PharmacoEconomics

, Volume 7, Issue 3, pp 229–237 | Cite as

Quality-of-Life Instruments for Severe Chronic Mental Illness

Implications for Pharmacotherapy
  • Marion Becker
Review Article

Summary

The care of persons with severe chronic mental illness is one of the most pervasive and neglected public health problems in the US. Increasingly researchers are focusing on the effectiveness of care and quality of life in these patients.

This article reviews the status of quality-of-life (QOL) research in mental health published until 1993. It describes conceptual and methodological approaches reviews QOL instruments developed for persons with severe chronic mental illness and discusses the implications for pharmacotherapy.

Consistent methods, definitions and models must be developed to make QOL research more applicable to the evaluation of pharmaceuticals. Standardisation of approach is necessary to facilitate meta-analyses and to increase our understanding of how pharmacotherapy can improve quality of life for persons with severe chronic mental illness.

QOL data cannot stand alone. Its use is limited by the reality that psychopathology affects quality of life, and quality of life affects psychopathology.

For the foreseeable future, evaluation of pharmacotherapy in severe chronic mental illness will require combined measurement of quality of life and psychopathological symptoms.

Keywords

Mental Illness Community Support Program Outpatient Mental Health Clinic Life Interview Client Quality 

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References

  1. 1.
    Spilker R. Standardisation of quality of life trials: an industry perspective. Pharmacoeconomics 1992: 1 (2): 73–5PubMedCrossRefGoogle Scholar
  2. 2.
    Diamond R. Drugs and the quality of life: the patient’s point of view. J Clin Psychiatry 1985: 46: 29–35PubMedGoogle Scholar
  3. 3.
    Strauss JS, Carpenter WT. The prediction outcome, in schizophrenia: II. Relationships between predictor and outcome variables: a report from the WHO international pilot Mudy of schizophrenia. Arch Gen Psychiatry 1974: 31: 37–42PubMedCrossRefGoogle Scholar
  4. 4.
    Jaeschke R, Guyatt GH, Cook D, Quality of life instruments in the evaluation of new drugs. Pharmacoeconomics 1992: 2: 84–94CrossRefGoogle Scholar
  5. 5.
    Kaplan HI, Sadock BJ. Synopsis of psychiatry: behavioraI sciences clinical psychiatry, 6th ed. New York: Williams & Wilkins, 1992Google Scholar
  6. 6.
    Lehman AF, Ward NC, Linn LS, Chronic mental patients: the quality of life issue. Am J Psychiatry 1982: 139 (10): 1271–6PubMedGoogle Scholar
  7. 7.
    Mechanic D. The challenge of chronic mental illness: a retrospective and prospective view. Hosp Community Psychiatry 1986: 37: 891–6PubMedGoogle Scholar
  8. 8.
    Rosenfield S. Factors contributing to the subjective quality of life or the chronic mentally ill. J Health Soc Behav 1992: 33: 299–315PubMedCrossRefGoogle Scholar
  9. 9.
    Bachrach LL. The homeIless mentally ill. In: Menninger WW, Hannah G, editors. The chronic mental patient II. Washington, DC; The American Psychiatric Press, 1987: 65–92Google Scholar
  10. 10.
    Avison WR, Speechley KN. The discharged psychiatric patient: a review of social–psychological and psychiatric correlates of outcome. Am J Psychiatry 1987; 144: 10–8PubMedGoogle Scholar
  11. 11.
    Anthony WA, Cohen MR, Vitalo R. The measurement of rehabilitation outcome. Schizophr Bull 1978: 4: 365–83Google Scholar
  12. 12.
    Bachrach LL. Assessment of outcome in community support systems: results, problems and limitations. Schizophr Bull 1982: 8: 39–61PubMedGoogle Scholar
  13. 13.
    Braum P, Kochansky G, Shapiro R, et al. Overview: deinstitutionalization of psythiatric patients, a critical review of outcome studies. Am J Psychiatry 1981; 138: 736–49Google Scholar
  14. 14.
    Clum GA. Intrapsychic variable and the patien’s environment as factors in prognosis. Psychol Bull 1975: 82: 413–31PubMedCrossRefGoogle Scholar
  15. 15.
    Strauss JS, Carpenter WT. The prediction of outcome in schizophrenia: five–year outcome and its predictors. Arch Gen Psychiatry 1977: 34: 159–63PubMedCrossRefGoogle Scholar
  16. 16.
    Turner RJ. Social support as a contingency in psychological well–being. J Health Soc Behav 1981: 11: 3357–67Google Scholar
  17. 17.
    Becker M, Diamond R, Sainford F, A new patient centered index for measuring quality of life in persons with severe and persistent mental iIlness. Qual Life Res 1993: 2: 239–51PubMedCrossRefGoogle Scholar
  18. 18.
    Bergner M. Quality of care, health status, and clinical research. Med Care 1989: 27 Suppl.: 5148–56Google Scholar
  19. 19.
    Guyatt GH, Veldhuysen Van Zanten SJ, Feeny DH, et al. Measuring quality of life in clinical trials: a taxonomy and review. Can Med Assoc J 1989: 140: 1441–8Google Scholar
  20. 20.
    Mor V, Guadagoli E. Quality of life measurement: a psychometric tower of Babel. J Clin Epidemiol 1988: 41: 1055–8PubMedCrossRefGoogle Scholar
  21. 21.
    Patrick DL. Health–related quality of life in pharmaceutical evaluation: forging progress and avoiding pitfalls. Pharmaceconomic 1992: 1 (2): 76–8CrossRefGoogle Scholar
  22. 22.
    Liu B. The quality of life in the: United States 1970. Kansas: Midwest Research Institute, 1973Google Scholar
  23. 23.
    Campbell A, Converse P, Rogers W. The quality of American life. New York: Russell Sage Foundation, 1976Google Scholar
  24. 24.
    Heinrichs OW, Hanlon TE, Carpenter WT. The quality of life scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull 1984: 10: 388–98PubMedGoogle Scholar
  25. 25.
    Anthony WA, Farkas MA, A client outcome planning model for assessing psychiatric rehabilitation interventions. Schizophr Bull 1982: 8 (1): 13–38PubMedGoogle Scholar
  26. 26.
    Lehman AF. The effects of psychiatric symptoms on quality of life assessments among the chronic mentally ill. Evaluation Program Planning 1983: 6: 143–51CrossRefGoogle Scholar
  27. 27.
    Patrick DL, Erickson P. Health status and health policy: quality of life in health care evaluation and resources allocation. New York: Oxford University Press, 1988Google Scholar
  28. 28.
    Ware JE. The use of health status and quality of life measures in outcomes and effectiveness research. Proceedings of the National Agenda Setting Conference on Outcomes and Effectiveness Research, Agency for Health Care Policy and Research: 1991 Apr 21: Alexandria, VA. Alexandria, VA: Agency for Health Care Pollicy Research, 1991Google Scholar
  29. 29.
    Warner R, Huxley P. Psychopathology and quality of life among mentally ill patients in the community, British and US samples compared. Br J Psychiatry 1993: 163: 505–9PubMedCrossRefGoogle Scholar
  30. 30.
    Ferrans CE. Quality of life: conceptual issues. Semin Oncol Nurs 1990: 6: 248–54PubMedCrossRefGoogle Scholar
  31. 31.
    Becker M. The development and use of quality of life indicators in mental health research and evaluation. Paper presented at the Midwest Nursing Research Society, 1992 Mar: Chicago, Chicago: Midwest Nursing Research Society, 1992Google Scholar
  32. 32.
    van Dam FSAM, Somers R, Van Beek-Couzijn AL. Quality of life: some theoretical issues. J Clin Pharmacol 1981; 21: 166–8Google Scholar
  33. 33.
    Spilker B, Molinek Jr FR, Johnson KA, et al. Quality of life bibliography and indexes. Med Care 1990: 28 Suppl.: 1–77Google Scholar
  34. 34.
    Tsevat J. Methods for assessing health–related quality of life in HIV–infected patients. Psychol Health 1994: 9: 19–30CrossRefGoogle Scholar
  35. 35.
    Guyatt GH, Jaeschke R, Measurement in cIinical trials: choosing the appropriate trials. In: Spilker B, editor. Quality of life assessments in clinical trials. New York: Raven Press, 1990: 37–46Google Scholar
  36. 36.
    Kaplan RM, Anderson JP. The general health policy model: an integrated approach. In: Spilker B, editor. Quality of life assessmentsin clinical trials. New York: Raven Press, 1990: 13; 1–49Google Scholar
  37. 37.
    Williams A. Economics of coronary artery bypass grafting. BMJ 1985: 2: 326–9CrossRefGoogle Scholar
  38. 38.
    Greenley JR, Greenberg J, Brown R. An improved quality of life measure. Presented at the Mental Health Research Center: Seminar Series 1993 Oct 14: Madison, WI. Madison WI: 1993Google Scholar
  39. 39.
    Sainfort F, Becker M, Diamond R. Judgments of quality of life of individuals with severe mental disorders: client self–report versus provider perspectives. Research Paper Series No.36. Madison, WI: Mental Health Research Center. 1994: 1–20Google Scholar
  40. 40.
    Widlack P, Greenley J, McKee D. Using case manager reports of client outcomes. Mental Health Research Series 1992Google Scholar
  41. 41.
    Spilker B. Quality of life assessments in clinical trials. New York: Raven Press, 1990Google Scholar
  42. 42.
    Hays RD, Stewart AL. The structure of self–reported health in chronic disease patients. Psychol Assess 1990: 2: 22–30CrossRefGoogle Scholar
  43. 43.
    Hanestad BR. Errors of measurement affecting reliability and validity of data acquired from self–assessed quality of life. Scand J Caring Sci 1990: 4: 29–34PubMedGoogle Scholar
  44. 44.
    Moum T. Yea–saying and mood–reporting quality of life. Soc Indicators Res 1988: 20: 117–39CrossRefGoogle Scholar
  45. 45.
    Andrews FM, McKennell AC. Measures of self–reported well–being: their affective, cognitive and other components. Soc Indicators Res 1980: 8: 127–55CrossRefGoogle Scholar
  46. 46.
    Schwartz N, Clore GL. Mood misattribution and judgements of well–being: informative and directive functions of affective states. J Pers Soc Psychol 1983: 45 (3): 513–33CrossRefGoogle Scholar
  47. 47.
    Becker M, Diamond R, Sainfort F. Factors afftecting quality of life among persons with severe and persistent mental illness. Mental Health Research Center 1994 Sep; 33Google Scholar
  48. 48.
    Thepa K, Rowland LA. Quality of life perspectives in long–term care: staff and patient perspectives. Acta Psychiatr Scand 1989; 80: 267–71CrossRefGoogle Scholar
  49. 49.
    Lehman AF. Tile effects of Psychiatric symptoms of quality of life assessments among the chronic mentally ill. J Health Soc Behav 1992: 33: 299–315CrossRefGoogle Scholar
  50. 50.
    Bergner M, Bobbitt RA, Carter WB, et al. The sickness impact profile: development and final revision of a health status measure, Med Care 1981: 19: 787–805PubMedCrossRefGoogle Scholar
  51. 51.
    Kaplan RM, Bush JW. Health related quality of life measurement for evaluation research and policy analysis. Health Psychol 1982: 1: 61–80CrossRefGoogle Scholar
  52. 52.
    Hunt SM, McKenna SP, McEwen EM, et al. A quantitative approach to perceived health status; a validation study. J Epidemiol Community Health 1980: 34: 281–6PubMedCrossRefGoogle Scholar
  53. 53.
    Sackett DL, Chambers LW, MacPherson AS, et al. The development and application of indices of health: general models and a summary of results, Am J Public Health 1977; 67: 423-8Google Scholar
  54. 54.
    Ware JE, Davies-Avery WM, Brook RH. Conceptualization and measurement of health for adults in the health insurance study, Vol. VI. Analysis of relationships among health status measures. Los Angeles: The RAND Corporation R–1987/6HEW, 1980Google Scholar
  55. 55.
    McDowell I, Newell C. Measuring health: a guide to rating scales and questionnaires. New York: Oxford University Press, 1987Google Scholar
  56. 56.
    Neigher W, Ciarlo JA, Hoven C. et al. Evaluation in the community mental health centers program: a bold new reproach? Evaluation Program Planning 1980; 5: 283–312CrossRefGoogle Scholar
  57. 57.
    Ciarlo JA, Brown TR, Edwards DW, et al. Assessing mental health treatment outcome measurement techniques. National Institute of Mental Health: Series FN No.9: DHHS Publication No. ADM 86-1301, 1986Google Scholar
  58. 58.
    Becker M, Diamond R, Sainfort F. Quality of life index for mental health (QLl–MH). Qual Life Res 1993: 2: 239–51PubMedCrossRefGoogle Scholar
  59. 59.
    Bigelow PA, Brodsky G, Steward L, et al. The concept and measurement of quality of life as a dependent variable in evaluation of mental health services. In: Stahler GJ, Tarsh WR, editors. Innovative approaches to mental health evaluation. New York: Academic Press, 1982Google Scholar
  60. 60.
    Bigelow DA, McFarland BH, Olson MM. Quality of life of community mental health program clients: validating a measure. Community Ment Health J 1991: 27 (1): 34–55CrossRefGoogle Scholar
  61. 61.
    Bigelow DA, Young DJ. Effectiveness of a case management program. Community Ment Health J 1991: 27 (2): 115–23PubMedCrossRefGoogle Scholar
  62. 62.
    Heinrichs DH, Halon TE, Carpenter Jr WR. Quality of life scale (QLS): an instrument for rating the schzophrenic deficit syndrome. Schizophr Bull 1984: 10 (3): 388–96PubMedGoogle Scholar
  63. 63.
    Lehman AF. Quality of life interview for the chronically mentally ill (QOLl ). Evaluation Program Planning 1988: 11: 51–62CrossRefGoogle Scholar
  64. 64.
    Andrews FM, Withey SB. Social indicators of well–being: America’s perception of life quality. New York: Plenum Press, 1976Google Scholar
  65. 65.
    Lehman AF, Slaughter JG, Myers CP. Quality of life in alternative residential settings. Psychiatr Q 1991: 62 (1): 35–49PubMedCrossRefGoogle Scholar
  66. 66.
    Levitt AJ, Hogan TP, Bocosky CM. Quality of life in chronically mentally ill patients in day treatment. Psychol Med 1990; 20: 703–10PubMedCrossRefGoogle Scholar
  67. 67.
    Slaughter JC, Lehman AF. Quality of life of severity mentally ill adults in residential care facilities. Adult Residential Care J 1991: 5: 97–111Google Scholar
  68. 68.
    Malm U, May PRA, Evaluation of the quality of life of the schizophrenic outpatient; a check list. Schizophr Bull 1981, 7: 477–87PubMedGoogle Scholar
  69. 69.
    Mulfem V, Agosta JM, Ashbaugh JW. et al. Community support program client follow–up study. Report to National Institute of Mental Health. Rockville, MD: National Institute of Mental Health, 1986Google Scholar
  70. 70.
    Meltzer HY, Burnen S, Bastani B, et al. Effects of six months of clozapine treatment on the quality of life of chronic schizophrenic patients. Hosp Community Psychiatry 1990; 41 (8): 892–6PubMedGoogle Scholar

Copyright information

© Adis International Limited 1995

Authors and Affiliations

  • Marion Becker
    • 1
  1. 1.Department of Health and Human IssuesUniversity of Wisconsin-MadisonMadisonUSA

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