Stephen P. McKenna

Measuring quality of life in psychiatry

Interest in quality of life measures for outcome assessment in psychiatry has been much slower to develop than in other disciplines such as cardiology, oncology and rheumatology. At first sight this is curious since it might be expected that psychiatrists would be more aware of the importance of social and psychological concomitants of illness and treatment. Unlike most medical specialties the accounts given by psychiatric patients and/or their relatives tend to form a major part of the material used in making a diagnosis and assessing improvement. However, even within psychiatry there is a strong tendency for the focus to be on the aetiology of the condition and those aspects of the patient’s function and feeling which are believed to be of clinical significance.

Quality-of-life assessment of adults with growth hormone deficiency: Implications for drug therapy:

SummaryGrowth hormone (GH) deficiency in adults affects many physiological functions. It may result in reduced muscle volume and strength, changes in body mass, lowered metabolic rate, low energy and sexual drive and impaired cognitive function. GH deficiency may also lead to an increase in mortality due to vascular disorders. However, the benefits of GH replacement are still controversial.Recently, investigators have looked at the effects of GH replacement therapy on the well-being of patients. However, the studies which have been published generally have small sample sizes, use inadequate methodology and employ health status measures that lack the necessary sensitivity. Despite these weaknesses, results suggest that replacement GH does have a positive effect on well-being.A GH-specific quality-of-life measure has now been produced, which will provide a clearer view of the benefits of replacement therapy for patients. The use of this measure should help guide decisions about the necessity of providing replacement therapy for GH-deficient patients.

Measuring Quality of Life in Patients with Depression or Anxiety

SummaryOne-fifth of all disability is caused by psychiatric morbidity, with depression and anxiety the most common conditions. Despite this, and the wide range of pharmaceutical treatments available, few quality-of-life studies have been conducted with depressed or anxious patients. Most studies focus on symptoms and adverse effects, rather than on the impact of these on the patient. Where health status is assessed, inappropriate generic measures have been used.Recently, a depression-specific measure of quality of life, the Quality of Life in Depression Scale, has been developed and is starting to be used in clinical trials. No equivalent measure for anxiety is available. Given the range and rapid increase in the number of treatments available for depression and anxiety, and issues of compliance and individual response to treatment, much more attention must be given to quality of life in these conditions.