Reliability and validity of the Chinese Short Warwick-Edinburgh Mental Well-being Scale in people living with dementia

Reliability and validity of the Chinese Short Warwick-Edinburgh Mental Well-being Scale in people living with dementia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Reliability and validity of the Chinese Short Warwick-Edinburgh Mental Well-being Scale in people living with dementia Dara Kiu Yi Leung, Yun-Lin Wang, Yun-Han Wang, Zuna Loong Yee Ng, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4023691/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Supporting people living with dementia to live well with the condition has been promoted as a policy and practice priority. A valid measure of mental well-being can facilitate related research in the growing Chinese dementia population. This study evaluated the reliability and validity of the Chinese Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) in Chinese people living with dementia in Hong Kong. Methods A total of 162 people living with dementia completed the SWEMWBS. Factorial validity of the scale was evaluated by confirmatory factor analysis (CFA). Convergent and divergent validity were assessed by Spearman’s correlations with Quality of Life in Alzheimer’s Disease (QoL-AD), EQ-5D-5L, EQ VAS, Neuropsychiatric Inventory Questionnaire (NPI-Q; depression and anxiety items). Known-group validity was examined based on sex, age, and education level. Congeneric reliability was assessed by standardized factor loadings and error variances, while internal consistency by Cronbach’s alpha. Results The one-factor structure of SWEMWBS was confirmed (CFI = 0.998, TLI = 0.996, RMSEA = 0.02). The scale had weak-to-moderate correlations with QoL-AD, EQ-5D-5L, EQ VAS, and NPI-Q Anxiety ( r = − .025 to 0.42) but no correlation with NPI-Q Depression. Respondents who were younger, male, and had higher education levels reported higher levels of mental well-being. SWEMWBS showed good congeneric reliability (0.80) and internal consistency (0.80). Conclusions The Chinese SWEMWBS showed good validity and reliability for measuring mental well-being in the Chinese dementia population in Hong Kong. Known-group validity results indicate a potentially distinct pattern of well-being among people living with dementia. well-being mental health dementia reliability validation psychometric Figures Figure 1 Background Dementia is a syndrome characterised by progressive cognitive decline that interferes with a person’s daily activities [ 1 ]. Globally, over 55 million individuals are affected by dementia, and the number is expected to increase by an additional 10 million new cases annually [ 1 ]. Moving beyond the deficit model, which focuses on the loss and impairments associated with dementia [ 2 ], there has been a conceptual shift in understanding the well-being of people with dementia. Supporting people living with dementia to live well with the condition has been promoted as a policy and practice priority [ 3 ]. Recent research on living well with dementia found that there is evidence for the maintenance of hope, resilience, a sense of independence, and social engagement in people living with dementia [ 1 , 4 ]. In order to adequately support the dementia population, it is crucial to enhance our understanding of their well-being and the factors that influence it. From a positive psychology standpoint, well-being comprises two aspects: feeling good (hedonia) and functioning well (eudaimonia) [ 5 ]. While well-being and quality of life are two highly related constructs and often used interchangeability in dementia research [ 6 ], quality-of-life measures do not capture the hedonic (subjective) aspect of well-being [ 7 , 8 ], and often lack the assessment of strengths-based factors such as self-efficacy [ 9 ]. Given the limitations, it has been suggested that well-being measures developed based on positive psychology may better represent mental well-being among those with dementia [ 9 ]. While there is a constant debate on how mental well-being should be conceptualised and assessed, there is a growing consensus that mental well-being comprises both hedonic and eudaimonic aspects [ 10 ]. For instance, the Warwick-Edinburgh Mental Well-being Scale covers both aspects of well-being and has been used as an indicator of positive mental health [ 11 ]. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) was initially developed as a 14-item self-report measure that assesses cognitive, affective-emotion, and psychological aspects of functioning [ 11 ]. A shortened version of the scale (i.e., the Short Warwick-Edinburgh Mental Well-being Scale; SWEMWBS) was later developed as a unidimensional measure of mental well-being, given the original WEMWBS included items that showed a lack of fit with the other items [ 12 ]. With the removal of 7 items, the SWEMWBS represents a more concise measure of well-being with stronger psychometric properties [ 12 ], while still covering both hedonic and eudaimonic aspects of well-being. To date, the SWEMWBS has been translated and validated in different populations, including Norwegian adolescents [ 13 ], Norwegian and Swedish adults [ 14 ], Chinese university students [ 15 ], Hong Kong residents [ 16 ], as well as in individuals with mental health disorders [ 17 , 18 ]. The Chinese version of the SWEMWBS has demonstrated moderate correlations with measures of health, depression, happiness, and satisfaction of life [ 15 , 16 ]. Compared with the 14-item WEMWBS, the SWEMWBS has been suggested to be a more suitable measure to assess mental well-being in the dementia population because it is briefer and potentially less cognitively demanding [ 19 , 20 ]. However, to the best of our knowledge, only two studies have used the SWEMWBS to assess mental well-being in people with dementia [ 19 , 21 ], and the reliability and validity of this measure to be used cross-culturally are unknown. With the growing prevalence of dementia in the Chinese population, there have been few studies discussing their living experience from a positive psychology or mental well-being perspective [ 22 ]. A valid measure for mental well-being is therefore needed to initiate such research. This present study aimed to evaluate the validity and reliability of the SWEMWBS in a Chinese dementia population in Hong Kong. Methods Respondents and procedure Data were collected from 180 people living with dementia who participated in an online dementia community support service (“BrainLive”) in Hong Kong [ 23 ]. The BrainLive service was a 9-month online service provided by trained volunteers to families living with dementia. It aimed to enhance cognition, quality of life, and communication among those living with dementia, as well as improve carers’ self-efficacy, reduce carer burden, and strengthen their social support network. People living with dementia were eligible to take part if they: (1) were diagnosed with mild to moderate dementia or receiving dementia services, (2) were able to communicate and receive service via a tablet, without severe visual or hearing impairment, (3) had a family carer who was willing to participate in a 9-month study, and (4) were from a relatively deprived family that did not have a tablet. During the first nine weeks of the service, people with dementia and their family carers were provided an online group-based Cognitive Stimulation Therapy (CST). Data used in this study was extracted from the assessment conducted at baseline and after the CST. All assessments were conducted by trained interviewers. Measures Demographic information was collected, including age (in years), sex (male or female), education level, marital status, whether they were receiving allowance from the government, and cognition. Well-being. The SWEMWBS comprises seven positively worded items measuring respondents’ hedonic and eudaimonic well-being [ 12 ]. It has been translated from English into Chinese, and validated in the Hong Kong population [ 16 ]. Each item is rated on a 5-point Likert scale from 1 (none of the time) to 5 (all of the time). The total score ranges from 7 to 35, with higher scores indicating better mental well-being. Quality of life. The Quality of Life in Alzheimer’s Disease (QoL-AD) comprises 13 items assessing people living with dementia’ quality of life in various aspects, including physical health, energy, mood, living situation, memory, family, marriage, friends, self as a whole, ability to do chores, ability to do things for fun, money, and life as a whole [ 24 , 25 ]. It is recommended by the European consensus with good reliability and validity [ 26 ]. Each item is rated on a 4-point Likert scale from 1 (poor) to 4 (excellent). The total score ranges from 13 to 52, with higher scores indicating a better quality of life. QoL-AD demonstrated good internal consistency (0.80) in this sample. Health-related quality of life. The EuroQol 5-Dimension 5-Level (EQ-5D-5L) measures health-related quality of life in five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression [ 27 ]. Each item is rated on five levels of severity from 1 (no problem) to 5 (extreme problems). A five-digit health state is defined by combining the severity level from each domain. For example, ‘11111’ indicates no problems in all five dimensions, and ‘55555’ indicates extreme problems in all five dimensions. The five-digit health state is then converted into a health index based on the Hong Kong references [ 28 ], ranging from − 0.864 to 1, with higher scores indicating better health-related quality of life. Overall health. The EuroQol Visual Analogue Scale (EQ VAS) is a vertical visual analogue scale assessing respondents’ perceived overall health on the assessment day [ 27 ]. The scale ranges from 0 (the worst health) to 100 (the best health), with higher scores indicating better self-rated overall health. Depressive and anxiety symptoms. The Neuropsychiatric Inventory Questionnaire (NPI-Q) is a proxy-reported questionnaire assessing the presence and severity of behavioural and psychological symptoms of dementia (BPSD) and associated carers’ distress [ 29 ]. It comprises 12 domains of common BPSD, including delusions, hallucinations, agitation/aggression, depression/dysphoria, anxiety, elation/euphoria, disinhibition, irritability/lability, motor disturbance, nighttime behaviour, and appetite/eating. Family carers rate whether BPSD has occurred since the people living with dementia demonstrated memory problems and, if yes, the severity of the presenting BPSD on a 3-point Likert scale from 1 (mild) to 3 (severe) and the carers’ distress from 0 (not distressing at all) to 5 (extreme or very severe). In this study, only the severity level of depression and anxiety was included. Respondents who reported no depression or anxiety were coded as 0 on the severity level. Data analysis Normal distribution of SWEMWBS total scores was evaluated using skewness < 2 and kurtosis < 7 [ 30 ]. If more than 15% of the respondents achieved the lowest or highest possible score, it suggested floor or ceiling effects, respectively [ 31 ]. Missing data were removed pairwise. All analyses were performed using SPSS 29.0 if unspecified. A p -value below .050 indicated statistical significance. Factorial validity of the one-factor model of the SWEMWBS was assessed using confirmatory factor analysis (CFA). The CFA was performed in R Studio using the lavaan package. Model fit was assessed using chi-squared test, comparative fit index (CFI) (≥ 0.95 acceptable), Tucker-Lewis index (TLI) (≥ 0.95 acceptable), root mean square error of approximation (RMSEA) (≤ 0.08 acceptable, ≤ 0.05 excellent), and standardised root mean square residual (SRMR) (≤ 0.08 acceptable) [ 32 ]. Convergent and divergent validity was assessed using Spearman’s coefficients for correlations between SWEMWBS and QoL-AD, EQ-5D-5L, EQ VAS, NPI-Q Depression, and NPI-Q Anxiety. The coefficients are categorised as weak (0.10 to 0.39), moderate (0.40 to 0.69), strong (0.7 to 0.89) or very strong (0.90 to 1.00) [ 33 ]. SWEMWBS was expected to be correlated positively with the EQ-5D-5L, QoL-AD and EQ VAS, and negatively with NPI-Q-Depression and NPI-Q-Anxiety. Known-group validity of the SWEMWBS by demographic characteristics was assessed using Spearman’s correlation or analysis of variance (ANOVA) with post-hoc tests. The level of mental well-being was expected to be similar by sex, but higher among respondents with older age and higher education levels [ 16 , 34 , 35 ]. Congeneric reliability was examined based on standardised factor loadings and error variance (≥ 0.6 good). Internal consistency was measured using Cronbach’s alpha (≥ 0.70 acceptable, ≥ 0.80 good). The corrected item-total correlation was the correlation between the score of a specific item and the overall score (≥ 0.3 good) [ 9 , 10 ]. Results Table 1 summarises respondents’ demographic characteristics. The mean age of respondents was 81.9 years (SD = 7.6), and the majority were female (67%). Respondents reported diverse education levels; 20% had no formal education, 46% completed primary school, 27% had secondary education or a postsecondary diploma, and 7% held a bachelor’s degree or above. Most respondents were married (61%) or widowed (37%). Around one in three (33%) reported receiving allowance from the government. Respondents showed low cognitive ability; the mean MoCA-5 score was 12.7 (6.5). Table 1 Participant characteristics (N = 180). n Mean (SD) / N (%) Age 180 81.9 (7.6) Sex 180 Male 59 (33) Female 121 (67) Years of education 173 6.2 (5.0) Education level 179 No formal education 35 (20) Primary 83 (46) Secondary/diploma 49 (27) Degree or above 12 (7) Marital status 179 Never married 1 (1) Married or cohabitated 110 (61) Divorced/separated 1 (1) Widowed 67 (37) Receiving allowance 180 59 (33) MoCA-5 176 12.7 (6.5) Dementia severity level 180 Mild 76 (42) Mild to moderate 15 (8) Moderate 59 (33) Unknown severity 30 (17) Approximately 90% (162/180) of the respondents provided complete SWEMWBS data. The SWEMWBS raw scores were normally distributed (M = 22.11, SD = 6.29, Skewness = -0.16, Kurtosis = -0.29). The percentages of the lowest score (score 7) and the highest score (score 35) were 1.2% and 1.9%, respectively, signifying no floor or ceiling effect. Factorial validity Figure 1 shows the factor loadings of the seven items (0.46 to 0.68). A one-factor model shows marginally satisfactory model fit (χ2 (14) = 31.33, p = .005, CFI = 0.936, TLI = 0.904, RMSEA = 0.09, SRMR = 0.06). After adding error correlations based on the modification indices, the one-factor model shows good model fit (χ2 (11) = 11.57, p = .396, CFI = 0.998, TLI = 0.996, RMSEA = 0.02, SRMR = 0.04). Convergent and divergent validity Table 2 shows the correlations between SWEMWBS and other scales. Positive, weak-to-moderate correlations were found between SWEMWBS and QoL-AD (r = 0.42, p < .001), EQ-5D-5L (r = 0.35, p < .001), and EQ VAS (r = 0.42, p < .001), showing that people with better well-being have better quality of life. SWEMWBS was negatively correlated with NPI-Q Anxiety (r = -0.25, p = .002), indicating that people with better well-being have a lower level of anxiety. There was no significant correlation between SWEMWBS and NPI-Q Depression. Table 2 The correlation of EQ-5D-5L and QoL-AD with the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) Measures n Score range M (SD) Spearman coefficients p QoL-AD 180 13–52 22.13 (5.31) 0.42 < .001 EQ-5D-5L 179 0.864-1 0.86 (0.20) 0.35 < .001 EQ VAS 179 0-100 67.68 (22.48) 0.42 < .001 NPI-Q—Depression 179 0–3 0.57 (0.85) -0.94 .237 NPI-Q—Anxiety 178 0–3 0.67 (0.97) -0.25 .002 Known-group validity Table 3 presents the SWEMWBS score of respondents with different demographic characteristics. Respondents who were older, female, and had no formal education had a lower level of well-being. There was no difference in SWEMWBS raw score by marital status, socioeconomic status, and cognitive ability. Table 3 Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) score of participants with different demographic characteristics n M (SD) Spearman coefficients ( p ) Mean difference (95% CI) Age 152 -0.19 (.018) Sex Male 46 24.22 (5.35) Reference Female 106 21.62 (6.40) 2.59 (0.47, 4.72) Years of education 149 0.40 (< .001) Education level No formal education 33 18.18 (5.38) Reference Primary 74 21.62 (6.40) 3.44 (0.28, 6.60) Secondary/diploma 44 25.16 (5.09) 6.98 (3.50, 10.45) Degree or above 10 25.70 (5.38) 7.52 (2.07, 12.96) Marital status (n = 179) Never married/ divorced/widowed 64 20.91 (7.00) Reference Married or cohabitated 97 22.95 (5.70) -2.04 (-4.12, 0.03) Receiving allowance No 102 22.54 (6.03) Reference Yes 50 22.14 (6.57) 0.39 (-1.72, 2.52) MoCA-5 149 0.12 (.137) Dementia severity level Mild 71 22.75 (5.54) Reference Mild to moderate 13 22.62 (6.41) 0.13 (-4.29, 4.56) Moderate 51 21.75 (6.95) 1.00 (-1.69, 3.69) Congeneric reliability and internal consistency The congeneric reliability coefficient and Cronbach’s alpha were both 0.80. The corrected item-total correlation ranged from 0.38 (item 6) to 0.60 (item 2), indicating moderate correlations (Table 4 ). Discussion This study showed that the Chinese version of the SWEMWBS is valid and reliable for people living with dementia. The SWEMWBS score showed no floor or ceiling effects. CFA supported the one-factor solution, implying that SWEMWBS measures a single underlying concept. The scale demonstrated high congeneric reliability and internal consistency and moderate item-total correlations. Our findings were consistent with previous validation studies in Chinese university students and the general population [ 15 , 16 ]. The SWEMWBS showed positive weak-to-moderate correlations with quality of life, health-related quality of life, and self-rated health. These findings supported that mental well-being is conceptually different from the quality of life, capturing more than the eudaimonic aspect of well-being. While previous studies suggested a strong association between mental well-being and depressive and anxiety symptoms [ 16 , 34 ], our findings showed that mental well-being was weakly correlated with anxiety and not significantly correlated with depressive symptoms. It is possible that, although anhedonia is a radical feature of major depressive disorder [ 36 ], the presence of mental well-being does not necessarily reflect a lack of negative affect [ 37 ]. The inconsistent findings may also be attributable to the use of informant-rated instruments in measuring depressive and anxiety symptoms. Depression shares similar symptoms with dementia, such as apathy, loss of interest, social withdrawal, isolation, trouble concentrating, and impaired thinking, and its representation varies across stages of dementia [ 38 ]. Symptoms associated with anxiety disorder, such as restlessness, fatigue, and difficulties with concentration, are also frequently observed in people living with dementia who do not have anxiety disorder [ 39 ]. In addition, people living with dementia may experience difficulty articulating their sadness or other feelings related to depression and anxiety due to their cognitive impairment. Therefore, family carers may be less aware of the depressive and anxiety symptoms exhibited by the persons living with dementia and, hence, underreported or misreported them. Mental well-being was correlated with several demographic factors, including age, sex, and education level. Apart from the positive association between SWEMWS and education level, our findings on known-group differences were inconsistent with previous studies, which, were mostly conducted with younger populations [ 16 , 34 , 35 ]. Older people or people living with dementia may exhibit different patterns of mental well-being. For instance, a validation study of WEMWBS conducted with older Iranians revealed that males reported having better mental well-being than females [ 40 ]. Similarly, a national survey conducted in England found that while SWEMWBS scores were higher in respondents of older age, the scores dropped in those aged over 75 years [ 35 ]. Older people are a heterogeneous group of individuals who encounter diverse life changes and respond to them differently. As they grow older, they may experience more age-related health challenges, such as chronic illness and reduced physical strength, as well as changes in social support networks, leading to feelings of loneliness and diminished quality of life and well-being [ 41 , 42 ]. Future research can explore the impact of these life challenges on mental well-being in people living with dementia and the broad older population. Furthermore, it is crucial to explore strategies and interventions that can provide support and enhance mental well-being in these individuals. Limitation This study has several limitations. First, depressive and anxiety symptoms were assessed using an informant-reported instrument, while other scales were completed by people living with dementia. Informant-reported instruments are common in dementia research since people living with dementia may experience difficulty communicating, reasoning, and recalling. However, informant ratings can be influenced by the informants’ feelings of distress [ 43 ], the relationship between the informant and the person living with dementia and the time they spent together during the reporting period [ 44 ]. Moreover, central symptoms of depression and anxiety, such as worthlessness and helplessness, might not be accurately reported since informant-rated instruments tend to capture more visible symptoms [ 45 ]. Discrepancies have been observed between self-reported and informant-reported quality of life of people living with dementia [ 46 ]. Future studies can consider including both self-reported and informant-reported measures to enhance our understanding of the relationship between mental well-being and psychological distress in the dementia population. Last, we did not control for the potential social desirability bias. Conclusion Promoting mental well-being is crucial for improving the lives of people living with dementia, and a valid measurement of mental well-being plays a vital role in the endeavour to foster positive mental health in this population. The Chinese SWEMWBS can serve as a reliable and valid tool for measuring mental well-being in the Chinese dementia population. However, the known-group validity results indicate a potential distinct pattern of well-being among people living with dementia, warranting further investigation. Table 4 Item-total statistics for the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) (N = 162) Items M (SD) Scale mean if item deleted Scale variance if item deleted Corrected item-total correlation Squared multiple correlation Cronbach's alpha if item deleted 1. Feeling optimistic about the future 2.77 (1.49) 19.35 28.86 0.54 0.38 0.77 2. Feeling useful 2.75 (1.41) 19.36 28.63 0.60 0.40 0.76 3. Feeling relaxed 3.45 (1.30) 18.66 31.28 0.46 0.26 0.78 4. Dealing with problems well 3.02 (1.28) 19.09 29.74 0.59 0.36 0.76 5. Thinking clearly 3.04 (1.34) 19.07 29.47 0.57 0.36 0.76 6. Feeling close to other people 4.02 (1.08) 18.09 33.69 0.38 0.20 0.80 7. Able to make up my own mind about things 3.06 (1.44) 19.06 28.87 0.56 0.35 0.77 Figure 1. Factor loadings of the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) from confirmatory factor analysis Declarations Ethics Approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Human Research Ethics Committee at The University of Hong Kong (reference number: EA200282). Consent to Participate Informed consent was obtained from all individual participants included in the study. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This work was supported by the Simon K.Y. Lee Elderly Fund. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Authors’ Contributions DKYL, JCPC, and GHYW contributed to the study conception and design. Material preparation and data collection were performed by MSLM and JCPC. Data analysis was performed by DKYL, MSLM, and JCPC. 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Quality of Life Research 26:1129–1144 Heininga VE, Dejonckheere E, Houben M, Obbels J, Sienaert P, Leroy B, van Roy J, Kuppens P (2019) The dynamical signature of anhedonia in major depressive disorder: positive emotion dynamics, reactivity, and recovery. BMC Psychiatry 19:59 Fortenberry KT, Jansen KL, Clark MS (2017) Positive Affectivity. In: Encyclopedia of Behavioral Medicine. Springer New York, New York, NY, pp 1–3 Cipriani G, Lucetti C, Carlesi C, Danti S, Nuti A (2015) Depression and dementia. A review. Eur Geriatr Med 6:479–486 Seignourel PJ, Kunik ME, Snow L, Wilson N, Stanley M (2008) Anxiety in dementia: A critical review. Clin Psychol Rev 28:1071–1082 Mavali S, Mahmoodi H, Sarbakhsh P, Shaghaghi A (2020) Psychometric properties of the Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS) in the Iranian older adults. Psychol Res Behav Manag Volume 13:693–700 Steptoe A, Deaton A, Stone AA (2015) Subjective wellbeing, health, and ageing. The Lancet 385:640–648 Golden J, Conroy RM, Bruce I, Denihan A, Greene E, Kirby M, Lawlor BA (2009) Loneliness, social support networks, mood and wellbeing in community‐dwelling elderly. Int J Geriatr Psychiatry 24:694–700 Robertson S, Cooper C, Hoe J, Hamilton O, Stringer A, Livingston G (2017) Proxy rated quality of life of care home residents with dementia: a systematic review. Int Psychogeriatr 29:569–581 Gräske J, Fischer T, Kuhlmey A, Wolf-Ostermann K (2012) Quality of life in dementia care – differences in quality of life measurements performed by residents with dementia and by nursing staff. Aging Ment Health 16:819–827 Leung DKY, Chan WC, Spector A, Wong GHY (2021) Prevalence of depression, anxiety, and apathy symptoms across dementia stages: A systematic review and meta-analysis. Int J Geriatr Psychiatry. https://doi.org/10.1002/gps.5556 Griffiths AW, Smith SJ, Martin A, Meads D, Kelley R, Surr CA (2020) Exploring self-report and proxy-report quality-of-life measures for people living with dementia in care homes. Quality of Life Research 29:463–472 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4023691","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":277238858,"identity":"07b3d5e6-461b-4d12-826f-0205c581ad6f","order_by":0,"name":"Dara Kiu Yi Leung","email":"","orcid":"","institution":"University of Hong Kong","correspondingAuthor":false,"prefix":"","firstName":"Dara","middleName":"Kiu Yi","lastName":"Leung","suffix":""},{"id":277238859,"identity":"7b32f6de-80d1-4d30-8a5f-bc0b458a769c","order_by":1,"name":"Yun-Lin Wang","email":"","orcid":"","institution":"University of Hong Kong","correspondingAuthor":false,"prefix":"","firstName":"Yun-Lin","middleName":"","lastName":"Wang","suffix":""},{"id":277238860,"identity":"3e933dcb-6d75-48d2-b38a-4434a8be69db","order_by":2,"name":"Yun-Han Wang","email":"","orcid":"","institution":"University of Hong Kong","correspondingAuthor":false,"prefix":"","firstName":"Yun-Han","middleName":"","lastName":"Wang","suffix":""},{"id":277238861,"identity":"08568c54-f03a-4174-83ae-1272f44181ef","order_by":3,"name":"Zuna Loong Yee Ng","email":"","orcid":"","institution":"University of Hong Kong","correspondingAuthor":false,"prefix":"","firstName":"Zuna","middleName":"Loong Yee","lastName":"Ng","suffix":""},{"id":277238862,"identity":"09ec5490-abc2-41e1-9a88-e4a76520ccbe","order_by":4,"name":"Maggie Sui Ling Ma","email":"","orcid":"","institution":"University of Hong Kong","correspondingAuthor":false,"prefix":"","firstName":"Maggie","middleName":"Sui Ling","lastName":"Ma","suffix":""},{"id":277238863,"identity":"c5dc3c81-d783-4118-9f94-650a13b3822c","order_by":5,"name":"Jacky Chak Pui Choy","email":"","orcid":"","institution":"University of Hong Kong","correspondingAuthor":false,"prefix":"","firstName":"Jacky","middleName":"Chak Pui","lastName":"Choy","suffix":""},{"id":277238864,"identity":"1eb09ab7-08b2-42a3-b29e-6efd734d9e80","order_by":6,"name":"Gloria Hoi Yan Wong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAs0lEQVRIiWNgGAWjYDACCQglZ8DDwMDMcIAELcaka0ncQLQW+egeM4mPO2rTt/OcMWAuOEOEFsM7Z8wkZ545nruzt8eAecYNYrTMyDG7zdt2LHfDeR4DZp4PJGhJNyBai7wEWEtNgsFZoMN4iHGYgURa+c+ZbQcMN5w5VnCYhxjvy89I3mzwsa1O3uBM8sbHPMeIseUAhwGQOgzmHCBCA9CWBvYHQKqOKMWjYBSMglEwQgEA89g7ViH6KDAAAAAASUVORK5CYII=","orcid":"","institution":"University of Hong Kong","correspondingAuthor":true,"prefix":"","firstName":"Gloria","middleName":"Hoi Yan","lastName":"Wong","suffix":""}],"badges":[],"createdAt":"2024-03-07 09:00:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4023691/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4023691/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52484145,"identity":"08540eb2-f16c-44eb-8560-edcd649a82fa","added_by":"auto","created_at":"2024-03-12 07:25:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":30001,"visible":true,"origin":"","legend":"\u003cp\u003eFactor loadings of the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) from confirmatory factor analysis\u003c/p\u003e","description":"","filename":"20240307WBSValidationFig1DL.png","url":"https://assets-eu.researchsquare.com/files/rs-4023691/v1/95e051d219fda1755963a615.png"},{"id":53523961,"identity":"90e2c425-93d8-4796-9435-13701b8405a5","added_by":"auto","created_at":"2024-03-27 04:30:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":388314,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4023691/v1/466fe276-3003-4965-8c01-6fbcdc169e6c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Reliability and validity of the Chinese Short Warwick-Edinburgh Mental Well-being Scale in people living with dementia","fulltext":[{"header":"Background","content":"\u003cp\u003eDementia is a syndrome characterised by progressive cognitive decline that interferes with a person\u0026rsquo;s daily activities [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Globally, over 55\u0026nbsp;million individuals are affected by dementia, and the number is expected to increase by an additional 10\u0026nbsp;million new cases annually [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Moving beyond the deficit model, which focuses on the loss and impairments associated with dementia [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], there has been a conceptual shift in understanding the well-being of people with dementia. Supporting people living with dementia to live well with the condition has been promoted as a policy and practice priority [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Recent research on living well with dementia found that there is evidence for the maintenance of hope, resilience, a sense of independence, and social engagement in people living with dementia [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In order to adequately support the dementia population, it is crucial to enhance our understanding of their well-being and the factors that influence it.\u003c/p\u003e \u003cp\u003eFrom a positive psychology standpoint, well-being comprises two aspects: feeling good (hedonia) and functioning well (eudaimonia) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. While well-being and quality of life are two highly related constructs and often used interchangeability in dementia research [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], quality-of-life measures do not capture the hedonic (subjective) aspect of well-being [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and often lack the assessment of strengths-based factors such as self-efficacy [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Given the limitations, it has been suggested that well-being measures developed based on positive psychology may better represent mental well-being among those with dementia [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. While there is a constant debate on how mental well-being should be conceptualised and assessed, there is a growing consensus that mental well-being comprises both hedonic and eudaimonic aspects [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. For instance, the Warwick-Edinburgh Mental Well-being Scale covers both aspects of well-being and has been used as an indicator of positive mental health [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Warwick-Edinburgh Mental Well-being Scale (WEMWBS) was initially developed as a 14-item self-report measure that assesses cognitive, affective-emotion, and psychological aspects of functioning [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A shortened version of the scale (i.e., the Short Warwick-Edinburgh Mental Well-being Scale; SWEMWBS) was later developed as a unidimensional measure of mental well-being, given the original WEMWBS included items that showed a lack of fit with the other items [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. With the removal of 7 items, the SWEMWBS represents a more concise measure of well-being with stronger psychometric properties [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], while still covering both hedonic and eudaimonic aspects of well-being. To date, the SWEMWBS has been translated and validated in different populations, including Norwegian adolescents [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], Norwegian and Swedish adults [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], Chinese university students [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], Hong Kong residents [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], as well as in individuals with mental health disorders [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The Chinese version of the SWEMWBS has demonstrated moderate correlations with measures of health, depression, happiness, and satisfaction of life [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCompared with the 14-item WEMWBS, the SWEMWBS has been suggested to be a more suitable measure to assess mental well-being in the dementia population because it is briefer and potentially less cognitively demanding [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, to the best of our knowledge, only two studies have used the SWEMWBS to assess mental well-being in people with dementia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], and the reliability and validity of this measure to be used cross-culturally are unknown. With the growing prevalence of dementia in the Chinese population, there have been few studies discussing their living experience from a positive psychology or mental well-being perspective [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. A valid measure for mental well-being is therefore needed to initiate such research. This present study aimed to evaluate the validity and reliability of the SWEMWBS in a Chinese dementia population in Hong Kong.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eRespondents and procedure\u003c/h2\u003e \u003cp\u003eData were collected from 180 people living with dementia who participated in an online dementia community support service (\u0026ldquo;BrainLive\u0026rdquo;) in Hong Kong [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The BrainLive service was a 9-month online service provided by trained volunteers to families living with dementia. It aimed to enhance cognition, quality of life, and communication among those living with dementia, as well as improve carers\u0026rsquo; self-efficacy, reduce carer burden, and strengthen their social support network. People living with dementia were eligible to take part if they: (1) were diagnosed with mild to moderate dementia or receiving dementia services, (2) were able to communicate and receive service via a tablet, without severe visual or hearing impairment, (3) had a family carer who was willing to participate in a 9-month study, and (4) were from a relatively deprived family that did not have a tablet. During the first nine weeks of the service, people with dementia and their family carers were provided an online group-based Cognitive Stimulation Therapy (CST). Data used in this study was extracted from the assessment conducted at baseline and after the CST. All assessments were conducted by trained interviewers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cp\u003eDemographic information was collected, including age (in years), sex (male or female), education level, marital status, whether they were receiving allowance from the government, and cognition.\u003c/p\u003e \u003cp\u003e \u003cem\u003eWell-being.\u003c/em\u003e The SWEMWBS comprises seven positively worded items measuring respondents\u0026rsquo; hedonic and eudaimonic well-being [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. It has been translated from English into Chinese, and validated in the Hong Kong population [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Each item is rated on a 5-point Likert scale from 1 (none of the time) to 5 (all of the time). The total score ranges from 7 to 35, with higher scores indicating better mental well-being.\u003c/p\u003e \u003cp\u003e \u003cem\u003eQuality of life.\u003c/em\u003e The Quality of Life in Alzheimer\u0026rsquo;s Disease (QoL-AD) comprises 13 items assessing people living with dementia\u0026rsquo; quality of life in various aspects, including physical health, energy, mood, living situation, memory, family, marriage, friends, self as a whole, ability to do chores, ability to do things for fun, money, and life as a whole [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. It is recommended by the European consensus with good reliability and validity [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Each item is rated on a 4-point Likert scale from 1 (poor) to 4 (excellent). The total score ranges from 13 to 52, with higher scores indicating a better quality of life. QoL-AD demonstrated good internal consistency (0.80) in this sample.\u003c/p\u003e \u003cp\u003e \u003cem\u003eHealth-related quality of life.\u003c/em\u003e The EuroQol 5-Dimension 5-Level (EQ-5D-5L) measures health-related quality of life in five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Each item is rated on five levels of severity from 1 (no problem) to 5 (extreme problems). A five-digit health state is defined by combining the severity level from each domain. For example, \u0026lsquo;11111\u0026rsquo; indicates no problems in all five dimensions, and \u0026lsquo;55555\u0026rsquo; indicates extreme problems in all five dimensions. The five-digit health state is then converted into a health index based on the Hong Kong references [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], ranging from \u0026minus;\u0026thinsp;0.864 to 1, with higher scores indicating better health-related quality of life.\u003c/p\u003e \u003cp\u003e \u003cem\u003eOverall health.\u003c/em\u003e The EuroQol Visual Analogue Scale (EQ VAS) is a vertical visual analogue scale assessing respondents\u0026rsquo; perceived overall health on the assessment day [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The scale ranges from 0 (the worst health) to 100 (the best health), with higher scores indicating better self-rated overall health.\u003c/p\u003e \u003cp\u003e \u003cem\u003eDepressive and anxiety symptoms.\u003c/em\u003e The Neuropsychiatric Inventory Questionnaire (NPI-Q) is a proxy-reported questionnaire assessing the presence and severity of behavioural and psychological symptoms of dementia (BPSD) and associated carers\u0026rsquo; distress [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. It comprises 12 domains of common BPSD, including delusions, hallucinations, agitation/aggression, depression/dysphoria, anxiety, elation/euphoria, disinhibition, irritability/lability, motor disturbance, nighttime behaviour, and appetite/eating. Family carers rate whether BPSD has occurred since the people living with dementia demonstrated memory problems and, if yes, the severity of the presenting BPSD on a 3-point Likert scale from 1 (mild) to 3 (severe) and the carers\u0026rsquo; distress from 0 (not distressing at all) to 5 (extreme or very severe). In this study, only the severity level of depression and anxiety was included. Respondents who reported no depression or anxiety were coded as 0 on the severity level.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eNormal distribution of SWEMWBS total scores was evaluated using skewness\u0026thinsp;\u0026lt;\u0026thinsp;2 and kurtosis\u0026thinsp;\u0026lt;\u0026thinsp;7 [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. If more than 15% of the respondents achieved the lowest or highest possible score, it suggested floor or ceiling effects, respectively [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Missing data were removed pairwise. All analyses were performed using SPSS 29.0 if unspecified. A \u003cem\u003ep\u003c/em\u003e-value below .050 indicated statistical significance.\u003c/p\u003e \u003cp\u003eFactorial validity of the one-factor model of the SWEMWBS was assessed using confirmatory factor analysis (CFA). The CFA was performed in R Studio using the \u003cem\u003elavaan\u003c/em\u003e package. Model fit was assessed using chi-squared test, comparative fit index (CFI) (\u0026ge;\u0026thinsp;0.95 acceptable), Tucker-Lewis index (TLI) (\u0026ge;\u0026thinsp;0.95 acceptable), root mean square error of approximation (RMSEA) (\u0026le;\u0026thinsp;0.08 acceptable, \u0026le;\u0026thinsp;0.05 excellent), and standardised root mean square residual (SRMR) (\u0026le;\u0026thinsp;0.08 acceptable) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConvergent and divergent validity was assessed using Spearman\u0026rsquo;s coefficients for correlations between SWEMWBS and QoL-AD, EQ-5D-5L, EQ VAS, NPI-Q Depression, and NPI-Q Anxiety. The coefficients are categorised as weak (0.10 to 0.39), moderate (0.40 to 0.69), strong (0.7 to 0.89) or very strong (0.90 to 1.00) [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. SWEMWBS was expected to be correlated positively with the EQ-5D-5L, QoL-AD and EQ VAS, and negatively with NPI-Q-Depression and NPI-Q-Anxiety.\u003c/p\u003e \u003cp\u003eKnown-group validity of the SWEMWBS by demographic characteristics was assessed using Spearman\u0026rsquo;s correlation or analysis of variance (ANOVA) with post-hoc tests. The level of mental well-being was expected to be similar by sex, but higher among respondents with older age and higher education levels [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCongeneric reliability was examined based on standardised factor loadings and error variance (\u0026ge;\u0026thinsp;0.6 good). Internal consistency was measured using Cronbach\u0026rsquo;s alpha (\u0026ge;\u0026thinsp;0.70 acceptable, \u0026ge;\u0026thinsp;0.80 good). The corrected item-total correlation was the correlation between the score of a specific item and the overall score (\u0026ge;\u0026thinsp;0.3 good) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarises respondents\u0026rsquo; demographic characteristics. The mean age of respondents was 81.9 years (SD\u0026thinsp;=\u0026thinsp;7.6), and the majority were female (67%). Respondents reported diverse education levels; 20% had no formal education, 46% completed primary school, 27% had secondary education or a postsecondary diploma, and 7% held a bachelor\u0026rsquo;s degree or above. Most respondents were married (61%) or widowed (37%). Around one in three (33%) reported receiving allowance from the government. Respondents showed low cognitive ability; the mean MoCA-5 score was 12.7 (6.5).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant characteristics (N\u0026thinsp;=\u0026thinsp;180).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean (SD) / N (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81.9 (7.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121 (67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.2 (5.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary/diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDegree or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried or cohabitated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110 (61)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced/separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceiving allowance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoCA-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.7 (6.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDementia severity level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild to moderate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown severity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eApproximately 90% (162/180) of the respondents provided complete SWEMWBS data. The SWEMWBS raw scores were normally distributed (M\u0026thinsp;=\u0026thinsp;22.11, SD\u0026thinsp;=\u0026thinsp;6.29, Skewness = -0.16, Kurtosis = -0.29). The percentages of the lowest score (score 7) and the highest score (score 35) were 1.2% and 1.9%, respectively, signifying no floor or ceiling effect.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eFactorial validity\u003c/h2\u003e \u003cp\u003eFigure 1 shows the factor loadings of the seven items (0.46 to 0.68). A one-factor model shows marginally satisfactory model fit (χ2 (14)\u0026thinsp;=\u0026thinsp;31.33, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.005, CFI\u0026thinsp;=\u0026thinsp;0.936, TLI\u0026thinsp;=\u0026thinsp;0.904, RMSEA\u0026thinsp;=\u0026thinsp;0.09, SRMR\u0026thinsp;=\u0026thinsp;0.06). After adding error correlations based on the modification indices, the one-factor model shows good model fit (χ2 (11)\u0026thinsp;=\u0026thinsp;11.57, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.396, CFI\u0026thinsp;=\u0026thinsp;0.998, TLI\u0026thinsp;=\u0026thinsp;0.996, RMSEA\u0026thinsp;=\u0026thinsp;0.02, SRMR\u0026thinsp;=\u0026thinsp;0.04).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eConvergent and divergent validity\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the correlations between SWEMWBS and other scales. Positive, weak-to-moderate correlations were found between SWEMWBS and QoL-AD (r\u0026thinsp;=\u0026thinsp;0.42, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), EQ-5D-5L (r\u0026thinsp;=\u0026thinsp;0.35, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), and EQ VAS (r\u0026thinsp;=\u0026thinsp;0.42, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), showing that people with better well-being have better quality of life. SWEMWBS was negatively correlated with NPI-Q Anxiety (r = -0.25, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.002), indicating that people with better well-being have a lower level of anxiety. There was no significant correlation between SWEMWBS and NPI-Q Depression.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe correlation of EQ-5D-5L and QoL-AD with the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeasures\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScore range\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSpearman coefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQoL-AD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u0026ndash;52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.13 (5.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEQ-5D-5L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.864-1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.86 (0.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEQ VAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0-100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67.68 (22.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNPI-Q\u0026mdash;Depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.57 (0.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNPI-Q\u0026mdash;Anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.67 (0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eKnown-group validity\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the SWEMWBS score of respondents with different demographic characteristics. Respondents who were older, female, and had no formal education had a lower level of well-being. There was no difference in SWEMWBS raw score by marital status, socioeconomic status, and cognitive ability.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eShort Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) score of participants with different demographic characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpearman coefficients (\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean difference (95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.19 (.018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.22 (5.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.62 (6.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.59 (0.47, 4.72)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.40 (\u0026lt;\u0026thinsp;.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.18 (5.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.62 (6.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.44 (0.28, 6.60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary/diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.16 (5.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.98 (3.50, 10.45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDegree or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.70 (5.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.52 (2.07, 12.96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status (n\u0026thinsp;=\u0026thinsp;179)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever married/ divorced/widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.91 (7.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried or cohabitated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.95 (5.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-2.04 (-4.12, 0.03)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceiving allowance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.54 (6.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.14 (6.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.39 (-1.72, 2.52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoCA-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.12 (.137)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDementia severity level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.75 (5.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild to moderate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.62 (6.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.13 (-4.29, 4.56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.75 (6.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00 (-1.69, 3.69)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eCongeneric reliability and internal consistency\u003c/h2\u003e \u003cp\u003eThe congeneric reliability coefficient and Cronbach\u0026rsquo;s alpha were both 0.80. The corrected item-total correlation ranged from 0.38 (item 6) to 0.60 (item 2), indicating moderate correlations (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study showed that the Chinese version of the SWEMWBS is valid and reliable for people living with dementia. The SWEMWBS score showed no floor or ceiling effects. CFA supported the one-factor solution, implying that SWEMWBS measures a single underlying concept. The scale demonstrated high congeneric reliability and internal consistency and moderate item-total correlations. Our findings were consistent with previous validation studies in Chinese university students and the general population [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe SWEMWBS showed positive weak-to-moderate correlations with quality of life, health-related quality of life, and self-rated health. These findings supported that mental well-being is conceptually different from the quality of life, capturing more than the eudaimonic aspect of well-being. While previous studies suggested a strong association between mental well-being and depressive and anxiety symptoms [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], our findings showed that mental well-being was weakly correlated with anxiety and not significantly correlated with depressive symptoms. It is possible that, although anhedonia is a radical feature of major depressive disorder [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], the presence of mental well-being does not necessarily reflect a lack of negative affect [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The inconsistent findings may also be attributable to the use of informant-rated instruments in measuring depressive and anxiety symptoms. Depression shares similar symptoms with dementia, such as apathy, loss of interest, social withdrawal, isolation, trouble concentrating, and impaired thinking, and its representation varies across stages of dementia [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Symptoms associated with anxiety disorder, such as restlessness, fatigue, and difficulties with concentration, are also frequently observed in people living with dementia who do not have anxiety disorder [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In addition, people living with dementia may experience difficulty articulating their sadness or other feelings related to depression and anxiety due to their cognitive impairment. Therefore, family carers may be less aware of the depressive and anxiety symptoms exhibited by the persons living with dementia and, hence, underreported or misreported them.\u003c/p\u003e \u003cp\u003eMental well-being was correlated with several demographic factors, including age, sex, and education level. Apart from the positive association between SWEMWS and education level, our findings on known-group differences were inconsistent with previous studies, which, were mostly conducted with younger populations [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Older people or people living with dementia may exhibit different patterns of mental well-being. For instance, a validation study of WEMWBS conducted with older Iranians revealed that males reported having better mental well-being than females [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Similarly, a national survey conducted in England found that while SWEMWBS scores were higher in respondents of older age, the scores dropped in those aged over 75 years [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Older people are a heterogeneous group of individuals who encounter diverse life changes and respond to them differently. As they grow older, they may experience more age-related health challenges, such as chronic illness and reduced physical strength, as well as changes in social support networks, leading to feelings of loneliness and diminished quality of life and well-being [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Future research can explore the impact of these life challenges on mental well-being in people living with dementia and the broad older population. Furthermore, it is crucial to explore strategies and interventions that can provide support and enhance mental well-being in these individuals.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLimitation\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, depressive and anxiety symptoms were assessed using an informant-reported instrument, while other scales were completed by people living with dementia. Informant-reported instruments are common in dementia research since people living with dementia may experience difficulty communicating, reasoning, and recalling. However, informant ratings can be influenced by the informants\u0026rsquo; feelings of distress [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], the relationship between the informant and the person living with dementia and the time they spent together during the reporting period [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Moreover, central symptoms of depression and anxiety, such as worthlessness and helplessness, might not be accurately reported since informant-rated instruments tend to capture more visible symptoms [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Discrepancies have been observed between self-reported and informant-reported quality of life of people living with dementia [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Future studies can consider including both self-reported and informant-reported measures to enhance our understanding of the relationship between mental well-being and psychological distress in the dementia population. Last, we did not control for the potential social desirability bias.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePromoting mental well-being is crucial for improving the lives of people living with dementia, and a valid measurement of mental well-being plays a vital role in the endeavour to foster positive mental health in this population. The Chinese SWEMWBS can serve as a reliable and valid tool for measuring mental well-being in the Chinese dementia population. However, the known-group validity results indicate a potential distinct pattern of well-being among people living with dementia, warranting further investigation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eItem-total statistics for the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) (N\u0026thinsp;=\u0026thinsp;162)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScale mean if item deleted\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eScale variance if item deleted\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCorrected item-total correlation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSquared multiple correlation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCronbach's alpha if item deleted\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Feeling optimistic about the future\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.77 (1.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Feeling useful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.75 (1.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Feeling relaxed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.45 (1.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Dealing with problems well\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.02 (1.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Thinking clearly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.04 (1.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Feeling close to other people\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.02 (1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Able to make up my own mind about things\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.06 (1.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure 1. Factor loadings of the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) from confirmatory factor analysis\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Human Research Ethics Committee at The University of Hong Kong (reference number: EA200282).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Simon K.Y. Lee Elderly Fund. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDKYL, JCPC, and GHYW contributed to the study conception and design. Material preparation and data collection were performed by MSLM and JCPC. Data analysis was performed by DKYL, MSLM, and JCPC. The first draft of the manuscript was written by DKYL, YHW, YLW, and ZLYN, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the people living with dementia, their family carers, trained volunteers, and social care staff who participated in the BrainLive service.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMartyr A, Clare L (2012) Executive Function and Activities of Daily Living in Alzheimer\u0026rsquo;s Disease: A Correlational Meta-Analysis. Dement Geriatr Cogn Disord 33:189\u0026ndash;203\u003c/li\u003e\n\u003cli\u003eArlt S, Hornung J, Eichenlaub M, Jahn H, Bullinger M, Petersen C (2008) The patient with dementia, the caregiver and the doctor: cognition, depression and quality of life from three perspectives. Int J Geriatr Psychiatry 23:604\u0026ndash;610\u003c/li\u003e\n\u003cli\u003eDepartment of Health and Social Care (2009) Living Well With Dementia: a national dementia strategy. https://www.gov.uk/government/publications/living-well-with-dementia-a-national-dementia-strategy. Accessed 17 Jan 2024\u003c/li\u003e\n\u003cli\u003eStoner CR, Orrell M, Long M, Csipke E, Spector A (2017) The development and preliminary psychometric properties of two positive psychology outcome measures for people with dementia: the PPOM and the EID-Q. BMC Geriatr 17:1\u0026ndash;12\u003c/li\u003e\n\u003cli\u003eRyan RM, Deci EL (2001) On Happiness and Human Potentials: A Review of Research on Hedonic and Eudaimonic Well-Being. Annu Rev Psychol 52:141\u0026ndash;166\u003c/li\u003e\n\u003cli\u003eBowling A, Rowe G, Adams S, Sands P, Samsi K, Crane M, Joly L, Manthorpe J (2015) Quality of life in dementia: a systematically conducted narrative review of dementia-specific measurement scales. Aging Ment Health 19:13\u0026ndash;31\u003c/li\u003e\n\u003cli\u003eDiener E, Chan MY (2011) Happy People Live Longer: Subjective Well-Being Contributes to Health and Longevity. Appl Psychol Health Well Being 3:1\u0026ndash;43\u003c/li\u003e\n\u003cli\u003eMartyr A, Nelis SM, Quinn C, et al (2018) Living well with dementia: a systematic review and correlational meta-analysis of factors associated with quality of life, well-being and life satisfaction in people with dementia. Psychol Med 48:2130\u0026ndash;2139\u003c/li\u003e\n\u003cli\u003eClarke C, Woods B, Moniz-Cook E, Mountain G, \u0026Oslash;ksnebjerg L, Chattat R, Diaz A, Gove D, Vernooij-Dassen M, Wolverson E (2020) Measuring the well-being of people with dementia: a conceptual scoping review. Health Qual Life Outcomes 18:249\u003c/li\u003e\n\u003cli\u003eShah N, Cader M, Andrews B, McCabe R, Stewart-Brown SL (2021) Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS): performance in a clinical sample in relation to PHQ-9 and GAD-7. Health Qual Life Outcomes 19:260\u003c/li\u003e\n\u003cli\u003eTennant R, Hiller L, Fishwick R, Platt S, Joseph S, Weich S, Parkinson J, Secker J, Stewart-Brown S (2007) The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health Qual Life Outcomes 5:63\u003c/li\u003e\n\u003cli\u003eStewart-Brown S, Tennant A, Tennant R, Platt S, Parkinson J, Weich S (2009) Internal construct validity of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS): a Rasch analysis using data from the Scottish Health Education Population Survey. Health Qual Life Outcomes 7:15\u003c/li\u003e\n\u003cli\u003eRingdal R, Bradley Eilertsen M-E, Bj\u0026oslash;rnsen HN, Espnes GA, Moksnes UK (2018) Validation of two versions of the Warwick-Edinburgh Mental Well-Being Scale among Norwegian adolescents. Scand J Public Health 46:718\u0026ndash;725\u003c/li\u003e\n\u003cli\u003eHaver A, Akerjordet K, Caputi P, Furunes T, Magee C (2015) Measuring mental well-being: A validation of the Short Warwick\u0026ndash;Edinburgh Mental Well-Being Scale in Norwegian and Swedish. Scand J Public Health 43:721\u0026ndash;727\u003c/li\u003e\n\u003cli\u003eFung S (2019) Psychometric evaluation of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) with Chinese University Students. Health Qual Life Outcomes 17:46\u003c/li\u003e\n\u003cli\u003eSun Y, Luk TT, Wang MP, Shen C, Ho SY, Viswanath K, Chan SSC, Lam TH (2019) The reliability and validity of the Chinese Short Warwick-Edinburgh Mental Well-being Scale in the general population of Hong Kong. Quality of Life Research 28:2813\u0026ndash;2820\u003c/li\u003e\n\u003cli\u003eVaingankar JA, Abdin E, Chong SA, Sambasivam R, Seow E, Jeyagurunathan A, Picco L, Stewart-Brown S, Subramaniam M (2017) Psychometric properties of the short Warwick Edinburgh mental well-being scale (SWEMWBS) in service users with schizophrenia, depression and anxiety spectrum disorders. Health Qual Life Outcomes 15:153\u003c/li\u003e\n\u003cli\u003eNg SSW, Lo AWY, Leung TKS, Chan FSM, Wong ATY, Lam RWT, Tsang DKY (2014) Translation and validation of the Chinese version of the Short Warwick-Edinburgh Mental Well-being Scale for patients with mental illness in Hong Kong. East Asian Arch Psychiatry 24:3\u0026ndash;9\u003c/li\u003e\n\u003cli\u003eAllward C, Dunn R, Forshaw G, Rewston C, Wass N (2020) Mental wellbeing in people with dementia following Cognitive Stimulation Therapy: Innovative practice. Dementia 19:496\u0026ndash;504\u003c/li\u003e\n\u003cli\u003eDeary IJ, Watson R, Booth T, Gale CR (2013) Does cognitive ability influence responses to the Warwick-Edinburgh Mental Well-Being Scale? Psychol Assess 25:313\u0026ndash;318\u003c/li\u003e\n\u003cli\u003eGiebel C, Pulford D, Cooper C, et al (2021) COVID-19-related social support service closures and mental well-being in older adults and those affected by dementia: a UK longitudinal survey. BMJ Open 11:e045889\u003c/li\u003e\n\u003cli\u003eLau WYT, Stoner C, Wong GH-Y, Spector A (2021) New horizons in understanding the experience of Chinese people living with dementia: a positive psychology approach. Age Ageing 50:1493\u0026ndash;1498\u003c/li\u003e\n\u003cli\u003eBrainLive (2024) BrainLive. https://www.brainlive.socialwork.hku.hk/. Accessed 19 Jan 2024\u003c/li\u003e\n\u003cli\u003eLogsdon RG, Gibbons LE, McCurry SM, Teri L (2002) Assessing Quality of Life in Older Adults With Cognitive Impairment. Psychosom Med 64:510\u0026ndash;519\u003c/li\u003e\n\u003cli\u003eThorgrimsen L, Selwood A, Spector A, Royan L, de Madariaga Lopez M, Woods RT, Orrell M (2003) Whose Quality of Life Is It Anyway? Alzheimer Dis Assoc Disord 17:201\u0026ndash;208\u003c/li\u003e\n\u003cli\u003eMoniz-Cook E, Vernooij-Dassen M, Woods R, et al (2008) A European consensus on outcome measures for psychosocial intervention research in dementia care. Aging Ment Health 12:14\u0026ndash;29\u003c/li\u003e\n\u003cli\u003eDevlin NJ, Brooks R (2017) EQ-5D and the EuroQol Group: Past, Present and Future. Appl Health Econ Health Policy 15:127\u0026ndash;137\u003c/li\u003e\n\u003cli\u003eWong EL yi, Xu RH, Cheung AW ling (2020) Measurement of health-related quality of life in patients with diabetes mellitus using EQ-5D-5L in Hong Kong, China. Quality of Life Research 29:1913\u0026ndash;1921\u003c/li\u003e\n\u003cli\u003eWong A, Cheng S-T, Lo ESK, Kwan PWL, Law LSN, Chan AYY, Wong LK-S, Mok V (2014) Validity and Reliability of the Neuropsychiatric Inventory Questionnaire Version in Patients With Stroke or Transient Ischemic Attack Having Cognitive Impairment. J Geriatr Psychiatry Neurol 27:247\u0026ndash;252\u003c/li\u003e\n\u003cli\u003eKim H-Y (2013) Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis. Restor Dent Endod 38:52\u003c/li\u003e\n\u003cli\u003eTerwee CB, Bot SDM, de Boer MR, van der Windt DAWM, Knol DL, Dekker J, Bouter LM, de Vet HCW (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34\u0026ndash;42\u003c/li\u003e\n\u003cli\u003eSchermelleh-Engel K, Moosbrugger H, M\u0026uuml;ller H (2003) Evaluating the fit of structural equation models: tests of significance and descriptive goodness-of-fit measures. Methods of Psychological Research 8:23\u0026ndash;74\u003c/li\u003e\n\u003cli\u003eSchober P, Boer C, Schwarte LA (2018) Correlation Coefficients: Appropriate Use and Interpretation. Anesth Analg 126:1763\u0026ndash;1768\u003c/li\u003e\n\u003cli\u003eKoushede V, Lasgaard M, Hinrichsen C, Meilstrup C, Nielsen L, Rayce SB, Torres-Sahli M, Gudmundsdottir DG, Stewart-Brown S, Santini ZI (2019) Measuring mental well-being in Denmark: Validation of the original and short version of the Warwick-Edinburgh mental well-being scale (WEMWBS and SWEMWBS) and cross-cultural comparison across four European settings. Psychiatry Res 271:502\u0026ndash;509\u003c/li\u003e\n\u003cli\u003eNg Fat L, Scholes S, Boniface S, Mindell J, Stewart-Brown S (2017) Evaluating and establishing national norms for mental wellbeing using the short Warwick\u0026ndash;Edinburgh Mental Well-being Scale (SWEMWBS): findings from the Health Survey for England. Quality of Life Research 26:1129\u0026ndash;1144\u003c/li\u003e\n\u003cli\u003eHeininga VE, Dejonckheere E, Houben M, Obbels J, Sienaert P, Leroy B, van Roy J, Kuppens P (2019) The dynamical signature of anhedonia in major depressive disorder: positive emotion dynamics, reactivity, and recovery. BMC Psychiatry 19:59\u003c/li\u003e\n\u003cli\u003eFortenberry KT, Jansen KL, Clark MS (2017) Positive Affectivity. In: Encyclopedia of Behavioral Medicine. Springer New York, New York, NY, pp 1\u0026ndash;3\u003c/li\u003e\n\u003cli\u003eCipriani G, Lucetti C, Carlesi C, Danti S, Nuti A (2015) Depression and dementia. A review. Eur Geriatr Med 6:479\u0026ndash;486\u003c/li\u003e\n\u003cli\u003eSeignourel PJ, Kunik ME, Snow L, Wilson N, Stanley M (2008) Anxiety in dementia: A critical review. Clin Psychol Rev 28:1071\u0026ndash;1082\u003c/li\u003e\n\u003cli\u003eMavali S, Mahmoodi H, Sarbakhsh P, Shaghaghi A (2020) Psychometric properties of the Warwick\u0026ndash;Edinburgh Mental Wellbeing Scale (WEMWBS) in the Iranian older adults. Psychol Res Behav Manag Volume 13:693\u0026ndash;700\u003c/li\u003e\n\u003cli\u003eSteptoe A, Deaton A, Stone AA (2015) Subjective wellbeing, health, and ageing. The Lancet 385:640\u0026ndash;648\u003c/li\u003e\n\u003cli\u003eGolden J, Conroy RM, Bruce I, Denihan A, Greene E, Kirby M, Lawlor BA (2009) Loneliness, social support networks, mood and wellbeing in community‐dwelling elderly. 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Int J Geriatr Psychiatry. https://doi.org/10.1002/gps.5556\u003c/li\u003e\n\u003cli\u003eGriffiths AW, Smith SJ, Martin A, Meads D, Kelley R, Surr CA (2020) Exploring self-report and proxy-report quality-of-life measures for people living with dementia in care homes. Quality of Life Research 29:463\u0026ndash;472\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"well-being, mental health, dementia, reliability, validation, psychometric","lastPublishedDoi":"10.21203/rs.3.rs-4023691/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4023691/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSupporting people living with dementia to live well with the condition has been promoted as a policy and practice priority. A valid measure of mental well-being can facilitate related research in the growing Chinese dementia population. This study evaluated the reliability and validity of the Chinese Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) in Chinese people living with dementia in Hong Kong.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 162 people living with dementia completed the SWEMWBS. Factorial validity of the scale was evaluated by confirmatory factor analysis (CFA). Convergent and divergent validity were assessed by Spearman\u0026rsquo;s correlations with Quality of Life in Alzheimer\u0026rsquo;s Disease (QoL-AD), EQ-5D-5L, EQ VAS, Neuropsychiatric Inventory Questionnaire (NPI-Q; depression and anxiety items). Known-group validity was examined based on sex, age, and education level. Congeneric reliability was assessed by standardized factor loadings and error variances, while internal consistency by Cronbach\u0026rsquo;s alpha.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe one-factor structure of SWEMWBS was confirmed (CFI\u0026thinsp;=\u0026thinsp;0.998, TLI\u0026thinsp;=\u0026thinsp;0.996, RMSEA\u0026thinsp;=\u0026thinsp;0.02). The scale had weak-to-moderate correlations with QoL-AD, EQ-5D-5L, EQ VAS, and NPI-Q Anxiety (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.025 to 0.42) but no correlation with NPI-Q Depression. Respondents who were younger, male, and had higher education levels reported higher levels of mental well-being. SWEMWBS showed good congeneric reliability (0.80) and internal consistency (0.80).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe Chinese SWEMWBS showed good validity and reliability for measuring mental well-being in the Chinese dementia population in Hong Kong. Known-group validity results indicate a potentially distinct pattern of well-being among people living with dementia.\u003c/p\u003e","manuscriptTitle":"Reliability and validity of the Chinese Short Warwick-Edinburgh Mental Well-being Scale in people living with dementia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-12 07:25:04","doi":"10.21203/rs.3.rs-4023691/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cbd453d1-5adb-4bc2-8ba8-d9062324b48f","owner":[],"postedDate":"March 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-27T04:22:45+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-12 07:25:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4023691","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4023691","identity":"rs-4023691","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}