A US experience: consumer responsive quality of life measurement

Abstract

Objective: In the United States, interest in quality of life and social disabilities associated with mental illness intensified in the wake of the deinstitutionalization of the late '60s and '70s. Although mental health professionals in the United States have begun to recognize the importance of quality of life considerations to patient management and treatment outcomes, review of the literature shows there is minimal research in mental health on this important topic. As a result, little theoretical or methodological progress has been made. Quality of life has not been clearly conceptualized or defined and there are no agreed-upon standards or criteria for measurement. This presentation will: (a) review important conceptual issues in quality of life research, (b) discuss the benefits of and obstacles to incorporating consumer values in judgments of quality of life, and (c) present data from the Wisconsin Quality of Life Index (W-QLI; Becker et al., 1993) to illustrate the usefulness of a consumer responsive model of quality of life and the importance of incorporating consumer values in the assessment of quality of life of persons with schizophrenia.

Methods: The W-QLI was administered to a convenience sample of psychiatric outpatients with a DSM-IV diagnosis of schizophrenia. The W-QLI is a self-administered individually preference-weighted index that measures nine separate domains encompassing quality of life. The W-QLI scoring method results in separate scores for each domain and allows for the relationships among separate domains to be studied. The nine separate domains include: (a) satisfaction level for different objective quality of life indicators, (b) occupational activities, (c) psychological well-being, (d) physical health, (e) social relations, (f) economics, (g) activities of daily living, (h) symptoms, and (i) goal attainment.

Results: Study findings are consistent with previous theory and empirical research which supports the independence of component quality of life domains. Results show that while consumers' and clinicians' judgments of outcome correlated, there were important differences. Clinicians systematically rated function higher and social relations lower than did consumers, and there were significant differences in consumer and provider goals for improvement with treatment. Overall ratings of quality of life and function are only weakly correlated with psychopathology. The findings support the importance and feasibility of incorporating consumer values and judgments of quality of life in outcome measurement.