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.
Similar content being viewed by others
References
Spilker R. Standardisation of quality of life trials: an industry perspective. Pharmacoeconomics 1992: 1 (2): 73–5
Diamond R. Drugs and the quality of life: the patient’s point of view. J Clin Psychiatry 1985: 46: 29–35
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: 37–42
Jaeschke R, Guyatt GH, Cook D, Quality of life instruments in the evaluation of new drugs. Pharmacoeconomics 1992: 2: 84–94
Kaplan HI, Sadock BJ. Synopsis of psychiatry: behavioraI sciences clinical psychiatry, 6th ed. New York: Williams & Wilkins, 1992
Lehman AF, Ward NC, Linn LS, Chronic mental patients: the quality of life issue. Am J Psychiatry 1982: 139 (10): 1271–6
Mechanic D. The challenge of chronic mental illness: a retrospective and prospective view. Hosp Community Psychiatry 1986: 37: 891–6
Rosenfield S. Factors contributing to the subjective quality of life or the chronic mentally ill. J Health Soc Behav 1992: 33: 299–315
Bachrach LL. The homeIless mentally ill. In: Menninger WW, Hannah G, editors. The chronic mental patient II. Washington, DC; The American Psychiatric Press, 1987: 65–92
Avison WR, Speechley KN. The discharged psychiatric patient: a review of social–psychological and psychiatric correlates of outcome. Am J Psychiatry 1987; 144: 10–8
Anthony WA, Cohen MR, Vitalo R. The measurement of rehabilitation outcome. Schizophr Bull 1978: 4: 365–83
Bachrach LL. Assessment of outcome in community support systems: results, problems and limitations. Schizophr Bull 1982: 8: 39–61
Braum P, Kochansky G, Shapiro R, et al. Overview: deinstitutionalization of psythiatric patients, a critical review of outcome studies. Am J Psychiatry 1981; 138: 736–49
Clum GA. Intrapsychic variable and the patien’s environment as factors in prognosis. Psychol Bull 1975: 82: 413–31
Strauss JS, Carpenter WT. The prediction of outcome in schizophrenia: five–year outcome and its predictors. Arch Gen Psychiatry 1977: 34: 159–63
Turner RJ. Social support as a contingency in psychological well–being. J Health Soc Behav 1981: 11: 3357–67
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: 239–51
Bergner M. Quality of care, health status, and clinical research. Med Care 1989: 27 Suppl.: 5148–56
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: 1441–8
Mor V, Guadagoli E. Quality of life measurement: a psychometric tower of Babel. J Clin Epidemiol 1988: 41: 1055–8
Patrick DL. Health–related quality of life in pharmaceutical evaluation: forging progress and avoiding pitfalls. Pharmaceconomic 1992: 1 (2): 76–8
Liu B. The quality of life in the: United States 1970. Kansas: Midwest Research Institute, 1973
Campbell A, Converse P, Rogers W. The quality of American life. New York: Russell Sage Foundation, 1976
Heinrichs OW, Hanlon TE, Carpenter WT. The quality of life scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull 1984: 10: 388–98
Anthony WA, Farkas MA, A client outcome planning model for assessing psychiatric rehabilitation interventions. Schizophr Bull 1982: 8 (1): 13–38
Lehman AF. The effects of psychiatric symptoms on quality of life assessments among the chronic mentally ill. Evaluation Program Planning 1983: 6: 143–51
Patrick DL, Erickson P. Health status and health policy: quality of life in health care evaluation and resources allocation. New York: Oxford University Press, 1988
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, 1991
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: 505–9
Ferrans CE. Quality of life: conceptual issues. Semin Oncol Nurs 1990: 6: 248–54
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, 1992
van Dam FSAM, Somers R, Van Beek-Couzijn AL. Quality of life: some theoretical issues. J Clin Pharmacol 1981; 21: 166–8
Spilker B, Molinek Jr FR, Johnson KA, et al. Quality of life bibliography and indexes. Med Care 1990: 28 Suppl.: 1–77
Tsevat J. Methods for assessing health–related quality of life in HIV–infected patients. Psychol Health 1994: 9: 19–30
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: 37–46
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; 1–49
Williams A. Economics of coronary artery bypass grafting. BMJ 1985: 2: 326–9
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: 1993
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: 1–20
Widlack P, Greenley J, McKee D. Using case manager reports of client outcomes. Mental Health Research Series 1992
Spilker B. Quality of life assessments in clinical trials. New York: Raven Press, 1990
Hays RD, Stewart AL. The structure of self–reported health in chronic disease patients. Psychol Assess 1990: 2: 22–30
Hanestad BR. Errors of measurement affecting reliability and validity of data acquired from self–assessed quality of life. Scand J Caring Sci 1990: 4: 29–34
Moum T. Yea–saying and mood–reporting quality of life. Soc Indicators Res 1988: 20: 117–39
Andrews FM, McKennell AC. Measures of self–reported well–being: their affective, cognitive and other components. Soc Indicators Res 1980: 8: 127–55
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): 513–33
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; 33
Thepa K, Rowland LA. Quality of life perspectives in long–term care: staff and patient perspectives. Acta Psychiatr Scand 1989; 80: 267–71
Lehman AF. Tile effects of Psychiatric symptoms of quality of life assessments among the chronic mentally ill. J Health Soc Behav 1992: 33: 299–315
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: 787–805
Kaplan RM, Bush JW. Health related quality of life measurement for evaluation research and policy analysis. Health Psychol 1982: 1: 61–80
Hunt SM, McKenna SP, McEwen EM, et al. A quantitative approach to perceived health status; a validation study. J Epidemiol Community Health 1980: 34: 281–6
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: 423-8
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, 1980
McDowell I, Newell C. Measuring health: a guide to rating scales and questionnaires. New York: Oxford University Press, 1987
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: 283–312
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, 1986
Becker M, Diamond R, Sainfort F. Quality of life index for mental health (QLl–MH). Qual Life Res 1993: 2: 239–51
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, 1982
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): 34–55
Bigelow DA, Young DJ. Effectiveness of a case management program. Community Ment Health J 1991: 27 (2): 115–23
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): 388–96
Lehman AF. Quality of life interview for the chronically mentally ill (QOLl ). Evaluation Program Planning 1988: 11: 51–62
Andrews FM, Withey SB. Social indicators of well–being: America’s perception of life quality. New York: Plenum Press, 1976
Lehman AF, Slaughter JG, Myers CP. Quality of life in alternative residential settings. Psychiatr Q 1991: 62 (1): 35–49
Levitt AJ, Hogan TP, Bocosky CM. Quality of life in chronically mentally ill patients in day treatment. Psychol Med 1990; 20: 703–10
Slaughter JC, Lehman AF. Quality of life of severity mentally ill adults in residential care facilities. Adult Residential Care J 1991: 5: 97–111
Malm U, May PRA, Evaluation of the quality of life of the schizophrenic outpatient; a check list. Schizophr Bull 1981, 7: 477–87
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, 1986
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): 892–6
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Becker, M. Quality-of-Life Instruments for Severe Chronic Mental Illness. Pharmacoeconomics 7, 229–237 (1995). https://doi.org/10.2165/00019053-199507030-00006
Published:
Issue Date:
DOI: https://doi.org/10.2165/00019053-199507030-00006