Abstract
Purpose
The World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) is used for patients with schizophrenia although no validation is available. This work addresses this issue by dealing with its psychometric properties in a clinical sample of patients with schizophrenia.
Methods
Two hundred forty-one patients from 10 Adult Mental Health Care Centers (AMHCC) meeting the following inclusion criteria were included: (1) International Classification of Diseases-10 or ICD-10 diagnosis of schizophrenia, (2) Global Assessment of Functioning scores or GAF ≤ 50, 3) Illness duration of more than 2 years and (4) Clinical stability at assessment time. Patients were evaluated at baseline and at one-year follow-up regarding quality of life (QOL), clinical variables and other psychosocial measures.
Results
Internal consistency was excellent for the total WHOQOL-BREF (0.88 at baseline and 0.89 at follow-up) and adequate (0.65–0.78 at baseline; 0.66–0.79 at one-year follow-up) for the WHOQOL-BREF domains. Correlations between WHOQOL-BREF scores and those of global functioning, psychiatric symptoms, disability and social support ranged between small and large. There were significant differences between groups of patients with schizophrenia in the WHOQOL-BREF. Patients who were anxious, disabled, lacked social support and used more social services scored significantly lower in some or all WHOQOL-BREF domains. Changes in WHOQOL-BREF scores were positively associated with changes over time in global functioning, social support and use of health services, and negatively with psychiatric symptoms and disability (correlation coefficients between small and moderate). After one-year follow-up, patients improved in overall functioning and there was a decrease in psychiatric symptoms.
Conclusions
This study shows that the WHOQOL-BREF has good reliability and validity, and suggests that it is suitable for the assessment of QOL in patients with schizophrenia.
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Abbreviations
- QOL:
-
Quality of life
- WHOQOL-100:
-
World Health Organization Quality of Life Scale
- WHOQOL-BREF:
-
World Health Organization Quality of Life Scale Brief Version
- AMHCC:
-
Adult Mental Health Care Centers
- GAF:
-
Global Assessment of Functioning
- ICD-10:
-
International Classification of Diseases-10
- PH:
-
Physical health
- P:
-
Psychological
- SR:
-
Social Relationships
- E:
-
Environment
- DSM-IV:
-
Diagnostic and Statistical Manual of Mental Disorders Fourth Edition
- PANSS:
-
The Positive and Negative Syndrome Scale
- DAS-s:
-
The World Health Organization Short Disability Assessment Schedule
- FSSQ:
-
The Functional Social Support Questionnaire
References
Bobes, J. (2001). Current status of quality of life assessment in schizophrenic patients. European Archives of Psychiatry and Clinical Neuroscience, 251(2), 38–42.
Lehman, A. F., Postrado, L. T., & Rachuba, L. T. (1993). Convergent validation of quality of life assessment for persons with severe mental illness. Quality of Life Research, 2(5), 327–333.
Bobes, J., García-Portilla, P., Sáiz, P. A., Bascarán, T., & Bousoño, M. (2005). Quality of life measures in schizophrenia. European Psychiatry, 20(3), 313–317.
Heinrichs, D. W., Hanlon, T. E., & Carpenter, W. T. (1984). The quality of life scale: An instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin, 10(3), 388–398.
Lehman, A. F. (1998). A quality of life interview for the chronically mentally ill. Evaluation and Program Planning, 11(1), 51–62.
Oliver, J. P., Huxley, P. J., Priebe, S., & Kaiser, W. (1997). Measuring the quality of life of severely mentally ill people using the Lancashire Quality of Life Profile. Social Psychiatry and Psychiatric Epidemiology, 32(2), 76–83.
The WHOQOL Group. (1998). The World Health Organization Quality of Life Assessment (WHOQOL): Development and general psychometric properties. Social Science and Medicine, 46(12), 1569–1585.
Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-Item Short-Form Health Survey (SF-36). Medical Care, 30(6), 473–483.
Kind, P. (1996). The EuroQoL instrument: An index of HRQL. In B. Spilker (Ed.), Quality of life and pharmacoeconomics in clinical trials (2nd ed., pp. 191–201). Philadelphia: Lippincott-Raven.
The WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551–558.
Skevington, S. M., Lotfy, M., & O’Connell, K. A. (2004). The World Health Organization’s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A Report from the WHOQOL Group. Quality of Life Research, 13(2), 299–310.
The WHOQOL Group. (1994). Development of the WHOQOL: Rationale and current status. International Journal of Mental Health, 23(3), 24–56.
World Health Organization. (1998). WHOQOL user manual. Geneva: World Health Organization.
Baumann, C., Erpelding, M. L., Regat, S., Collin, J. F., & Briancon, S. (2010). The WHOQOL-BREF questionnaire: French adult population norms for the physical health, psychological health and social relationship dimensions. Revue d’Épidémiologe et de Santé Publique, 58(1), 33–39.
Jaracz, K., Kalfoss, M., Gorna, K., & Baczyk, G. (2006). Quality of life in Polish respondents: Psychometric properties of the Polish WHOQOL-Bref. Scandinavian Journal of Caring Sciences, 20(3), 251–260.
Tsutsumi, A., Izutsu, T., Kato, S., Islam, M. A., Yamada, H. S., Kato, H., et al. (2006). Reliability and validity of the Bangla version of WHOQOL-BREF in an adult population in Dhaka, Bangladesh. Psychiatry and Clinical Neurosciences, 60(4), 493–498.
Usefy, A. R., Ghassemi, G. R., Sarrafzadegan, N., Mallik, S., Baghaei, A. M., & Rabiei, K. (2010). Psychometric properties of the WHOQOL-BREF in an Iranian adult sample. Community Mental Health Journal, 46(2), 139–147.
Izutsu, T., Tsutsumi, A., Islam, A., Matsuo, Y., Yamada, H. S., Kurita, H., et al. (2005). Validity and reliability of the Bangla version of WHOQOL-BREF on an adolescent population in Bangladesh. Quality of Life Research, 14(7), 1783–1789.
Chachamovich, E., Trentini, C., & Fleck, M. P. (2007). Assessment of the psychometric performance of the WHOQOL-BREF instrument in a sample of Brazilian older adults. International Psychogeriatrics, 19(4), 635–646.
Liang, W. M., Chang, C. H., Yeh, Y. C., Shy, H. Y., Chen, H. W., & Lin, M. R. (2009). Psychometric evaluation of the WHOQOL-BREF in community-dwelling older people in Taiwan using rasch analysis. Quality of Life Research, 18(5), 605–618.
Naumann, V. J., & Byrne, G. J. (2004). WHOQOL-BREF as a measure of quality of life in older patients with depression. International Psychogeriatrics, 16(2), 159–173.
Castro, M. G., Oliveira, M. S., Miguel, A. C., & Araujo, R. B. (2007). WHOQOL-BREF psychometric properties in a sample of smokers. Revista Brasileira de Psiquiatria, 29(3), 254–257.
da Silva Lima, A. F., Fleck, M., Pechansky, F., de Boni, R., & Sukop, P. (2005). Psychometric properties of the World Health Organization quality of life instrument (WHOQOL-BREF) in alcoholic males: A pilot study. Quality of Life Research, 14(2), 473–478.
Sakthong, P., Schommer, J. C., Gross, C. R., Sakulbumrungsil, R., & Prasithsirikul, W. (2007). Psychometric properties of WHOQOL-BREF-THAI in patients with HIV/AIDS. Journal of the Medical Association of Thailand, 90(11), 2449–2460.
Jang, Y., Hsieh, C. L., Wang, Y. H., & Wu, Y. H. (2004). A validity study of the WHOQOL-BREF assessment in persons with traumatic spinal cord injury. Archives of Physical Medicine Rehabilitation, 85(11), 1890–1895.
Chiu, W. T., Huang, S. J., Hwang, H. F., Tsauo, J. Y., Chen, C. F., Tsai, S. H., et al. (2006). Use of the WHOQOL-BREF for evaluating persons with traumatic brain injury. Journal of Neurotrauma, 23(11), 1609–1620.
Berlim, M. T., Pavanello, D. P., Caldieraro, M. A., & Fleck, M. P. (2005). Reliability and validity of the WHOQOL-BREF in a sample of Brazilian outpatients with major depression. Quality of Life Research, 14(2), 561–564.
Carpiniello, B., Pinna, M., Carta, M. G., & Orru, M. G. (2006). Reliability, validity and acceptability of the WHOQOL-Bref in a sample of Italian psychiatric outpatients. Epidemiologia e Psichiatria Sociale, 15(3), 228–232.
Trompenaars, F. J., Masthoff, E. D., Van Heck, G. L., Hodiamont, P. P., & De Vries, J. (2005). Content validity, construct validity, and reliability of the WHOQOL-Bref in a population of Dutch adult psychiatric outpatients. Quality of Life Research, 14(1), 151–160.
Adewuya, A. O., & Makanjuola, R. O. (2009). Subjective quality of life of Nigerian schizophrenia patients: Sociodemographic and clinical correlates. Acta Psychiatrica Scandinavica, 120(2), 160–164.
Chiu, M. Y., Ho, W. W., Lo, W. T., & Yiu, M. G. (2010). Operationalization of the SAMHSA model of recovery: A quality of life perspective. Quality of Life Research, 19(1), 1–13.
Kim, E. J., Song, D. H., Kim, S. J., Park, J. Y., Lee, E., Seok, J. H., et al. (2010). Proxy and patients ratings on quality of life in patients with schizophrenia and bipolar disorder in Korea. Quality of Life Research, 19(4), 521–529.
Konig, H. H., Gunther, O. H., Angermeyer, M. C., & Roick, C. (2009). Utility assessment in patients with mental disorders: Validity and discriminative ability of the time trade-off method. Pharmacoeconomics, 27(5), 405–419.
Woon, P. S., Chia, M. Y., Chan, W. Y., & Sim, K. (2010). Neurocognitive, clinical and functional correlates of subjective quality of life in Asian outpatients with schizophrenia. Progress in Neuropsychopharmacology and Biological Psychiatry, 34(3), 463–468.
Ristner, M., Modai, I., Endicott, J., Rivkin, O., Nechamkin, Y., Barak, P., et al. (2000). Differences in quality of life domains and psychopathologic and psychosocial factors in psychiatric patients. Journal of Clinical Psychiatry, 61(11), 880–889.
Ristner, M., Gibel, A., & Ratner, Y. (2006). Determinant of changes in perceived quality of life in the course of schizophrenia. Quality of Life Research, 15(3), 515–526.
Bengtsson-Tops, A., & Hansson, L. (2001). Quantitative and qualitative aspects of the social network in schizophrenic patients living in the community. Relationship to sociodemographic characteristics and clinical factors and subjective quality of life. International Journal of Social Psychiatry, 47(3), 66–77.
Ritsner, M., & Gibel, A. (2007). Quality of life impairment syndrome in schizophrenia. In M. Ritsner & G. Awad (Eds.), Quality of life impairment in schizophrenia, mood and anxiety disorders (pp. 173–226). Dordrecht: Springer.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.
World Health Organization. (1995). The ICD-10 classification of mental and behavioural disorders. Geneva: World Health Organization.
World Health Organization. (1998). WHOQOL User Manual. Geneva: World Health Organization.
Skevington, S. M., Lotfy, M., & O’Connell, K. A. (2004). The World Health Organization’s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A Report from the WHOQOL Group. Quality of Life Research, 13(2), 299–310.
Lucas Carrasco, R. (1998). La versión española del WHOQOL. Madrid: Ergón, D. L.
Kay, R. S., Fiszbein, A., & Opler, L. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276.
Peralta, V., & Cuesta, M. J. (1994). Validación de la escala de los síndromes positivo y negative (PANSS) en una muestra de esquizofrénicos españoles. Actas Luso-Españolas de Neurología y Psiquiatría, 22(4), 171–177.
Janca, A., Kastrup, M., Katschnig, H., Lopez-Ibor, J. J., Jr., Mezzich, J. E., & Sartorius, N. (1996). The World Health Organization Short Disability Assessment Schedule (WHO DAS-S): A tool for the assessment of difficulties in selected areas of functioning of patients with mental disorders. Social Psychiatry and Psychiatric Epidemiology, 31(6), 349–354.
Broadhead, W. E., Gelbach, S. H., Degruy, F. V., & Kaplan, V. H. (1988). The Duke-UNC functional social support questionnaire: Measurement of social support in family medicine patients. Medical Care, 26(7), 709–723.
Bellón-Saameño, J. A., Delgado-Sánchez, A., del Castillo, J., & Lardelli-Claret, P. (1996). Validez y fiabilidad del cuestionario de apoyo social funcional DUKE-UNC-11. Atención Primaria, 18(4), 153–163.
Haertel, E. H. (2006). Reliability. In R. L. Brennan (Ed.), Educational measurement (pp. 65–110). Wesport, CT: American Council on Education and Praeger Publishers.
American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (1999). Standards for educational and psychological testing. Washington, DC: American Educational Research Association.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New Jersey: Lawrence Erlbaum.
Field, A. (2005). Discovering statistics using SPSS (2nd ed.). London: SAGE Publications.
Rosnow, R. L., & Rosenthal, R. (2005). Beginning behavioral research: A conceptual primer (5th edition ed.). Englewood Cliffs, NJ: Pearson/Prentice Hall.
Nedjat, S., Montazeri, A., Holakouie, K., Mohammad, K., & Majdzadeh, R. (2008). Psychometric properties of the Iranian interview-administered version of the World Health Organization’s Quality of Life Questionnaire (WHOQOL-BREF): A population-based study. BMC Health Service Research, 8, 61.
Xiang, Y. T., Wang, C. Y., Wang, Y., Chiu, H. F., Zhao, J. P., Chen, Q., et al. (2010). Socio-demographic and clinical determinants of quality of life in Chinese patients with schizophrenia: A prospective study. Quality of Life Research, 19(3), 317–322.
Vorungati, M., Cortese, L., Oyewumi, L., Cernovsky, Z., Zirul, S., & Awad, A. (2000). Quality of life measurement in schizophrenia: Reconciling the quest for subjectivity. Medical Care, 28(1), 165–172.
Wehmeier, P., Kluge, M., Schneider, E., Schacht, A., Wagner, T., & Schreiber, W. (2007). Quality of life and subjective well-being during treatment with antipsychotics in out-patients with schizophrenia. Progress in Neuropsychopharmacology & Biological Psychiatry, 31(3), 703–712.
Fitzgerald, P. B., Williams, C. L., Corteling, N., Filia, S. L., Brewer, K., Adams, A., et al. (2001). Subject and observer-rated quality of life in schizophrenia. Acta Psychiatrica Scandinavica, 103(5), 387–392.
Lasalvia, A., Ruggeri, M., & Santolini, N. (2002). Subjective quality of life: its relationship with clinician-rated and patient-rated psychopathology. The South-Verona Outcome Project 6. Psychotherapy and Psychosomatics, 71(5), 275–284.
Ruggeri, M., Bisoffi, G., Fontecedro, L., & Warner, R. (2001). Subjective and objective dimensions of quality of life in psychiatric patients: a factor analytical approach: The South Verona Outcome Project 4. British Journal of Psychiatry, 178, 268–275.
Becchi, A., Rucci, P., Placentino, A., Neri, G., & de Girolamo, G. (2004). Quality of life in patients with schizophrenia–comparison of self-report and proxy assessments. Social Psychiatry and Psychiatric Epidemiology, 39(5), 397–401.
Skantze, K., Malm, U., Dencker, S., May, P. R., & Corrigan, P. (1992). Comparison of quality of life with standard of living in schizophrenic outpatients. British Journal of Psychiatry, 161, 797–801.
Vandiver, V. L. (1998). Quality of life, gender and schizophrenia: A cross-national survey in Canada, Cuba and USA. Community Mental Health Journal, 34(5), 501–511.
Young, K. M. (2004). Factors predicting overall life satisfaction for people with long-term mental illness factors. International Journal of Psychosocial Rehabilitation, 9, 23–35.
Xiang, Y. T., Weng, Y. Z., Leung, C. M., Tang, W. K., & Ungvari, G. S. (2008). Subjective quality of life in outpatients with schizophrenia in Hong Kong and Beijing: Relationship to socio-demographic and clinical factors. Quality of Life Research, 17(1), 27–36.
Akvardar, Y., Akdede, B. B., Özerdem, A., Eser, E., Topkaya, S., & Alptekin, K. (2006). Assessment of quality of life with the WHOQOL-BREF in a group of Turkish psychiatric patients compared with diabetic and healthy subjects. Psychiatry and Clinical Neurosciences, 60(6), 693–699.
Acknowledgments
This study was supported by grant PI050789 from the Ministerio de Salud de España, Instituto de Salud Carlos III, Fondo de Investigación Sanitario, Madrid, Spain and grant 2009SGR00822 from the Agency for Management of University and Research Grants, Generalitat de Catalunya, Barcelona, Spain. We thank the WHOQOL group for allowing the use of the WHOQOL-BREF.
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The authors declare no conflict of interest.
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This study is conducted for the Research Group on Severe Mental Disorder.
Please refer the Appendix section for the members of Research Group on Severe Mental Disorder.
Appendix
Appendix
The Work Group on Severe Mental Disorder is composed of the following members from Adult Mental Health Care Centers in Barcelona: Mª Antonia Argany, Francesca Asensio, Marta Berruezo, Carlos Blecua, Ignasi Bros, Ana Isabel Cerrillo, Ana del Cuerpo, Amparo Escudero, Judit Farré, Clara Fort, Marisa García, Mª Carmen González, Eva Leno, Lluís Mauri, Isabel Mitjà, Mónica Montoro, Montserrat Nicolás, Rosa Ordoñez, Carmen Pinedo, Montserrat Prats, Mª Joaquina Redin, Mª Teresa Romero, Francesc Segarra, Juan Carlos Valdearcos, Immaculada Zafra, Matías Zamora y Antonio Zúñiga.
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Mas-Expósito, L., Amador-Campos, J.A., Gómez-Benito, J. et al. The World Health Organization Quality of Life Scale Brief Version: a validation study in patients with schizophrenia. Qual Life Res 20, 1079–1089 (2011). https://doi.org/10.1007/s11136-011-9847-1
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DOI: https://doi.org/10.1007/s11136-011-9847-1