Developing and Validating a Patient-Centered Measure of Well-Being in Bipolar Disorder: The WELL-B

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.

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.

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.

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.