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Changes in quality of life from a homelessness intervention: true change, response shift, or random variation

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Abstract

Background and objective

Participants experiencing homelessness and mental illness who received housing and support through the At Home/Chez Soi trial showed modest gains in quality of life (QOL) compared to treatment as usual participants. Participants’ QOL ratings over time may have been affected by either response shift triggered by new life circumstances or by random variation in the meaning of QOL ratings. This study seeks to identify both phenomena to estimate the intervention’s effect on true change in QOL.

Methods

Using the residuals from a regression model of the global item of Lehman’s 20-item quality of life interview (QOLI-20), latent trajectory analysis was used to identify response shift, while a measure of overall variability in residuals identified random variation of QOL. The latter was used to adjust group comparisons of QOLI-20 total scores and the global item.

Results

Equivalent distributions of both groups’ participants across latent trajectory classes (χ2 = 2.97, p = .397) suggest that the intervention did not trigger response shift. However, random variation interacted significantly with the treatment effect on global item ratings. For every increase of one standard deviation of residuals, treatment odds ratios decreased by a factor of 0.70 (SE 1.18, p = .036, 95% CI 0.50–0.98).

Conclusions

Measuring random variation in QOL ratings from the standard deviation of residuals offers the ability to approximate, although indirectly, how participants’ QOL is truly affected by a housing intervention. Specifically, we found that QOL improvement is more evident when QOL ratings have a consistent meaning over time.

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References

  1. Sprangers, M. A., & Schwartz, C. E. (1999). Integrating response shift into health-related quality of life research: A theoretical model. Social Science and Medicine (1982), 48(11), 1507–1515.

    Article  CAS  Google Scholar 

  2. Mayo, N. E., Scott, S. C., Dendukuri, N., Ahmed, S., & Wood-Dauphinee, S. (2008). Identifying response shift statistically at the individual level. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 17(4), 627–639. doi:10.1007/s11136-008-9329-2.

    Article  Google Scholar 

  3. Schwartz, C. E., Bode, R., Repucci, N., Becker, J., Sprangers, M. A. G., & Fayers, P. M. (2006). The clinical significance of adaptation to changing health: A meta-analysis of response shift. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 15(9), 1533–1550. doi:10.1007/s11136-006-0025-9.

    Article  Google Scholar 

  4. Schwartz, C. E., Merriman, M. P., Reed, G. W., & Hammes, B. J. (2004). Measuring patient treatment preferences in end-of-life care research: Applications for advance care planning interventions and response shift research. Journal of Palliative Medicine, 7(2), 233–245. doi:10.1089/109662104773709350.

    Article  PubMed  Google Scholar 

  5. Rapkin, B. D., & Schwartz, C. E. (2004). Toward a theoretical model of quality-of-life appraisal: Implications of findings from studies of response shift. Health and Quality of Life Outcomes, 2, 14. doi:10.1186/1477-7525-2-14.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schwartz, C. E., & Rapkin, B. D. (2004). Reconsidering the psychometrics of quality of life assessment in light of response shift and appraisal. Health and Quality of Life Outcomes, 2, 16. doi:10.1186/1477-7525-2-16.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Goering, P. N., Streiner, D. L., Adair, C., Aubry, T., Barker, J., Distasio, J., … Zabkiewicz, D. M. (2011). The At Home/Chez Soi trial protocol: A pragmatic, multi-site, randomised controlled trial of a Housing First intervention for homeless individuals with mental illness in five Canadian cities. BMJ Open, 1(2), e000323–e000323. doi:10.1136/bmjopen-2011-000323.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Goering, P., Veldhuizen, S., Watson, A., Adair, C. E., Kopp, B. C., Latimer, E., … Aubry, T. (2014). National At Home/Chez Soi Final Report. Calgary, AB: Mental Health Commission of Canada. Retrieved from http://www.mentalhealthcommission.ca.

  9. Atkinson, M., Zibin, S., Chuang, H., & others (1997). Characterizing quality of life among patients with chronic mental illness: A critical examination of the self-report methodology. American Journal of Psychiatry, 154(1), 99–105.

    Article  CAS  PubMed  Google Scholar 

  10. Ahmed, S., Mayo, N., Scott, S., Kuspinar, A., & Schwartz, C. (2011). Using latent trajectory analysis of residuals to detect response shift in general health among patients with multiple sclerosis. [corrected]. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 20(10), 1555–1560. doi:10.1007/s11136-011-0005-6.

    Article  Google Scholar 

  11. Mayo, N. E., Scott, S. C., & Ahmed, S. (2009). Case management poststroke did not induce response shift: The value of residuals. Journal of Clinical Epidemiology, 62(11), 1148–1156. doi:10.1016/j.jclinepi.2009.03.020.

    Article  PubMed  Google Scholar 

  12. Mayo, N. E., Scott, S. C., Bernstein, C. N., & Lix, L. M. (2015). How are you? Do people with inflammatory bowel disease experience response shift on this question? Health and Quality of Life Outcomes, 13(1), 52. doi:10.1186/s12955-015-0232-6.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Stergiopoulos, V., Hwang, S. W., Gozdzik, A., Nisenbaum, R., Latimer, E., Rabouin, D., Goering, P. N. (2015). Effect of scattered-site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: A Randomized Trial. JAMA: The Journal of The American Medical Association, 313(9), 905. doi:10.1001/jama.2015.1163.

    Article  CAS  PubMed  Google Scholar 

  14. Aubry, T., Goering, P., Veldhuizen, S., Adair, C. E., Bourque, J., Distasio, J., Streiner, D. L. (2015). A randomized controlled trial in five Canadian cities of the effectiveness of housing first with assertive community treatment for persons with serious mental illness and a history of homelessness. Psychiatric Services, 67(3), 275–281.

    Article  PubMed  Google Scholar 

  15. Sheehan, D., & Lecrubier, Y. (2010). The Mini International Neuropsychiatric Interview Version 6.0 (MINI 6.0). Jacksonville, FL: Medical Outcomes System Inc.

    Google Scholar 

  16. Uttaro, T., & Lehman, A. (1999). Graded response modeling of the Quality of Life interview. Evaluation and Program Planning, 22(1), 41–52. doi:10.1016/S0149-7189(98)00039-1.

    Article  Google Scholar 

  17. Lehman, A. F. (1988). A quality of life interview for the chronically mentally ill. Evaluation and Program Planning, 11(1), 51–62. doi:10.1016/0149-7189(88)90033-X.

    Article  Google Scholar 

  18. Lam, J. A., & Rosenheck, R. A. (2000). Correlates of improvement in quality of life among homeless persons with serious mental illness. Psychiatric Services (Washington, D.C.), 51(1), 116–118.

    Article  CAS  Google Scholar 

  19. Lehman, A. F. (1996). Measures of quality of life among persons with severe and persistent mental disorders. Social Psychiatry and Psychiatric Epidemiology, 31(2), 78–88. doi:10.1007/BF00801903.

    Article  CAS  PubMed  Google Scholar 

  20. Lehman, A. F., Postrado, L. T., & Rachuba, L. T. (1993). Convergent validation of quality of life assessments for persons with severe mental illnesses. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 2(5), 327–333.

    Article  CAS  Google Scholar 

  21. Lehman, A. F. (1983). The effects of psychiatric symptoms on quality of life assessments among the chronic mentally ill. Evaluation and Program Planning, 6(2), 143–151. doi:10.1016/0149-7189(83)90028-9.

    Article  CAS  PubMed  Google Scholar 

  22. Lehman, A. F., Dixon, L. B., Kernan, E., DeForge, B. R., & Postrado, L. T. (1997). A randomized trial of assertive community treatment for homeless persons with severe mental illness. Archives of General Psychiatry, 54(11), 1038–1043.

    Article  CAS  PubMed  Google Scholar 

  23. Lehman, A. F., Kernan, E., DeForge, B. R., & Dixon, L. B. (1995). Effects of homelessness on the quality of life of persons with severe mental illness. Psychiatric Services (Washington, D.C.), 46(9), 922–926.

    Article  CAS  Google Scholar 

  24. Statistics Canada. (2005). Canadian Community Health Survey (Survey). Ottawa, ON: Statistical Society of Canada.

    Google Scholar 

  25. Reavis, J. A., Looman, J., Franco, K. A., & Rojas, B. (2013). Adverse childhood experiences and adult criminality: How long must we live before we possess our own lives? The Permanente Journal, 17(2), 44–48. doi:10.7812/TPP/12-072.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Corrigan, P. W., Salzer, M., Ralph, R. O., Sangster, Y., & Keck, L. (2004). Examining the Factor Structure of the Recovery Assessment Scale. Schizophrenia Bulletin, 30(4), 1035–1041.

    Article  PubMed  Google Scholar 

  27. Barker, S., Barron, N., McFarland, B. H., & Bigelow, D. A. (1994). A community ability scale for chronically mentally ill consumers: Part I. Reliability and validity. Community Mental Health Journal, 30(4), 363–383.

    Article  CAS  PubMed  Google Scholar 

  28. Boothroyd, R. A., & Chen, H. J. (2008). The psychometric properties of the Colorado Symptom Index. Administration and Policy in Mental Health, 35(5), 370–378. doi:10.1007/s10488-008-0179-6.

    Article  PubMed  Google Scholar 

  29. Rabin, R., & de Charro, F. (2001). EQ-SD: A measure of health status from the EuroQol Group. Annals of Medicine, 33(5), 337–343. doi:10.3109/07853890109002087.

    Article  CAS  PubMed  Google Scholar 

  30. Ware, J., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.

    Article  PubMed  Google Scholar 

  31. Dennis, M. L., Chan, Y.-F., & Funk, R. R. (2006). Development and validation of the GAIN Short Screener (GSS) for internalizing, externalizing and substance use disorders and crime/violence problems among adolescents and adults. The American Journal on Addictions/American Academy of Psychiatrists in Alcoholism and Addictions, 15 (Suppl 1), 80–91. doi:10.1080/10550490601006055.

    Article  Google Scholar 

  32. Boucekine, M., Boyer, L., Baumstarck, K., Millier, A., Ghattas, B., Auquier, P., & Toumi, M. (2015). Exploring the response shift effect on the quality of life of patients with schizophrenia: An application of the random forest method. Medical Decision Making: An International Journal of the Society for Medical Decision Making, 35(3), 388–397. doi:10.1177/0272989X14559273.

    Article  Google Scholar 

  33. Nakagawa, S., & Schielzeth, H. (2013). A general and simple method for obtaining R2 from generalized linear mixed-effects models. Methods in Ecology and Evolution, 4(2), 133–142. doi:10.1111/j.2041-210x.2012.00261.x.

    Article  Google Scholar 

  34. Zissi, A., Barry, M. M., & Cochrane, R. (1998). A mediational model of quality of life for individuals with severe mental health problems. Psychological Medicine, 28(5), 1221–1230.

    Article  CAS  PubMed  Google Scholar 

  35. Lehman, A. F. (1983). The well-being of chronic mental patients. Archives of General Psychiatry, 40(4), 369–373.

    Article  CAS  PubMed  Google Scholar 

  36. Proust-Lima, C., Philipps, V., & Liquet, B. (2015). Estimation of extended mixed models using latent classes and latent processes: the R package lcmm. arXiv:1503.00890 [stat]. Retrieved from http://arxiv.org/abs/1503.00890.

  37. StataCorp (2013). Stata Statistical Software: Release 13. College Station, TX: StataCorp LP.

    Google Scholar 

  38. Spearman, C. (1910). Correlation calculated from faulty data. British Journal of Psychology (1904), 3(3), 271–295. doi:10.1111/j.2044-8295.1910.tb00206.x.

    Google Scholar 

  39. Barclay-Goddard, R., Epstein, J. D., & Mayo, N. E. (2009). Response shift: A brief overview and proposed research priorities. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 18(3), 335–346. doi:10.1007/s11136-009-9450-x.

    Article  Google Scholar 

  40. Schwartz, C. E., Quaranto, B. R., Rapkin, B. D., Healy, B. C., Vollmer, T., & Sprangers, M. A. G. (2014). Fluctuations in appraisal over time in the context of stable versus non-stable health. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 23(1), 9–19. doi:10.1007/s11136-013-0471-0.

    Article  Google Scholar 

  41. Calsyn, R. J., Morse, G. A., Tempelhoff, B., Smith, R., & Allen, G. (1995). Homeless mentally ill clients and the quality of life. Evaluation and Program Planning, 18(3), 219–225. doi:10.1016/S0149-7189(95)00016-X.

    Article  Google Scholar 

  42. Hubley, A. M., Russell, L. B., Palepu, A., & Hwang, S. W. (2014). Subjective quality of life among individuals who are homeless: A review of current knowledge. Social Indicators Research, 115(1), 509–524. doi:10.1007/s11205-012-9998-7.

    Article  Google Scholar 

  43. Evans, S., & Huxley, P. (2005). Adaptation, response-shift and quality of life ratings in mentally well and unwell groups. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 14(7), 1719–1732.

    Article  Google Scholar 

  44. Ruta, D. A., Garratt, A. M., Leng, M., Russell, I. T., & MacDonald, L. M. (1994). A new approach to the measurement of quality of life: The patient-generated index. Medical Care, 32(11), 1109–1126.

    Article  CAS  PubMed  Google Scholar 

  45. Ahmed, S., Mayo, N. E., Wood-Dauphinee, S., Hanley, J. A., & Cohen, S. R. (2005). Using the patient generated index to evaluate response shift post-stroke. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 14(10), 2247–2257. doi:10.1007/s11136-005-8118-4.

    Article  Google Scholar 

  46. Schwartz, C. E., Sprangers, M. A. G., Oort, F. J., Ahmed, S., Bode, R., Li, Y., & Vollmer, T. (2011). Response shift in patients with multiple sclerosis: An application of three statistical techniques. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 20(10), 1561–1572. doi:10.1007/s11136-011-0056-8.

    Article  Google Scholar 

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Disclaimer

We thank Jayne Barker (2008–2011), Cameron Keller (2011–2012), and Catharine Hume (2012–2015), Mental Health Commission of Canada at Home/Chez Soi National Project Leads; the National Research Team; the 5 site research teams; the site coordinators; and the numerous service and housing providers, as well as persons with lived experience, who have contributed to this project and the research. This research has been made possible through a financial contribution from Health Canada. The views expressed herein solely represent the authors.

Funding

This research has been made possible through a financial contribution from Health Canada to the Mental Health Commission of Canada.

Role of the funder/sponsor

The Mental Health Commission of Canada oversaw the conduct of the study and provided training and technical support to the service teams and research staff throughout the project. However, the funder had no role in the analysis and interpretation of the data and preparation, review, or approval of the manuscript.

Author information

Authors and Affiliations

  1. Department of Epidemiology, McGill University, Montreal, Canada

    Guido Antonio Powell & Nancy Mayo

  2. Departments of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Canada

    Carol E. Adair

  3. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada

    David L. Streiner

  4. Center for Outcomes Research and Evaluation (CORE), Research Institute of McGill University Health Center, Montreal, Canada

    Nancy Mayo

  5. Douglas Institute Research Centre, McGill University, Montreal, Canada

    Eric Latimer

  6. Department of Psychiatry, McGill University, Montreal, Canada

    Eric Latimer

Authors
  1. Guido Antonio Powell
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  2. Carol E. Adair
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  3. David L. Streiner
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  4. Nancy Mayo
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Corresponding author

Correspondence to Guido Antonio Powell.

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Conflict of interest

Author CA was on contract to the Mental Health Commission of Canada as the quantitative research lead. Her role was otherwise the same as all other academic investigators. GP, DLS, NM, EL declare they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Powell, G.A., Adair, C.E., Streiner, D.L. et al. Changes in quality of life from a homelessness intervention: true change, response shift, or random variation. Qual Life Res 26, 1853–1864 (2017). https://doi.org/10.1007/s11136-017-1522-8

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  • DOI: https://doi.org/10.1007/s11136-017-1522-8

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