negative affect, and posi-
tive relations with others. Three of the four instruments also measure global
life satisfaction. The Comprehensive Quality of Life Scale offers a unique
contribution in the measurement of life satisfaction by asking respondents to
rate (a) their satisfaction with each of seven life domains and (b) the impor-
tance they place on each domain in their personal lives.

Wellness instruments. The seven instruments whose authors specifically iden-

tified them as wellness measures tend to include a larger number of items
than most of the other well-being instruments—only two of these had less
than 100 items (range = 36–135). Two of these instruments (the Wellness
Evaluation of Lifestyle [WEL] and Five Factor Wellness Evaluation of Life-
style [5F-WEL]) were developed by the same authors and are very similar in
content and theoretical orientation, with the only differences being number of
items and factor structure. Internal consistency was reported for all instru-
ments (range = .52–.98), and test–retest reliability was reported for only one
measure. Some form of validity evidence was presented for all of these
instruments, with 71% reporting at least two types of validity evidence.
There was significant variability in the conceptualizations of wellness
used to develop these measures. Some of these instruments defined wellness
primarily in terms of a process that is oriented toward personal improvement
(e.g., TestWell, Wellness Inventory), whereas others defined wellness as an
optimal state of well-being or a way of life oriented toward optimal well-
being (e.g., Optimal Living Profile, WEL, 5F-WEL). These measures also
tended to incorporate factors that extend beyond those included in the other
categories of well-being instruments (e.g., intellectual wellness, spiritual
wellness). Some factors were unique to these instruments such as nutrition,
physical fitness, spirituality, and occupational wellness, and these four fac-
tors were also the most commonly measured across the wellness instruments.
Except for the Wellness Inventory and the Life Assessment Questionnaire, all
the instruments measured at least one biological, psychological, and one
social factor, although fewer social factors were represented within this group
of instruments. No single factor was included in all these instruments, yet all
of them measured spirituality except for the Wellness Inventory. Similar to
the eudaimonic measures, none of the wellness instruments included assess-
ments of life satisfaction or positive/negative affect.

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748 The Counseling Psychologist 44(5)

Composite instruments. A total of 14 instruments were identified as composite

measures of well-being because their authors did not identify them as belong-
ing in one of the previous categories, and they combined aspects of hedonic
and eudaimonic approaches as well as aspects of QoL and/or wellness
approaches. These instruments were all relatively brief (range = 10–36
items). Internal consistency coefficients were presented for 86% of these
instruments (range = .44–.95), and test–retest reliability data were presented
for 36% of these instruments (range = .19–.85). Validity evidence was pre-
sented for 93% of the instruments, with 71% presenting at least two types of
validity evidence.
Like the eudaimonic, QoL, and wellness measures, there was significant
variability in the constructs assessed by the composite instruments. The con-
ceptualization of well-being underlying these instruments was also generally
broader than was the case for the hedonic and eudaimonic measures. The
majority of these instruments included biological factors (79%), and over
half (57%) included social factors. Overall, 43% included at least one bio-
logical, psychological, and social factor. The total number of factors mea-
sured by each instrument ranged from three to 11, and 93% measured positive
affect, 71% measured vitality/energy and negative affect, 57% measured
global life satisfaction, and 50% measured purpose/meaning in life. The
Pemperton Happiness Index was the most comprehensive composite measure
(11 factors), whereas the 12-Item Well-Being Questionnaire was the least
comprehensive (three factors).

Discussion
The number of instruments developed to measure various aspects of well-
being has been steadily growing. These instruments are also being applied in
a variety of research, clinical, and public policy arenas, suggesting that posi-
tive conceptualizations of health and well-being are useful for an increasing
number of purposes. A wide variety of perspectives have been applied to
measure the construct of well-being, however, and the literature remains
unsettled regarding many aspects of this topic. There are several important
issues that researchers, clinicians, and public policy makers need to consider
when using these instruments.
The comprehensive approach taken in this review resulted in the identifi-
cation of a wide variety of instruments that were designed to measure vari-
ous aspects of health and well-being. The range of instruments and the
variety in their underlying conceptualizations suggest that there is little or no
consensus as to what constitutes well-being and how it should be measured.
This review found not only wide divergence across the different theoretical

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Cooke et al. 749

conceptualizations of well-being, but also divergence in how well-being is

operationalized within particular theoretical categories. Constructs such as
life satisfaction, positive affect, and positive relations with others are
assessed by many of the instruments, but no single construct was found to be
included in more than one half of the instruments (although positive affect
was included in 50% of the instruments). This was also generally the case
within the four broad theoretical approaches to conceptualizing well-being.
The hedonic measures tended to share greater similarity in terms of the con-
ceptualization of well-being, but the eudaimonic, QoL, and wellness mea-
sures varied considerably even when compared to other measures within the
same category. This was the case for the composite measures as well.
Clearly, there is significant diversity of thought when it comes to defining
and measuring the construct of well-being.
Diversity in the way well-being is conceptualized and measured is also
reflected in the terms used to identify the various measures and their sub-
scales. In some cases, different terms were used to refer to a very similar
conceptualization of well-being (e.g., the use of “happiness” appears indistin-
guishable from “life satisfaction” in the European Social Survey, 2014;
Renger et al., 2000, p. 404, noted that “wellness represents the optimum state
of well-being” with regard to the Optimal Living Profile). There appeared to
be no distinction between the terms “quality of life” and “subjective well-
being” in the Quality of Life Inventory (Frisch et al., 1992), but this scale also
appears to measure life satisfaction, which is usually thought of as related to
the hedonic conceptualization of well-being rather than the QoL approach.
The inconsistent use of terminology and definitions is likely to lead to confu-
sion for researchers, clinicians, and policy makers who investigate health and
well-being and base decisions on data obtained with these instruments.
The most comprehensive measures of well-being we reviewed tended to
be those designed to measure QoL. All but one of the QoL instruments mea-
sured a variety of factors in each of the three biopsychosocial domains which
may make these instruments useful for researchers and clinicians seeking a
comprehensive assessment of health and well-being. These instruments were
generally developed out of the medical field, which may be why physical
functioning and perhaps also social and vocational functioning were included
in these measures.
The construct of life satisfaction was the focus of many of the instruments
included in this review and was frequently used as the operationalization of
well-being. This approach has important advantages but also limitations.
Given the lack of agreement on how to conceptualize well-being, inquiring
about one’s subjective global assessment of one’s level of life satisfaction
avoids the thorny issues related to defining the construct, a major advantage

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750 The Counseling Psychologist 44(5)

considering the state of the literature in this area. Nonetheless, researchers

hold a variety of views about whether ratings of life satisfaction reflect well-
being, one’s present emotional state, a general personality characteristic such
as optimism or extraversion, or some other construct (Jayawickreme et al.,
2012). The varying viewpoints on what comprises life satisfaction and well-
being is also reflected in the wide range of instruments included in this
review, the majority of which do not assess life satisfaction specifically.
Taken as a whole, the well-being measures reviewed tend to be oriented
toward intrapsychic dimensions of functioning. The major exception are
the hedonic measures, most of which focus on global life satisfaction,
which presumably includes external factors as well as intrapsychic func-
tioning (i.e., respondents are usually asked to rate their life satisfaction as a
whole and they are free to choose their own criteria for making their rat-
ings). Nonetheless, the reviewed instruments as a whole do not specifically
emphasize factors that are often considered important to well-being, such
as ability to satisfy basic needs or adequacy of financial income. The level
of functioning of one’s family system is also largely excluded from these
instruments, an omission that may reflect a Western individualistic orienta-
tion to conceptualizing health and well-being. Thus, the instruments may be
less relevant for use in cultures that emphasize the health and well-being of
one’s family or community. Sexual health and sexuality are other important
aspects of many people’s lives that are generally excluded from consider-
ation in these instruments. In addition, few of the instruments measure
socioeconomic and sociocultural factors related to an individual’s experi-
ence of systemic oppression or marginalization as it relates to well-being.
This review was, of course, limited to measures that included some aspect
of psychological well-being, and intrapsychic functioning was likely
emphasized in this group of instruments as a result. Nonetheless, the spe-
cific factors included in these instruments raise questions regarding the cul-
tural sensitivity and the content-related validity of these measures as a
whole. These questions have not received extensive examination in the
empirical research on these instruments.
For many of the measures, the evidence available to evaluate their psycho-
metric characteristics was limited. The reliability coefficients for several
instruments were low and sometimes lower than what is recommended even
for research purposes. The degree of evidence provided to document the
validity of several instruments was minimal, and there seemed to be a reli-
ance on face validity in many cases. This is generally a larger problem when
the instruments are used for clinical or social policy purposes than for research
purposes, although focusing more on these issues would obviously also
advance research on the nature and measurement of well-being.

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Cooke et al. 751

The limitations of this review need to be taken into account because they
affect the results. First, although extensive efforts were made to include all
published instruments that met the inclusion criteria, it is certainly possible
that some instruments were not found. The exclusion of domain-specific,
population-specific, and child- and adolescent-specific instruments also may
have inadvertently excluded instruments that provide a more comprehensive
or fundamentally different approach to measuring well-being. The attempt to
include all self-report instruments that assessed psychological well-being,
including those beyond the usual focus on hedonic and eudaimonic approaches
(i.e., that also addressed QoL and wellness), had the advantage of making
broad observations at more general levels of analysis, but the ability to con-
duct detailed analyses of particular instruments was limited as a result (e.g.,
a more detailed examination of the psychometric characteristics of items,
subscales, and scales).

Conclusions and Suggestions for Future Research

Clearly there is still significant work to do regarding the measurement of
well-being. In fact, a substantial amount of research still needs to be con-
ducted before greater consensus will be reached on how well-being can be
measured in a valid manner. The literature reviewed does not suggest consen-
sus regarding an exemplary instrument for measuring well-being. The only
area one might consider to present an exemplary measurement approach is
within the hedonic approach to conceptualizing well-being. Within this
school of thought, there are very well established measures for assessing life
satisfaction (e.g., Satisfaction With Life Scale; Diener et al., 1985) where
respondents are given the responsibility to interpret the meaning of life satis-
faction for themselves. Presumably individuals respond to these questions by
identifying the criteria that are important to them and then rate their satisfac-
tion with those elements on the basis of whatever intuitive or explicit factors
they choose. This approach has the major advantage of avoiding the difficult
definitional issues discussed earlier, although it leaves open questions about
exactly what is being measured by these approaches. For researchers, clini-
cians, and policy makers needing information regarding the particular com-
ponents that contribute to life satisfaction or well-being, a variety of measures
are available that capture important physical, psychological, and social
aspects of health and well-being. It is unclear, however, what range of com-
ponents should be included, and there appears to be no single instrument that
captures WHO’s (1948) multidimensional conceptualization of health that
refers to “a state of complete physical, mental, and social well-being and not
merely the absence of disease and infirmity.”

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752 The Counseling Psychologist 44(5)

More research is needed to identify the important biopsychosocial com-

ponents of well-being and whether there are aspects of health and well-
being that can be reliably differentiated from constructs such as life
satisfaction, happiness, QoL, and wellness. This research would be aided
by greater consensus regarding criteria for identifying individuals with high
and low levels of well-being. One proposed solution was offered by Keyes
(2002) who distinguished between individuals who are “flourishing” and
those who are “languishing” based on their scores on measures of affect,
psychological well-being (i.e., Ryff’s psychological well-being model;
Ryff, 1989), and social well-being (Keyes, 1998). Keyes’s criteria for plac-
ing individuals into these two groups were not made independently, how-
ever, but were based on specific theories and measures of well-being.
Nonetheless, investigations into the characteristics, circumstances, and life
experiences of individuals in groups such as these could help uncover pre-
dictors and outcomes of well-being that would help clarify the nature of the
construct. Another approach to clarifying the important components of
well-being is to test the process models of well-being that have been pro-
posed by researchers such as Lent (2004) and Jayawickreme et al. (2012).
Testing these models in various configurations through structural equation
modeling and other procedures may help identify constructs that are more
appropriately conceptualized as inputs of well-being, mediators and mod-
erators of well-being, or outcomes of well-being.
The cross-cultural validity of these constructs is also an open question at
this point, and more research that measures well-being across sociocultural
groups might be very helpful for clarifying the nature of well-being. For
example, future research might employ multiple approaches to measuring
well-being along with individual difference variables such as personality and
psychopathology in diverse samples that include a variety of sociocultural
subgroups (e.g., based on race/ethnicity, socioeconomic status, age, religion/
spirituality, or ability status). Fine-grained examinations of these data might
clarify the extent to which particular conceptualizations of well-being are
generalizable across individuals and subgroups.
The results of this review also suggest a need for greater discussion and
theoretical clarification across schools of thought within psychology as well
as across well-being researchers from the medical and behavioral science
discipline. Doing so may help clarify relationships among physical health and
functioning, psychological well-being, family and community functioning,
vocational and economic well-being, and perhaps several additional variables.
Such an approach may ultimately provide a much more comprehensive under-
standing of health and well-being that will be useful across a variety of human
service professions as well as for guiding social policy and public health

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Cooke et al. 753

interventions. Greater clarity about the nature and measurement of well-being

will better equip health care researchers and clinicians to identify and address
deficits in well-being, increase public understanding about well-being and
how to develop it, and provide clearer direction for policy makers interested in
promoting societal well-being. The importance of the clinical, psychoeduca-
tional, and social policy implications of these questions suggests that this
research should be a priority.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding
The authors received no financial support for the research, authorship, and/or publica-
tion of this article.

Supplemental Material
Table S1 is available online at tcp.sagepub.com/supplemental.

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Author Biographies
Philip J. Cooke is a doctoral candidate in counseling psychology at Marquette
University. His research interests include the psychosocial well-being of gender and
sexual minorities, and the promotion of well-being for minority populations through
psychotherapy.
Timothy P. Melchert is a member of the counseling psychology faculty at Marquette
University. He received his PhD in counseling psychology from the University of
Wisconsin-Madison.
Korey Connor is a doctoral candidate in counseling psychology at Marquette
University. He received his MA from the University of St. Thomas. His research
interests include psychological well-being and integrative models of well-being in
particular.

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