General Well-Being Schedule (GWB)

Abstract

The General Well-Being Schedule (GWB) is an established, multidimensional psychometric instrument originally developed by Harold J. Dupuy for the United States National Center for Health Statistics (NCHS). Designed for deployment in broad epidemiological investigations—most notably the landmark First National Health and Nutrition Examination Survey (NHANES I)—the instrument assesses subjective psychological well-being, affective stability, and psychological distress within non-institutionalized community populations. The core assessment inventory comprises 18 self-administered psychometric items measuring subjective states experienced over the preceding month across six distinct subscales: Anxiety, Depression, Positive Well-Being, Self-Control, Vitality, and General Health. Items 1 through 14 utilize 6-point Likert-type response scales anchored by frequency or intensity descriptors, while items 15 through 18 utilize 0-to-10 visual-numerical rating scales anchored by polar emotional or somatic endpoints. The comprehensive instrument additionally includes situational-behavioral indicator items (items 19 through 25) capturing historical mental health crises, formal psychiatric service utilization, and social support availability.

Extensive psychometric investigations have established that the GWB displays robust structural integrity, exceptional internal consistency reliability (full-scale Cronbach’s alpha coefficients regularly ranging from .88 to .95 across diverse population cohorts), and acceptable test-retest stability (coefficients ranging from .68 to .85 across intervals ranging from two weeks to three months). The scale exhibits profound concurrent, convergent, and criterion validity, demonstrating significant correlations with clinical psychiatric evaluations, structured clinician-rated depression scales, the Minnesota Multiphasic Personality Inventory (MMPI), and the Zung Self-Rating Depression Scale. The GWB yields a cumulative continuous score ranging from 0 to 110, stratified into validated thresholds identifying positive psychological well-being (73–110), moderate distress (61–72), and severe psychological distress (0–60), making it an indispensable tool for epidemiological health surveillance, clinical outcome evaluations, and public health research.

Keywords

General Well-Being Schedule, GWB, Harold J. Dupuy, Psychological Well-Being, Psychological Distress, Health and Nutrition Examination Survey, Quality of Life, Psychometrics, Affective Assessment, Epidemiological Mental Health

Authors

The General Well-Being Schedule was conceptualized, formulated, and psychometrically standardized by Harold J. Dupuy, Ph.D., who served as a research psychologist at the Division of Health Examination Statistics within the National Center for Health Statistics (NCHS), U.S. Department of Health, Education, and Welfare (now the U.S. Department of Health and Human Services), located in Hyattsville, Maryland, United States.

Dupuy developed the instrument between 1969 and 1973 specifically to provide a population-based, standardized self-report metric capable of capturing both the positive and negative poles of psychological functioning for nationwide surveillance programs. Major subsequent methodological evaluations, validation trials, and psychometric refinements were conducted in collaboration with prominent psychometricians and epidemiologists, notably Anthony F. Fazio, Ph.D., who conducted the primary concurrent validation study published by the NCHS in 1977, and later clinical researchers who derived the 22-item Psychological General Well-Being (PGWB) Index for biomedical and cardiovascular clinical trials.

Purpose

The primary purpose of the General Well-Being Schedule (GWB) is to provide an efficient, comprehensive, and psychometrically valid measurement of self-perceived psychological well-being and distress among adults within community, epidemiological, and medical settings. Historically, psychiatric epidemiology and clinical psychopathology relied heavily on diagnostic screening tools that were almost exclusively deficit-oriented. Such traditional instruments focused entirely on pathology, functional impairment, psychiatric symptomatology, or overt neurosis (such as the Cornell Medical Index or the Health Opinion Survey). Dupuy recognized that the absence of mental illness does not inherently denote the presence of positive mental health. Consequently, the GWB was deliberately constructed to capture a continuous spectrum extending from severe subjective distress at the negative pole to optimal vitality, cheerfulness, and positive subjective flourishing at the positive pole.

In epidemiological and public health surveillance, the GWB served as the foundational psychological component of the First National Health and Nutrition Examination Survey (NHANES I, 1971–1975), which gathered baseline clinical and psychological profiles on tens of thousands of individuals across the United States. Its broad application allows epidemiologists and health economists to examine the complex interrelations between subjective emotional states, chronic physical health disorders (e.g., hypertension, coronary heart disease, diabetes mellitus), socioeconomic determinants, nutritional profiles, and subsequent mortality rates. Because psychological distress operates as both a direct etiology and a modifying cofactor in physical illness progression, the GWB provides an empirical baseline to quantify the psychological burden of physical diseases.

In clinical trials and evaluative health research, the GWB is employed to monitor patient-reported outcomes (PROs) across pharmacological, psychotherapeutic, and lifestyle interventions. By evaluating distinct facets of psychological functioning—such as energy levels, affective tone, cognitive control, and health preoccupation—investigators can track how specific medical therapies impact patient-centered quality of life. Unlike lengthier psychiatric batteries, the GWB core items can be completed by respondents in 5 to 10 minutes, minimizing participant fatigue while maintaining high diagnostic sensitivity. Furthermore, its situational and behavioral indicator items (items 19 to 25) provide essential contextual data regarding professional mental health service utilization, subjective history of nervous breakdowns, and informal social support systems.

Psychological Construct

The overarching psychological construct measured by the GWB is Subjective Psychological Well-Being, conceived as an integrated, multidimensional affective and cognitive state reflecting an individual’s evaluation of their personal psychological adjustment and internal stability. Rather than assessing external social indicators (such as income, housing, or occupational prestige), the GWB focuses squarely on internal self-representations and subjective emotional experience over a specified temporal window (the past month). Dupuy partitioned this overarching construct into six interconnected yet conceptually distinguishable psychological dimensions:

1. Anxiety

The Anxiety subscale measures the subjective intensity and frequency of generalized nervous tension, free-floating apprehension, internal agitation, and perceived autonomic arousal. Rather than indexing phobic avoidance or circumscribed panic attacks, this dimension captures the persistent feeling of being “on edge,” overwhelmed by worry, or experiencing functional disruption due to somatic nervousness (e.g., Item 2: nervousness; Item 5: feelings of strain, stress, or pressure; Item 8: feeling anxious, worried, or upset; Item 16: subjective tension along a relaxed-tense continuum). Elevated scores indicate calmness, tranquility, and freedom from incapacitating nervous strain.

2. Depression

The Depression dimension evaluates dysphoric mood, feelings of despair, emotional deflation, and existential hopelessness. It assesses the presence of depressive affect wherein the individual questions the value of continued living or experiences pervasive sorrow (e.g., Item 4: feeling so sad, discouraged, or hopeless that one wonders if anything is worthwhile; Item 12: feeling down-hearted and blue; Item 18: positioning oneself along a continuum from depressed to cheerful). High scores on this subscale reflect high morale, affective cheerfulness, and freedom from clinical despondency.

3. Positive Well-Being

Reflecting Dupuy’s commitment to measuring positive psychological states, the Positive Well-Being subscale explicitly quantifies hedonic tone, life satisfaction, and subjective engagement with existence. It evaluates an individual’s general affective optimism and the intrinsic reward found in daily routines (e.g., Item 1: general spirits; Item 6: happiness and satisfaction with personal life; Item 11: daily life being full of interesting things). High scores designate genuine contentment, optimism, and active affective enrichment.

4. Self-Control

The Self-Control subscale captures ego-strength, cognitive integration, and emotional self-regulation. It evaluates the individual’s confidence in their ability to maintain mastery over their behavioral impulses, emotional expressions, and cognitive processes, alongside freedom from fears of cognitive dissolution (e.g., Item 3: firm control of behavior, thoughts, and emotions; Item 7: fear of losing one’s mind or control; Item 13: feeling emotionally stable and self-assured). Lower scores on this dimension often signal impending crisis, severe emotional lability, or perceived cognitive decompensation.

5. Vitality

The Vitality dimension assesses somatic energy, physical and mental vigor, recuperative rest, and resistance to psychophysiological exhaustion. It differentiates between restorative sleep states and debilitating fatigue (e.g., Item 9: waking up fresh and rested; Item 14: feeling tired, worn out, or exhausted; Item 17: ratings of energy, pep, and vitality). This subscale bridges somatic health perceptions and emotional vitality, serving as a sensitive indicator of both clinical depression and chronic medical morbidity.

6. General Health

The General Health subscale reflects the cognitive appraisal of one’s physical condition and the degree to which somatic distress or hypochondriacal anxiety occupies attention. It captures somatic preoccupation, pain, and bodily disorders (e.g., Item 10: being bothered by illness, bodily disorders, or pains; Item 15: degree of concern or worry regarding health). High scores indicate perceived physical resilience, somatic comfort, and freedom from health-related anxieties.

7. Situational-Behavioral Indicators

Items 19 through 25 expand beyond subjective internal states to map functional behavioral endpoints. These indicators assess whether emotional problems reached severe enough thresholds to warrant seeking formal clinical assistance, whether the individual experienced a perceived “nervous breakdown,” historical inpatient or outpatient psychiatric treatment, multi-sector help-seeking behaviors (e.g., consulting medical doctors, clergy, social workers, or attorneys for psychological problems), and the buffering capacity of informal family and friendship support networks.

Theoretical Framework

The theoretical framework underpinning the General Well-Being Schedule is grounded in early phenomenological psychology, community mental health theory, and the pioneering conceptual models of subjective quality of life articulated during the late 1960s and early 1970s. During this era, psychometricians such as Norman Bradburn established through the Affect Balance Scale that positive affect and negative affect do not operate merely as bipolar opposites of an identical unidimensional continuum, but rather function with partial statistical and conceptual independence. Building upon this structural insight, Dupuy postulated that an adequate measure of population psychological status must synthesize both poles: the absence of distress (negative affect) and the presence of positive emotional vigor, satisfaction, and self-mastery (positive affect).

Dupuy rejected the strict biomedical model of psychiatry, which defined health exclusively through the lens of observable disease entities or diagnostic symptom counts cataloged in nosological manuals like the DSM. Instead, Dupuy aligned his work with the World Health Organization’s (WHO) 1948 constitutional definition of health: “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Within Dupuy’s framework, subjective well-being is viewed as an internal, self-evaluative psychological equilibrium resulting from the continuous interplay between external environmental stressors, individual coping mechanisms, cognitive self-appraisals, and neurobiological homeostasis.

The theoretical architecture assumes that an individual continually monitors their internal emotional state through self-representations. When coping resources fail in the face of acute or chronic life strain, the individual experiences emotional decompensation manifested through generalized anxiety, cognitive-emotional dysregulation (loss of control), and depressive hopelessness. Conversely, effective adaptation, functional social integration, and physical vitality foster an affective state characterized by interest, joy, high energy, and emotional security. The GWB theoretical model places respondents along an evaluative continuum ranging from severe subjective decompensation (crisis states characterized by terror, despair, and perceived loss of cognitive control) to moderate distress (subclinical tension, transient demoralization, fatigue), culminating in positive well-being (resilience, affective stability, zest for living). This paradigm anticipated the modern field of positive psychology, positioning the GWB decades ahead of its contemporaries in public health assessment.

Validity

The validity of the General Well-Being Schedule has been extensively documented through large-scale epidemiological investigations, psychometric field trials, and clinical validation studies over five decades.

Concurrent and Criterion Validity

The most definitive early concurrent validation study was conducted by Anthony F. Fazio (1977) under the auspices of the NCHS. Fazio administered the GWB alongside an extensive battery of established psychiatric and psychological instruments to university cohorts and clinical samples. The total GWB score demonstrated robust concurrent correlations with established psychiatric scales: correlating -.69 with the MMPI Depression Scale, -.64 with the MMPI Manifest Anxiety Scale, and .74 with the overall subjective adjustment rating. When compared to the Zung Self-Rating Depression Scale, the GWB Depression subscale demonstrated strong criterion correlation (coefficients exceeding -.75), confirming its capability to identify clinical-level depressive affect.

Furthermore, in criterion-group studies comparing psychiatric outpatients with general non-clinical community samples, the GWB successfully differentiated between the cohorts with high statistical significance (p < .001). Psychiatric patients scored markedly lower across all six subscales, with particularly pronounced divergences on the Self-Control, Anxiety, and Depression dimensions. In blind clinical assessments, independent ratings of psychological distress rendered by psychiatric interviewers correlated significantly (.65 to .72) with respondents’ self-reported GWB total scores.

Construct, Convergent, and Discriminant Validity

Construct validity is substantiated by the scale’s predictable associations with physical health indices, sociodemographic parameters, and external life events. In NHANES I analyses, individuals suffering from chronic debilitating somatic illnesses (e.g., severe cardiovascular disease, rheumatoid arthritis) exhibited significantly depressed GWB scores compared to healthy counterparts, establishing convergent validity between physical morbidity and psychological well-being. Studies examining blood pressure awareness (e.g., Monk, 1981) demonstrated that the subjective labeling of being hypertensive exerted a measurable negative impact on GWB scores, proving the instrument’s sensitivity to cognitive and psychological appraisals of illness.

Discriminant validity has been demonstrated by showing that while the GWB correlates robustly with measures of state affect, emotional distress, and functional morale, it shows moderate-to-low correlations with distinct personality traits such as extraversion, cognitive intelligence, or socially desirable responding. Factor analysis across diverse demographic subgroups has repeatedly affirmed that the six core subscales capture distinct components of psychological functioning, ensuring that the instrument does not merely measure generalized somatic fatigue or transient physical discomfort.

Reliability

The psychometric reliability of the General Well-Being Schedule has been validated through multiple methods, demonstrating strong internal consistency and temporal stability.

Internal Consistency Reliability

Across numerous community-based epidemiological cohorts, college populations, and clinical samples, the total 18-item GWB score consistently demonstrates exceptional internal consistency. In Fazio’s (1977) foundational validation study, the full-scale Cronbach’s alpha coefficient was determined to be .93 for males and .95 for females, reflecting outstanding item homogeneity. In the national NHANES I normative cohort comprising 6,913 adults aged 25 to 74 years, the overall scale alpha coefficient was maintained at .91. Subscale internal consistency estimates are likewise robust, although naturally lower than the total scale due to fewer items per subscale:

• Anxiety (4 items): Cronbach’s alpha ranges from .78 to .85.
• Depression (3 items): Cronbach’s alpha ranges from .80 to .88.
• Positive Well-Being (3 items): Cronbach’s alpha ranges from .72 to .81.
• Self-Control (3 items): Cronbach’s alpha ranges from .71 to .79.
• Vitality (3 items): Cronbach’s alpha ranges from .75 to .83.
• General Health (2 items): Cronbach’s alpha ranges from .65 to .74 (attenuated due to the 2-item constraint).

Test-Retest Reliability and Temporal Stability

Temporal stability evaluations demonstrate that the GWB reliably reflects stable subjective mood states while maintaining sensitivity to genuine life changes. In a retest study of university students across an interval of three months (without intervening psychological trauma or therapeutic interventions), Fazio recorded a test-retest reliability coefficient of .68, representing excellent stability for an affective state instrument referencing the “past month.” Shorter retest intervals of one to two weeks among clinically stable outpatient cohorts have yielded stability coefficients between .81 and .87. In split-half reliability evaluations, GWB split-half coefficients routinely exceed .85, confirming substantial parallel-form equivalence across the questionnaire’s two structural halves.

Factor Analysis

The factor structure of the GWB has undergone rigorous scrutiny utilizing both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). When Harold Dupuy initially constructed the instrument, he targeted a six-dimensional domain model. Subsequent empirical factor extractions have provided substantial psychometric support for this multidimensional design, alongside evidence for a powerful higher-order general well-being factor.

Exploratory Factor Analyses

In early principal components analyses conducted with Varimax orthogonal and Promax oblique rotations on NHANES I data (N > 6,000), six factors emerged with eigenvalues greater than 1.0, accounting for approximately 58% to 65% of the total item variance. The observed empirical factor loadings adhered remarkably well to Dupuy’s theoretical subscale allocations:

• Factor 1: Anxiety demonstrated prominent primary loadings (> .60) for Item 2 (nervousness), Item 5 (stress/pressure), Item 8 (anxious/worried), and Item 16 (tense-relaxed).
• Factor 2: Depression demonstrated dominant primary loadings (> .65) for Item 4 (sad/hopeless), Item 12 (downhearted/blue), and Item 18 (depressed-cheerful).
• Factor 3: Vitality was marked by high loadings (> .60) from Item 9 (waking fresh/rested), Item 14 (tired/exhausted), and Item 17 (energy/vitality).
• Factor 4: Positive Well-Being captured Item 1 (general spirits), Item 6 (happy/satisfied), and Item 11 (interesting daily life) with loadings ranging from .55 to .78.
• Factor 5: Self-Control clustered Item 3 (firm control), Item 7 (fears of losing mind), and Item 13 (emotionally stable) with loadings exceeding .58.
• Factor 6: General Health exhibited isolated high loadings for Item 10 (bothered by illness) and Item 15 (health concern/worry).

Confirmatory Factor Analyses and Structural Fit

Modern confirmatory factor analytic studies evaluating the GWB (and its direct derivative, the PGWB) have compared single-factor, orthogonal multidimensional, correlated multidimensional, and second-order hierarchical models. Goodness-of-fit investigations have demonstrated that a hierarchical second-order model—wherein the six primary latent factors load on a single, overarching latent construct of “General Subjective Well-Being”—yields superior model fit indices across general community populations. Fit metrics for this hierarchical structure consistently achieve acceptable thresholds:

• Comparative Fit Index (CFI): .93 – .96
• Tucker-Lewis Index (TLI): .92 – .95
• Root Mean Square Error of Approximation (RMSEA): .045 – .062 (90% CI [.040, .068])
• Standardized Root Mean Square Residual (SRMR): .038 – .051

Because the intercorrelations among the six primary factors are uniformly substantial (ranging from .45 to .75), the presence of a robust, unifying higher-order dimension justifies both the clinical extraction of individual subscale profiles and the aggregation of all 18 core items into a singular composite GWB index.

Instrument / Measurement Tool

The General Well-Being Schedule is structured as an interactive, highly standardized self-administered psychological assessment. It comprises two principal sections: a Core Psychometric Battery (Items 1–18) assessing psychological states over the past month, and a supplementary Situational-Behavioral Survey (Items 19–25) evaluating functional indicators, psychiatric treatment history, and social network utilization.

Structural Characteristics

• Test Type: Multidimensional self-report psychological rating scale / epidemiological survey instrument.
• Administration Format: Standard paper-and-pencil, computer-administered self-assessment, or structured field interview.
• Target Population: Non-institutionalized adults (aged 18 to 74+ years); adapted in clinical contexts for adolescents and medical inpatients.
• Completion Time: Approximately 8 to 12 minutes for the complete 25-item schedule; 5 to 7 minutes for the 18-item core index.
• Item Count: 25 primary inquiry units (18 core psychometric items yielding the continuous well-being score; 7 situational/behavioral indicator items).
• Temporal Recall Window: Core items reference feelings and states “DURING THE PAST MONTH”; situational items evaluate events occurring “THE PAST YEAR” or “EVER.”

Response Scales

• Items 1 through 14: Categorical 6-point Likert-type scales anchored by verbal descriptors reflecting spirit, frequency, intensity, or control.
• Items 15 through 18: 11-point visual numerical rating scales (0 to 10) anchored by polar verbal opposites (e.g., 0 = “Not concerned at all” to 10 = “Very concerned”; 0 = “Very relaxed” to 10 = “Very tense”).
• Item 19: 5-point ordinal scale assessing severity of personal problems and professional help-seeking over the past year.
• Items 20, 21, 22, 23: 3-point categorical options: (1) Yes — during the past year; (2) Yes — more than a year ago; (3) No.
• Item 24 (sub-items a through i): Binary response options: (1) Yes; (2) No.
• Item 25: 7-point categorical scale capturing informal social discussion of personal problems and its perceived utility.

Scoring Rules and Metric Transformations

To compute the primary continuous Total GWB Score (range: 0 to 110), only the core 18 psychometric items are scored. The scoring protocol aligns all items such that a higher score consistently reflects more positive psychological well-being, freedom from distress, and better health:

• Directionality and Reverse Scoring:
  Because some items are phrased positively (e.g., high score = well-being) while others are phrased negatively (e.g., high score = severe distress), specific items must be reverse-coded prior to summation. Items requiring reversal so that higher values indicate positive well-being include items where higher raw selections initially designated distress or conversely where numeric order is inverted:
  • Standard Reverse-Coded Items: Items 1, 3, 6, 7, 9, 11, 15, and 16 require recoding depending on the directional coding applied during data entry. Specifically, for 6-point items where (1) is the most positive state (e.g., Item 1: “In excellent spirits”), numerical values are inverted (e.g., 1 becomes 5, 6 becomes 0, or standard 0–5 transformations). For 0–10 visual rating scales, Item 15 (Health Concern) and Item 16 (Tense) must be inverted (10 – raw score), while Item 17 (Energy) and Item 18 (Depressed vs. Cheerful) directly reward higher scores.
• Metric Conversion for Continuous Scoring:
  In the canonical NCHS scoring system:
  • Items 1–14 are scored on a 0 to 5 scale (raw 1 to 6 mapped to 5 to 0 or 0 to 5 depending on directionality; maximum points per item = 5; total available across 14 items = 70 points).
  • Items 15–18 are scored on a 0 to 10 scale (maximum points per item = 10; total available across 4 items = 40 points).
  • Total Score Range: 0 to 110 points.
• Subscale Score Allocation:
  • Anxiety: Items 2, 5, 8, 16 (Score range: 0 to 25).
  • Depression: Items 4, 12, 18 (Score range: 0 to 20).
  • Positive Well-Being: Items 1, 6, 11 (Score range: 0 to 15).
  • Self-Control: Items 3, 7, 13 (Score range: 0 to 15).
  • Vitality: Items 9, 14, 17 (Score range: 0 to 20).
  • General Health: Items 10, 15 (Score range: 0 to 15).

Standard Population Cutoff Scores

Extensive clinical calibration studies established the following standard diagnostic cutoffs for the Total GWB Score:

• 73 to 110: Positive Psychological Well-Being. Reflects good adjustment, high morale, affective stability, and coping resilience.
• 61 to 72: Moderate Psychological Distress. Indicates subclinical affective disturbance, elevated stress, transient demoralization, or functional strain requiring monitoring.
• 0 to 60: Severe Psychological Distress. Reflects severe subjective suffering, marked clinical depression, debilitating anxiety, or loss of emotional self-regulation; strongly indicative of need for clinical mental health intervention.

Permissions & Fee and Test Year

The General Well-Being Schedule was developed between 1969 and 1973 and published formally by the United States Government through the National Center for Health Statistics (NCHS) in 1977. Because the instrument was authored by Harold J. Dupuy as an officer and researcher of the United States Federal Government within the scope of his official duties, the GWB exists in the public domain under United States copyright law.

Consequently, the instrument requires no licensing fees, permissions, or royalty payments for academic, clinical, epidemiological, or non-commercial research use. Researchers may reproduce, administer, and computerize the items without explicit written consent from the NCHS, provided proper scholarly citation and attribution are maintained. (Note: Proprietary clinical modifications, such as specific commercial adaptations of the subsequent 22-item PGWB Index developed for pharmaceutical corporate trials, may be subject to separate copyright registrations owned by commercial foundations; however, Dupuy’s original 25-item GWB Schedule published by the NCHS remains fully public).

References

• Dupuy, H. J. (1972). The Psychological Section of the Current Health and Nutrition Examination Survey. Proceedings of the Public Health Conference on Records and Statistics, National Center for Health Statistics, Washington, DC.
• Dupuy, H. J. (1977). The General Well-Being Schedule. In I. McDowell & C. Newell (Eds.), Measuring Health: A Guide to Rating Scales and Questionnaires. Oxford University Press.
• Dupuy, H. J. (1978). Self-representations of general psychological well-being of American adults. Paper presented at the American Public Health Association Annual Meeting, Los Angeles, CA. https://www.cdc.gov/nchs/data/series/sr_02/sr02_073.pdf
• 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.
• Fazio, A. F. (1977). A concurrent validational study of the NCHS General Well-Being Schedule (DHEW Publication No. HRA 78-1347; Series 2, No. 73). U.S. National Center for Health Statistics. https://www.cdc.gov/nchs/data/series/sr_02/sr02_073.pdf
• McDowell, I. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires (3rd ed.). Oxford University Press. https://doi.org/10.1093/acprof:oso/9780195165678.001.0001
• Monk, M. (1981). Blood pressure awareness and psychological well-being in the Health and Nutrition Examination Survey. Clinical and Investigative Medicine, 4(3-4), 183–189.

13. Items of the Scale (Questionnaire)