Developing and Validating a Patient‐Centered Measure of Well‐Being in Bipolar Disorder: The
WELL
‐
B
Audrey R. Stromberg, Alexandra H. Vinson, Claudia Diaz‐Byrd, Ravleen Kaur, Melvin G. McInnis, Sarah H. Sperry ABSTRACT
Objectives
Traditional measures of well‐being in bipolar disorder (BD) often equate well‐being with the absence of mood symptoms, overlooking strengths‐based indicators like acceptance, agency, and positive emotion that individuals with BD identify as central to their lived experience of wellness. To address this misalignment, we developed and psychometrically validated a new well‐being measure, the Well‐being Evaluation for Living with Bipolar (WELL‐B), grounded in the concept of thriving.
Methods
The WELL‐B was co‐designed with individuals with BD and caregivers through a collaborative learning health system and piloted in the Prechter Longitudinal Study for Bipolar Disorder (PLS‐BD). Participants ( N = 192) completed the WELL‐B twice over 2 months. The WELL‐B captured personalized, qualitative examples of well‐being across eight domains and corresponding quantitative ratings using four overarching prompts. Using both Classical Test Theory and Modern Test Theory frameworks, we evaluated factor structure, internal consistency, item‐level properties, test–retest reliability, and convergent and divergent validity.
Results
Exploratory factor analysis revealed a stable three‐factor solution: general well‐being, time availability, and work‐related well‐being factors. All factors showed strong internal consistency (alphas > 0.85), and item response theory analyses indicated moderate to high item discrimination. The well‐being factor was strongly associated with better mental health functioning and lower depression, anxiety, and alcohol use. Most participants rated the WELL‐B as acceptable, feasible, and meaningful for reflecting on their wellness.
Conclusions
The WELL‐B offers a strengths‐based, patient‐centered approach to assessing well‐being in BD. Future directions include refinement, broader validation, and testing clinical utility for treatment planning and monitoring.