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8 - Measures of quality of life for persons with severe mental disorders

from Part II - Domains of outcome measurement


This chapter provides clinicians, researchers, programme evaluators and administrators with current information on the assessment of quality-of-life (QOL) outcomes for persons with severe mental illnesses. Measures are summarised according to purpose, content, psychometric properties, patient subgroups with whom used and key references. A series of QOL measures are summarised and reflect considerable variability on the parameters examined. Comprehensive, reliable, and valid measures of QOL are available, although further development of QOL assessment methods is needed. More importantly, we must strive for a better understanding of how to interpret and use QOL outcome information.

The broad impact that severe mental illnesses have on people's lives and the resulting complexity of the needs generated by such illnesses pose a particular challenge in the assessment of the outcomes of services for these persons (Lehman et al, 1982; Ruggeri & Tansella, 1995). Relevant outcome domains include psychiatric symptoms, functional status, access to resources and opportunities, subjective well-being, family burden and community safety. Because of this broad array of relevant outcomes and because of a prevailing concern that outcome assessments should include the patient's perspective (Lasalvia & Ruggeri, 2007), there has been increased attention paid over the past decade to the development of measures of patients’ QOL.

This chapter summarises the measures of QOL that have been developed specifically for persons with severe mental illnesses. We do not consider generic health-related QOL measures, such as the WHOQOL–100 (WHOQOL Group, 1998a) or its abbreviated version, the WHOQOL–BREF (WHOQOL Group, 1998b), the Medical Outcome Study (MOS) 36-Item Short-Form Health Survey (SF–36) (Ware & Sherbourne, 1992) or the EQ–5D (Kind, 1996). Although these measures have been widely used for assessing QOL in studies conducted on psychiatric populations, they have been designed to asses it in a wide spectrum of physical disorders and in a variety of situations and population groups (e.g. cancer patients, refugees, the elderly and those with certain diseases, such as HIV/AIDS). ‘Quality of life’ is a broad term and conceptually could cover all outcome measures, including measures of clinical symptoms and functional status (Katschnig, 2000). However, many of these measures are reviewed elsewhere in this volume or have been reviewed previously. Therefore, they are not included in this review. Also excluded here are measures of client satisfaction with services and ‘family burden’, which are considered in detail in Chapters 6 and 7, respectively.