Quality of life assessment in psychiatry: the Subjective Quality of Life Profile (SQLP)--first results of a new instrument

Patients on methadone maintenance treatment in Geneva

The purpose of this study was to evaluate the quality of life of heroin dependent patients before and 1 year after the start of methadone maintenance treatment. Subjects were patients (n = 102) requesting treatment in a public methadone maintenance programme in Geneva (Switzerland). This was a prospective follow-up study using a validated questionnaire (SQLP). The SQLP was well accepted by patients and staff. Validity of the questionnaire was reconfirmed in this population. Compared to previously studied populations, the quality of life of heroin dependent patients before start of treatment was poor. More than half the patients were still in treatment after 1 year and their quality of life had clearly improved, in most domains. Like many of their peers in the psychiatric field, the patients had high initial expectations. Expectations decreased significantly over time. It was found that the higher were the initial expectations, the poorer was the quality of life after 1 year. The quality of life of heroin abusers requesting treatment is mediocre, and improved considerably after 1 year of comprehensive methadone maintenance treatment. Quality of life evaluation is feasible in this population and can offer an additional evaluation of quality of substance abuse treatment.

The Development and Evaluation of the Mayers' Lifestyle Questionnaire (2)

The Mayers' Lifestyle Questionnaire (2) is a client-centred tool which enables people with enduring mental health problems to identify and prioritise issues affecting their quality of life. It was developed following requests from occupational therapists working in community mental health teams. This article briefly describes how the tool was developed and then describes the main study used to evaluate the Mayers' Lifestyle Questionnaire (2). Eighty-three occupational therapists from around the United Kingdom offered to take part in the study. The results are from data returned by 33 occupational therapists and 75 clients.

The occupational therapists and the clients were positive overall in their comments. Three occupational therapists in the study worked with people with brain injury rather than with clients with enduring mental health problems and, having seen and used the tool, they stated that it would prove suitable for some of their clients. The evaluation has led to minor changes being made to the Mayers' Lifestyle Questionnaire (2).

Quality of Life: Priorities for People with Enduring Mental Health Problems

Eleven people with enduring mental health problems were interviewed about their quality of life. The analysis of the data collected indicated that the key areas that were problems affecting their quality of life were lack of personal achievement, lack of job, difficulty in forming and maintaining relationships, loneliness, health problems (both mental and physical), lack of leisure activities, personal safety and looking after self. The literature review also clearly indicated that finance and access to benefits were priorities for people with enduring mental health problems. The data collected will be used in the development of the Mayers' Lifestyle Questionnaire (2), a tool for use in identifying priority quality of life issues for people with enduring mental health problems. The interviewees said that they would be highly motivated to complete such a questionnaire.

Quality of life in bipolar disorder: a review of the literature

A sizable body of research has now examined the complex relationship between quality of life (QoL) and depressive disorder. Uptake of QoL research in relation to bipolar disorder (BD) has been comparatively slow, although increasing numbers of QoL studies are now being conducted in bipolar populations. We aimed to perform a review of studies addressing the assessment of generic and health-related QoL in patients with bipolar disorder.

A literature search was conducted in a comprehensive selection of databases including MEDLINE up to November 2004. Key words included: bipolar disorder or manic-depression, mania, bipolar depression, bipolar spectrum and variants AND quality of life, health-related QoL, functional status, well-being and variants. Articles were included if they were published in English and reported on an assessment of generic or health-related QoL in patients with BD. Articles were not included if they had assessed fewer than 10 patients with BD, were only published in abstract form or only assessed single dimensions of functioning.

The literature search initially yielded 790 articles or abstracts. Of these, 762 did not meet our inclusion criteria, leaving a final total of 28 articles. These were sub-divided into four categories (assessment of QoL in patients with BD at different stages of the disorder, comparisons of QoL in Patients with BD with that of other patient populations, QoL instrument evaluation in patients with BD and treatment studies using QoL instruments to assess outcome in Patients with BD) and described in detail.

The review indicated that there is growing interest in QoL research in bipolar populations. Although the scientific quality of the research identified was variable, increasing numbers of studies of good design are being conducted. The majority of the studies we identified indicated that QoL is markedly impaired in patients with BD, even when they are considered to be clinically euthymic. We identified several important avenues for future research, including a need for more assessment of QoL in hypo/manic patients, more longitudinal research and the development of a disease-specific measure of QoL for patients with BD.

Life satisfaction and disability after severe traumatic brain injury

OBJECTIVE

To assess the relationships between life satisfaction and disability after a severe traumatic brain injury (TBI).

DESIGN

Cross-sectional study, including 75 patients 2 years or more after a severe TBI.

METHODS

Life satisfaction was assessed with the Subjective Quality of Life Profile. Impairments, activities and participation were assessed with standardized tests.

RESULTS

The satisfaction profile was flat, i.e. the majority of items obtained mean satisfaction scores close to 0, suggesting that participants felt indifferent to these items or in other words that they were neither satisfied nor unsatisfied. Patients were on average slightly dissatisfied with their cognitive functions, physical abilities and self-esteem. A factor analysis revealed three underlying factors. The main finding was that the relationships between life satisfaction and disability were not linear: the lowest satisfaction scores were reported by participants with moderate disability rated by the Glasgow Outcome Scale, while individuals with severe disability did not significantly differ from the good recovery group.

CONCLUSION

Life satisfaction is not linearly related to disability after severe TBI.

Satisfaction in different life domains in children receiving home parenteral nutrition and their families

OBJECTIVE

To assess the quality-of-life (QOL) of children receiving home parenteral nutrition (HPN).

STUDY DESIGN

A national multicenter study of 72 patients (median age 4 years) presenting with a digestive disease requiring HPN, and 90 siblings, 67 fathers, and 69 mothers of these children. Median duration of HPN was 2 years (3 months-18 years). QOL was measured using validated, nondisease-specific questionnaires appropriate to the children's ages.

RESULTS

The QOL scores were high in patients of all ages and were not significantly different from scores in a reference population of healthy children and adolescents. Lower QOL scores were recorded in the domains related to hospital, health, doctors, medications, and obligations. The QOL was not affected in siblings but was significantly impaired in parents, especially in mothers, who showed a lower level of satisfaction than did fathers for items related to work, inner life, and freedom. Presence of an ileostomy was the only factor that influenced QOL, especially of adolescents.

CONCLUSIONS

QOL of HPN-dependent children and siblings is not different from that of healthy children, suggesting that these children actively use effective coping strategies. In contrast, the QOL of parents of HPN-dependent children is low.

Measuring quality of life in the mentally ill

It has been our experience that it is easier to measure quality of life among persons with serious mental illness than it is to intervene to improve it. This article presents background and historical context of service delivery to persons with severe mental illness. We then examine approaches to assessing outcomes of services, especially quality of life. We conclude with an illustration and discussion of dilemmas in measuring quality of life in this vulnerable population.

Activity-related quality of life in rehabilitation and traumatic brain injury

OBJECTIVES

To review approaches to assessment of quality of life (QOL) outcomes in rehabilitation, focusing particularly on traumatic brain injury (TBI), and to introduce the concept of activity-related QOL.

DATA SOURCES

A conceptual review, based on extensive searches of MEDLINE, PsychInfo, and other information sources.

STUDY SELECTION

Studies indexed under QOL and brain injury.

DATA EXTRACTION

Literature search on key words quality of life and traumatic brain injury.

DATA SYNTHESIS

Past research in rehabilitation and TBI has concentrated largely on assessment of function or activity. Although research on QOL after TBI remains limited, many studies have made inferences about QOL without actually assessing it. Persons with TBI experience serious long-enduring problems with QOL. Progress has been made in measurement of QOL and understanding of predictors of QOL after TBI.

CONCLUSIONS

Future research in rehabilitation would do well to consider not only activity outcomes but also the affective quality of everyday life, and the connections between the two. Measures of activity-related QOL may provide a more sensitive, valid, and useful evaluation of rehabilitative therapies than other approaches. Further research is needed to improve measurement and interpretation of QOL assessments. By assessing both objective and subjective features of outcomes, outcomes assessment becomes more complete and potentially more useful.