The Veterinary Journal 187 (2011) 397–398
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The Veterinary Journal
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Short Communication
Validation of the Warwick–Edinburgh Mental Well-being Scale (WEMWBS) as
an overall indicator of population mental health and well-being in the
UK veterinary profession
David J. Bartram a,*, Ghasem Yadegarfar b,1, Julia M.A. Sinclair a, David S. Baldwin a
a
University Department of Mental Health, Division of Clinical Neurosciences, School of Medicine, University of Southampton, Royal South Hants Hospital,
Brintons Terrace, Southampton SO14 0YG, UK
b
Research and Development Support Unit, School of Medicine, University of Southampton, Level C, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
a r t i c l e
i n f o
Article history:
Accepted 15 February 2010
Keywords:
Warwick–Edinburgh Mental Well-being
Scale
Veterinary surgeons
a b s t r a c t
The Warwick–Edinburgh Mental Well-being Scale (WEMWBS) was evaluated as an indicator of mental
health and well-being within the veterinary profession in a cross-sectional study among a representative
sample of 3200 veterinary surgeons practising in the UK. The WEMWBS mean score for the sample was
48.85 (95% confidence interval 48.43–49.28). The score showed a negative correlation with anxiety and
depressive symptoms and a positive correlation with favourable psychosocial working conditions. A 1
unit increase in score was associated with reduced odds of reporting having experienced suicidal
thoughts in the previous 12 months, and reduced odds of reporting depressive or anxiety symptoms of
clinical significance. The results support the validity of the scale as an overall indicator of population
mental health and well-being for this occupational group.
Ó 2010 Elsevier Ltd. All rights reserved.
Mental ill-health appears to be prevalent in the UK veterinary
profession (Bartram et al., 2009). The identification of an instrument with validity as an overall indicator of population mental
health and well-being, suitable for inclusion within, for example,
the Royal College of Veterinary Surgeons (RCVS) Survey of the Profession, would facilitate the monitoring of trends within the profession (Bartram et al., in press). This paper investigates the
potential for the Warwick–Edinburgh Mental Well-being Scale
(WEMWBS) (Tennant et al., 2007), an instrument developed to
monitor positive mental well-being at a population level, to be
used for this purpose. Associations with other standardised measures assessing different dimensions of mental health and working
conditions were examined in a cross-sectional study of veterinary
surgeons practising in the UK. We hypothesised that WEMWBS
scores would show negative associations with scales assessing psychological distress.
The WEMWBS comprises 14 positively phrased items which
measure positive affect (such as feelings of optimism, cheerfulness,
and relaxation), psychological functioning (for example, energy,
clear thinking, self-acceptance, and competence) and interpersonal
relationships. Each item is scored (based on experience over the previous 2 weeks) on a 5-point Likert-style scale from ‘none of the time’
(1) to ‘all of the time’ (5). The overall score is the sum of each item
* Corresponding author. Tel.: +44 2380 825533; fax: +44 2380 234243.
E-mail address: [email protected] (D.J. Bartram).
1
Present address: Department of Biostatistics and Epidemiology, School of Public
Health Sciences, Isfahan University of Medical Sciences, Isfahan 73461-81746, Iran.
1090-0233/$ - see front matter Ó 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.tvjl.2010.02.010
score, giving a possible summary score of 14–70; higher scores indicate higher levels of mental well-being (Tennant et al., 2007). Examples of items used in the WEMWBS include: ‘I’ve been dealing with
problems well’ and ‘I’ve been feeling close to other people’.
The study was reviewed and approved by Southampton and
South West Hampshire Research Ethics Committee (B) (REC reference number: 07/H0504/122). The WEMWBS was embedded in a
120-item questionnaire which was mailed in 2007 to a stratified
random sample of 3200 veterinary surgeons practising in the UK,
comprising approximately 20% of the membership of the RCVS. Replies were anonymous. The questionnaire assessed multiple
dimensions of mental health and well-being using valid and reliable instruments. Anxiety and depressive symptoms were assessed
using the Hospital Anxiety and Depression Scale (HADS) (Zigmund
and Snaith, 1983), psychosocial working conditions with the
Health and Safety Executive Management Standards Indicator Tool
(HSE MSIT) (Cousins et al., 2004), suicidal ideation with questions
developed by Paykel et al. (1974) and alcohol consumption with
the Alcohol Use Disorders Identification Test alcohol consumption
questions (AUDIT-C) (Bush et al., 1998). Further details of the questionnaire are reported elsewhere (Bartram et al., 2009). For up to
three missing WEMWBS responses, the missing scores were imputed using the mean of the remaining items. If more than 3/14
possible responses were missing, the scale was judged as invalid
for that respondent and the case was excluded from the analysis.
Usable questionnaires were returned by 1796 participants, representing a response rate of 56.1%. The demographic and occupational profile of study respondents was generally in close
398
D.J. Bartram et al. / The Veterinary Journal 187 (2011) 397–398
I've been feeling optimistic about the future (n=1795)
I've been feeling useful (n=1789)
I've been feeling relaxed (n=1788)
I've been feeling interested in other people (n=1788)
I've had energy to spare (n=1787)
I've been dealing with problems well (n=1793)
I've been thinking clearly (n=1790)
I've been feeling good about myself (n=1791)
I've been feeling close to other people (n=1788)
I've been feeling confident (n=1791)
I've been able to make up my own mind about things (n=1789)
I've been feeling loved (n=1790)
I've been interested in new things (n=1793)
I've been feeling cheerful (n=1796)
0%
None of the time
Rarely
20%
Some of the time
40%
Often
60%
80%
100%
All of the time
Fig. 1. Warwick–Edinburgh Mental Well-being Scale (WEMWBS) question responses for sample. Imputed values are excluded.
alignment with RCVS membership and the original sample (Bartram et al., 2009). The WEMWBS mean score (± standard deviation,
SD) for the sample was 48.85 (± 9.06) (95% confidence interval, CI
48.43–49.28) and the median score was 49 (inter-quartile range,
IQR, 43–55). The score distribution was near normal, with a slight
negative skew, and the scale did not show floor or ceiling effects.
Item response frequencies showed little evidence of highly skewed
distributions, with each of the response categories for all items
being used by at least one respondent (Fig. 1).
Correlations between scores on the WEMWBS and other scales
were calculated using Pearson correlation coefficients (Bonferroni
correction applied). The WEMWBS score showed a high negative
correlation with anxiety (r = 0.69, P < 0.001) and depressive
symptoms (r = 0.76, P < 0.001). There was a significant
(P < 0.001) low-to-moderate positive correlation with subscales
measuring favourable psychosocial working conditions (low risk
of work-related stress): demands (r = 0.32), control (r = 0.45), managerial support (r = 0.48), peer support (r = 0.50), relationships
(r = 0.37), role (r = 0.45) and change (r = 0.41).
Multiple logistic regression was used to explore any association
between the WEMWBS score and each of the other scales after
adjusting for age, gender and the other scales. A 1 unit increase
in score was associated with a 7% reduction in the odds of reporting having experienced suicidal thoughts in the previous
12 months (odds ratio, OR 0.93, 95% CI 0.90–0.96, P < 0.001). There
was no association with at-risk drinking (i.e. AUDIT-C score P5 for
men or P4 for women) (OR 0.99, 95% CI 0.97–1.02, P = 0.525). A 1
unit increase in the score was associated with a 15% reduction in
the odds of reporting anxiety symptoms of possible or probable
clinical significance (i.e., HADS-A score > 8) or probable clinical significance (HADS-A score > 11) (OR 0.85, 95% CI 0.83–0.87,
P < 0.001). A 1 unit increase in the score was also associated with
a 22% reduction in the odds of reporting depressive symptoms of
possible or probable clinical significance (HADS-D score > 8) (OR
0.78, 95% CI 0.76–0.81, P < 0.001) and a 25% reduction in the odds
of reporting depressive symptoms of probable clinical significance
(HADS-D score > 11) (OR 0.75, 95% CI 0.71–0.79, P < 0.001).
The associations of the WEMWBS score with other standardised
measures in the current study support the validity of the scale as
an overall indicator of population mental health and well-being
for veterinary surgeons. The results are complementary to previous
tests of the criterion validity of the WEMWBS, which are limited to
general population samples and examine correlations with scales
that assess dimensions of mental health and well-being different
from those in the current study (Tennant et al., 2007). Further research is needed to evaluate the sensitivity of the scale to change
and to determine whether the associations can be generalised to
other occupational groups. A shortened (7 item) version of the
WEMWBS, embedded within the 14 item scale, has robust measurement properties and offers an alternative for monitoring mental well-being in populations (Stewart-Brown et al., 2009).
Conflict of interest statement
None of the authors of this paper has any financial or personal
relationship with other people or organisations that could inappropriately bias the content of the paper.
Acknowledgements
We thank the veterinary surgeons throughout the UK who participated in the survey. The study was supported by the Veterinary
Times and BUPA Giving. The Warwick–Edinburgh Mental Wellbeing Scale is jointly owned by NHS Scotland, the University of
Warwick and the University of Edinburgh.
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