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8 - Measures of quality of life for persons with severe mental disorders
- from Part II - Domains of outcome measurement
-
- By Anthony F. Lehman, University of Maryland School of Medicine in Baltimore, Maryland, USA, Antonio Lasalvia, University of Verona, Verona, Italy
- Edited by Graham Thornicroft, { Author Role= exceeds the limit of 5 characters including spacing}, Michele Tansella, { Author Role= exceeds the limit of 5 characters including spacing}
-
- Book:
- Mental Health Outcome Measures
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 135-168
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- Chapter
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Summary
This chapter provides clinicians, researchers, programme evaluators and administrators with current information on the assessment of quality-of-life (QOL) outcomes for persons with severe mental illnesses. Measures are summarised according to purpose, content, psychometric properties, patient subgroups with whom used and key references. A series of QOL measures are summarised and reflect considerable variability on the parameters examined. Comprehensive, reliable, and valid measures of QOL are available, although further development of QOL assessment methods is needed. More importantly, we must strive for a better understanding of how to interpret and use QOL outcome information.
The broad impact that severe mental illnesses have on people's lives and the resulting complexity of the needs generated by such illnesses pose a particular challenge in the assessment of the outcomes of services for these persons (Lehman et al, 1982; Ruggeri & Tansella, 1995). Relevant outcome domains include psychiatric symptoms, functional status, access to resources and opportunities, subjective well-being, family burden and community safety. Because of this broad array of relevant outcomes and because of a prevailing concern that outcome assessments should include the patient's perspective (Lasalvia & Ruggeri, 2007), there has been increased attention paid over the past decade to the development of measures of patients’ QOL.
This chapter summarises the measures of QOL that have been developed specifically for persons with severe mental illnesses. We do not consider generic health-related QOL measures, such as the WHOQOL–100 (WHOQOL Group, 1998a) or its abbreviated version, the WHOQOL–BREF (WHOQOL Group, 1998b), the Medical Outcome Study (MOS) 36-Item Short-Form Health Survey (SF–36) (Ware & Sherbourne, 1992) or the EQ–5D (Kind, 1996). Although these measures have been widely used for assessing QOL in studies conducted on psychiatric populations, they have been designed to asses it in a wide spectrum of physical disorders and in a variety of situations and population groups (e.g. cancer patients, refugees, the elderly and those with certain diseases, such as HIV/AIDS). ‘Quality of life’ is a broad term and conceptually could cover all outcome measures, including measures of clinical symptoms and functional status (Katschnig, 2000). However, many of these measures are reviewed elsewhere in this volume or have been reviewed previously. Therefore, they are not included in this review. Also excluded here are measures of client satisfaction with services and ‘family burden’, which are considered in detail in Chapters 6 and 7, respectively.
Contributors
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- By Krista Adamek, Ana Luisa K. Albernaz, J. Marcio Ayres†, Andrew J. Baker, Karen L. Bales, Adrian A. Barnett, Christopher Barton, John M. Bates, Jennie Becker, Bruna M. Bezerra, Júlio César Bicca-Marques, Richard Bodmer, Jean P. Boubli, Mark Bowler, Sarah A. Boyle, Christini Barbosa Caselli, Janice Chism, Elena P. Cunningham, José Maria C. da Silva, Lesa C. Davies, Nayara de Alcântara Cardoso, Manuella A. de Souza, Stella de la Torre, Ana Gabriela de Luna, Thomas R. Defler, Anthony Di Fiore, Eduardo Fernandez-Duque, Stephen F. Ferrari, Wilsea M.B. Figueiredo-Ready, Tracy Frampton, Paul A. Garber, Brian W. Grafton, L. Tremaine Gregory, Maria L. Harada, Amy Harrison-Levine, Walter C. Hartwig, Stefanie Heiduck, Eckhard W. Heymann, André Hirsch, Leandro Jerusalinsky, Gareth Jones, Richard F. Kay, Martin M. Kowalewski, Shawn M. Lehman, Laura Marsh, Jesús Martinez, William A. Mason, Hope Matthews, Wynlyn McBride, Shona McCann-Wood, W. Scott McGraw, D. Jeffrey Meldrum, Sally P. Mendoza, Nohelia Mercado, Russell A. Mittermeier, Mirjam N. Nadjafzadeh, Marilyn A. Norconk, Robert Gary Norman, Marcela Oliveira, Marcelo M. Oliveira, Maria Juliana Ospina Rodríguez, Erwin Palacios, Suzanne Palminteri, Liliam P. Pinto, Marcio Port-Carvalho, Leila Porter, Carlos Portillo-Quintero, George Powell, Ghillean T. Prance, Rodrigo C. Printes, Pablo Puertas, P. Kirsten Pullen, Helder L. Queiroz, Luis Reginaldo R. Rodrigues, Adriana Rodríguez, Alfred L. Rosenberger, Anthony B. Rylands, Ricardo R. Santos, Horacio Schneider, Eleonore Z.F. Setz, Suleima S.B. Silva, José S. Silva Júnior, Andrew T. Smith, Marcelo C. Sousa, Antonio S. Souto, Wilson R. Spironello, Masanaru Takai, Marcelo F. Tejedor, Cynthia L. Thompson, Diego G. Tirira, Raul Tupayachi, Bernardo Urbani, Liza M. Veiga, Marianela Velilla, João Valsecchi, Jean-Christophe Vié, Tatiana M. Vieira, Suzanne E. Walker-Pacheco, Rob Wallace, Patricia C. Wright, Charles E. Zartman
- Edited by Liza M. Veiga, Universidade Federal do Pará, Brazil, Adrian A. Barnett, Roehampton University, London, Stephen F. Ferrari, Universidade Federal de Sergipe, Brazil, Marilyn A. Norconk, Kent State University, Ohio
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- Book:
- Evolutionary Biology and Conservation of Titis, Sakis and Uacaris
- Published online:
- 05 April 2013
- Print publication:
- 11 April 2013, pp xii-xv
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8 - Measures of quality of life for persons with severe mental disorders
- from Part II - Domains of outcome measurement
-
- By Anthony F. Lehman, Professor and Chair, Department of Psychiatry, University of Maryland School of Medicine in Baltimore, Maryland, USA, Antonio Lasalvia, Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
- Edited by Graham Thornicroft, Michelle Tansella
-
- Book:
- Mental Health Outcome Measures
- Published online:
- 02 January 2018
- Print publication:
- 01 September 2010, pp 135-168
-
- Chapter
- Export citation
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Summary
This chapter provides clinicians, researchers, programme evaluators and administrators with current information on the assessment of quality-oflife (QOL) outcomes for persons with severe mental illnesses. Measures are summarised according to purpose, content, psychometric properties, patient subgroups with whom used and key references. A series of QOL measures are summarised and reflect considerable variability on the parameters examined. Comprehensive, reliable, and valid measures of QOL are available, although further development of QOL assessment methods is needed. More importantly, we must strive for a better understanding of how to interpret and use QOL outcome information.
The broad impact that severe mental illnesses have on people's lives and the resulting complexity of the needs generated by such illnesses pose a particular challenge in the assessment of the outcomes of services for these persons (Lehman et al, 1982; Ruggeri & Tansella, 1995). Relevant outcome domains include psychiatric symptoms, functional status, access to resources and opportunities, subjective well-being, family burden and community safety. Because of this broad array of relevant outcomes and because of a prevailing concern that outcome assessments should include the patient's perspective (Lasalvia & Ruggeri, 2007), there has been increased attention paid over the past decade to the development of measures of patients’ QOL.
This chapter summarises the measures of QOL that have been developed specifically for persons with severe mental illnesses. We do not consider generic health-related QOL measures, such as the WHOQOL–100 (WHOQOL Group, 1998a) or its abbreviated version, the WHOQOL–BREF (WHOQOL Group, 1998b), the Medical Outcome Study (MOS) 36-Item Short-Form Health Survey (SF–36) (Ware & Sherbourne, 1992) or the EQ–5D (Kind, 1996). Although these measures have been widely used for assessing QOL in studies conducted on psychiatric populations, they have been designed to asses it in a wide spectrum of physical disorders and in a variety of situations and population groups (e.g. cancer patients, refugees, the elderly and those with certain diseases, such as HIV/AIDS). ‘Quality of life’ is a broad term and conceptually could cover all outcome measures, including measures of clinical symptoms and functional status (Katschnig, 2000). However, many of these measures are reviewed elsewhere in this volume or have been reviewed previously. Therefore, they are not included in this review. Also excluded here are measures of client satisfaction with services and ‘family burden’, which are considered in detail in Chapters 6 and 7, respectively.
Cost-effectiveness of assertive community treatment for homeless persons with severe mental illness
- Anthony F. Lehman, Lisa Dixon, Jeffrey S. Hoch, Bruce Deforge, Eimer Kernan, Richard Frank
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- Journal:
- The British Journal of Psychiatry / Volume 174 / Issue 4 / April 1999
- Published online by Cambridge University Press:
- 02 January 2018, pp. 346-352
- Print publication:
- April 1999
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Background
Homelessness is a major public health problem among persons with severe mental illness (SMI). Cost-effective programmes that address this problem are needed.
AimsTo evaluate the cost-effectiveness of an assertive community treatment (ACT) programme for these persons in Baltimore, Maryland.
MethodsA total of 152 homeless persons with SMI were randomly allocated to either ACT or usual services. Direct treatment costs and effectiveness, represented by days of stable housing, were assessed.
ResultsCompared with usual care, ACT costs were significantly lower for mental health in-patient days and mental health emergency room care, and significantly higher for mental health out-patient visits and treatment for substance misuse. ACT patients spent 31% more days in stable housing than those receiving usual care. ACT and usual services incurred $242 and $415 respectively in direct treatment costs per day of stable housing, an efficiency ratio of 0. 58 in favour of ACT. Patterns of care and costs varied according to race.
ConclusionACT provides a cost-effective approach to reducing homelessness among persons with severe and persistent mental illnesses.