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Licensed Unlicensed Requires Authentication Published by De Gruyter June 25, 2021

Translation and cross-cultural adaption of an instrument measuring patient’s well-being under treatment for schizophrenia

Julaeha Julaeha ORCID logo, Umi Athiyah, Margarita Maria Maramis, Agus Sugianto and Andi Hermansyah ORCID logo



The Subjective Well-Being under Neuroleptic (SWN) Scale is a self-rating scale measuring the well-being of patients with schizophrenia under antipsychotic drug treatment. The instrument has been globally used, with issues regarding the well-being assessment scale across different cultures, patient characteristics, and country-setting remains a controversy. This study aimed to translate and culturally adapt the SWN scale into the Indonesian version (Indonesian Modified SWN or IM-SWN) and evaluate its validity and reliability.


The SWN instrument was translated and culturally adapted following internationally accepted procedures, including forward translation, expert panel review, backward-translation, pretesting and cognitive interviewing, and psychometric analysis for the final version of the scale. The translated instrument was tested on 108 schizophrenia patients. The instrument’s validity and reliability were assessed using Pearson’s correlation and Cronbach’s Alpha coefficient. Additional analysis for the socio-demographic and psychometric properties of the patient was also conducted.


The range of IM-SWN total score between 30 and 112. IM-SWN was found to have a high-reliability coefficient (0.897), and the internal consistency values of each question item ranged between 0.885 and 0.910. The results also showed a high correlation between five order factors (Physical functioning, mental functioning, self-control, emotional regulation, and social integration), with a total score of between 0.768 and 0.885.


This study highlighted that the IM-SWN is a valid and reliable instrument for measuring well-being among the Indonesian population with schizophrenia.

Corresponding author: Andi Hermansyah, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia, Phone: +62315933150, E-mail:

Funding source: Indonesian Endowment Fund

Funding source: Universitas Airlangga


The authors thanked the head and all staffs of the Menur National Mental Hospital Indonesia and Indonesian Community Care for Schizophrenia for providing supports and facilitating data collections. We also thanked participants of this study who have provided time and efforts for this study.

  1. Research funding: The authors thanked the Indonesian Endowment Fund for Education and Universitas Airlangga for supporting this study.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors stated no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: Ethical approval was obtained from the Research Ethics Committee of Menur Mental Hospital Surabaya, East Java, Indonesia with number 070/7556/305/2019.


1. Bullinger, M, Quitmann, J. Quality of life as patient-reported outcomes: principles of assessment. Dialogues Clin Neurosci 2014;16:137–45.10.31887/DCNS.2014.16.2/mbullingerSearch in Google Scholar

2. Karow, A, Wittmann, L, Schöttle, D, Schäfer, I, Lambert, M. The assessment of quality of life in clinical practice in patients with schizophrenia. Dialogues Clin Neurosci 2014;16:185–95.10.31887/DCNS.2014.16.2/akarowSearch in Google Scholar

3. The WHOQOL Group. The world health organization quality of life assessment (WHOQOL). Soc Sci Med 1995;41:1403–9.10.1016/0277-9536(95)00112-KSearch in Google Scholar

4. Bobes, J, Garcia-Portilla, MP, Bascaran, MT, Saiz, PA, Bousoño, M. Quality of life in schizophrenic patients. Dialogues Clin Neurosci 2007;9:215–26.10.31887/DCNS.2007.9.2/jbobesSearch in Google Scholar

5. Camfield, L, Skevington, SM. On subjective well being and quality of life. J Health Psychol 2008;13:764–75.10.1177/1359105308093860Search in Google Scholar

6. Heinrichs, DH, Hanlon, TE, Carpenter, WT. The quality of life scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull 1984;10:388–98.10.1093/schbul/10.3.388Search in Google Scholar

7. Tollefson, GD, Beasley, CM, Tran, PV, Street, JS, Krueger, JA, Tamura, RN, et al.. Olanzapine versus haloperidol in the treatment of schizophrenia and schizoaffective and schizophreniform disorders: results of an international collaborative trial. Am J Psychiatr 1997;154:457–65.10.1176/ajp.154.4.457Search in Google Scholar

8. Tran, PV, Hamilton, SH, Kuntz, AJ, Potvin, JH, Andersen, SW, Beasley, C, et al.. Double-blind comparison of olanzapine versus risperidone in the treatment of schizophrenia and other psychotic disorders. J Clin Psychopharmacol 1997;17:400–18.10.1097/00004714-199710000-00010Search in Google Scholar

9. Hamilton, SH, Revicki, DA, Genduso, LA, Beasley, CM. Olanzapine versus placebo and haloperidol: quality of life and efficacy results of the North American double blind trial. Neuropsychopharmacology 1998;18:41–9.10.1016/S0893-133X(97)00111-5Search in Google Scholar

10. Revicki, DA, Genduso, LA, Hamilton, SH, Ganoczy, D, Beasley, CM. Olanzapine versus haloperidol in the treatment of schizophrenia and other psychotic disorders. Quality of life and clinical outcomes of a randomized clinical trial. Qual Life Res 1999;8:417–26.10.1023/A:1008958925848Search in Google Scholar

11. Hamilton, SH, Edgell, ET, Revicki, DA, Breir, A. Functional outcomes in schizophrenia: a comparison of olanzapine and haloperidol in European sample. Int Clin Psychopharmacol 2000;15:245–55.10.1097/00004850-200015050-00001Search in Google Scholar

12. Gureje, O, Miles, W, Keks, N, Grainger, D, Lamber, T, McGrath, J, et al.. Olanzapine versus risperidone in the management of schizophrenia: a randomized double-blind trial in Australia and New Zealand. Schizophr Res 2003;61:303–14.10.1016/S0920-9964(02)00226-8Search in Google Scholar

13. Whitty, P, Browne, S, Clarke, M, McTigue, O, Waddington, J, Kinsella, T, et al.. Systematic comparison of subjective and objective measures of quality of life at 4-year follow-up subsequent to a first episode of psychosis. J Nerv Ment Dis 2004;71:137–44.10.1097/01.nmd.0000146733.26005.bdSearch in Google Scholar

14. Naber, D. A self-rating to measure subjective effects of neuroleptic drugs. Relationships to objective psychopatology, quality of life, compliance and other clinical variables. Int Clin Psychopharmacol 1995;10(3 Suppl):133–8.10.1097/00004850-199509000-00017Search in Google Scholar

15. Naber, D, Moritz, S, Lambert, M, Rajonk, F, Holzbach, R, Mass, R, et al.. Improvement of schizophrenic patients’ subjective well-being under atypical antipsychotic drugs. Schizophr Res 2001;50:79–88.10.1016/S0920-9964(00)00166-3Search in Google Scholar

16. De Haan, L, Weisfelt, M, Dingemans, PMAJ, Linszen, DH, Wouters, L. Psychometric properties of the subjective well-being under neuroleptics scale and the subjective deficit syndrome scale. Psychopharmacology 2002;162:24–8.10.1007/s00213-002-1054-xSearch in Google Scholar PubMed

17. Kluge, M, Wehmeier, PM, Dittmann, RW, Langer, F, Czekalla, J, Lehmann, M, et al.. A simple switching strategy for inadequately treated patients with schizophrenia to olanzapine: changes in psychopathology and subjective well-being. Pharmacopsychiatry 2005;38:6–12.10.1055/s-2005-837764Search in Google Scholar PubMed

18. Naber, D, Riedel, M, Klimke, A, Vorbach, EU, Lambert, M, Kuhn, KU, et al.. Randomized double blind comparison of olanzapine vs clozapine on subjective well-being and clinical outcomes in patients with schizophrenia. Acta Psychiatr Scand 2005;111:106–15.10.1111/j.1600-0447.2004.00486.xSearch in Google Scholar PubMed

19. Lambert, M, Schimmelmann, BG, Naber, D, Schacht, A, Karow, A, Wagner, T, et al.. Prediction of remission as a combination of symptomatic and functional remission and adequate subjective well-being in 2960 patients with schizophrenia. J Clin Psychiatr 2006;67:1690–7.10.4088/JCP.v67n1104Search in Google Scholar

20. Vothknecht, S, Schoevers, RA, de Haan, L. Subjective well-being in schizophrenia as measured with the subjective well-being under neuroleptic treatment scale: a review. Aust N Z Collage of Psychiatr 2011;45:182–92.10.3109/00048674.2010.545984Search in Google Scholar PubMed

21. Balestrieri, M, Giaroli, G, Mazzi, M, Bellantuono, C. Performance of the Italian version of the subjective well-being under neuroleptic (SWN) scale in schizophrenic outpatients. Pharmacopsychiatry 2006;39:81–4.10.1055/s-2006-941480Search in Google Scholar

22. Siamouli, M, Moutou, K, Pantoula, E, Magiria, S, Chatzivasileiou, I, Arapidis, K, et al.. Preliminary data concerning the reliability and psychometric properties of the Greek translation of the 20-item Subjective Well-Being under Neuroleptic Treatment Scale (SWN-20). Ann Gen Psychiatr 2009;8:3.10.1186/1744-859X-8-3Search in Google Scholar

23. Pazvantoglu, O, Simsek, OF, Aydemir, O, Sarisoy, G, Korkmaz, IZ, Mor, S, et al.. Reliability and validity of subjective well-being under neuroleptics scales-short form Turkish version. Bull Clin Psychopharmacol 2012;22:235–43.10.5455/bcp.20120731082335Search in Google Scholar

24. Haring, L, Mottus, R, Jaanson, P, Pilli, R, Magi, K, Maron, E. Subjective well-being under neuroleptics scale short form (SWN-K): reliability and validity in an Estonian speaking sample. Ann Gen Psychiatr 2013;12:28.10.1186/1744-859X-12-28Search in Google Scholar

25. Sanjuan, J, Haro, JM, Maurino, J, Diez, T, Ballesteros, J. Validation of the Spanish version of the subjective well-being under neuroleptic (SWN) scale in patients with schizophrenia. Med Clin 2012;25:151–4.10.1016/S0924-9338(10)71092-0Search in Google Scholar

26. Guo, J, Zhao, Z, Ha, S. Testing the reliability and validity of Chinese version of subjective well-being under neuroleptics (SWN) short form. Med J Chin People Health 2003;15:1–2.Search in Google Scholar

27. Yoon, JS, Kook, SH, Lee, HY, Lee, C, Paik, IH. The development of a Korean modification of the scale to measure subjective well-being under neuroleptic treatment (KmSWN). J Korean Neuropsychiatr Assoc 2000;39:987–98.Search in Google Scholar

28. Wild, D, Grove, A, Martin, M, Eremenco, S, McElroy, S, Verjee-Lorenz, A, et al.. Principles of good practice for translation and cultural adaptation process for Patient-Report Outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value Health 2005;8:94–104.10.1111/j.1524-4733.2005.04054.xSearch in Google Scholar

29. Bullinger, M. Generic quality of life assessment in psychiatry. Potentials and limitations. Eur Psychiatr 1997;12:203–9.10.1016/S0924-9338(97)89106-7Search in Google Scholar

30. Karow, A, Naber, D. Subjective well-being and quality of under atypical antipsychotic treatment. Psychopharmacol 2002;162:3–10.10.1007/s00213-002-1052-zSearch in Google Scholar PubMed

31. Lambert, M, Schimmelman, BG, Karow, A, Naber, D. Subjective well-being and initial dysphoric reaction under antipsychotic drugs-concepts, measurement and clinical relevance. Pharmacopsychiatry 2003;36:181–90.10.1055/s-2003-45128Search in Google Scholar PubMed

32. Lambert, M, Naber, D, Schacht, A, Wagner, T, Hundemer, HP, Karow, A, et al.. Rates and predictors of remission and recovery during 3 years in 392 never-treated patients with schizophrenia. Acta Psychiatr Scand 2008;118:220–9.10.1111/j.1600-0447.2008.01213.xSearch in Google Scholar PubMed

33. Lambert, M, Schimmelmann, BG, Schacht, A, Karow, A, Wagner, T, Wehmeier, PM, et al.. Long-term patterns of subjective wellbeing in schizophrenia: cluster, predictors of cluster affiliation, and relation to recovery criteria in 2842 patients followed over 3 years. Schizophr Res 2009;107:165–72.10.1016/j.schres.2008.08.035Search in Google Scholar PubMed

34. Wehmeier, PM, Kluge, M, Schneider, E, Schacht, A, Wagner, T, Schreiber, W. Quality of life and subjective well-being during treatment with antipsychotics in out-patients with schizophrenia. Prog Neuro-Psychopharmacol Biol Psychiatr 2007;31:703–12.10.1016/j.pnpbp.2007.01.004Search in Google Scholar PubMed

Received: 2021-01-02
Accepted: 2021-03-08
Published Online: 2021-06-25

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