Wolfgang Kaiser

Measuring the quality of life of severely mentally ill people using the Lancashire Quality of Life Profile

Quality of life (QOL) has become an important outcome measure for many disorders, including mental illness. The Lancashire Quality of Life Profile (LQOLP) was developed for use in operational contexts, and has been translated into several languages. It is in use in several European and North American community psychiatric services. The present paper addresses the questions: how easy is it to use?; how reliable is it?; do the results of the LQOLP vary by setting in a meaningful way?; how do the results co-vary with measures of clinical symptoms and social functioning?; how well does it measure change?; is it clinically useful? While most of the answers to these questions are favourable, there is a need for further research and development of the profile, in particular with reference to the consequences of the use of the profile as a routine monitoring instrument and the most appropriate form of statistical analysis in longitudinal data-sets.

Quality of life in first-admitted schizophrenia patients: a follow-up study

BACKGROUNDnWhile most studies of quality of life (QoL) in schizophrenia have investigated long-term patients, relatively little is known about QoL early in the illness and how it changes over time. This study was conducted to investigate objective and subjective quality of life in first-admitted schizophrenia patients as compared to patients with long-term schizophrenia, changes between first admission and 9-month follow-up and predictors of changes.nnnMETHODnEighty-six patients were examined after first admission and 51 were re-interviewed at follow-up. Results were compared with samples of in-patients and out-patients with long-term schizophrenia. QoL was assessed using a German version of the Lancashire Quality of Life Profile.nnnRESULTSnAlthough some objective QoL data were more favourable in first-admitted patients, subjective QoL was lower than in each of the other two groups, even when psychopathology and age were controlled for. On a group level, patients showed a slight improvement in subjective QoL, which was not statistically significant. Individual changes over time were not predicted by initial data, but were correlated with changes in anxiety/depression.nnnCONCLUSIONnSubjective QoL appears to be lower in first-admitted schizophrenics than in groups with long-term illness and, on a group level, it changes little within 9 months. On an individual level, changes in depressive symptoms need to be considered when interpreting changes in satisfaction with life.

Profiles of subjective quality of life in schizophrenic in- and out-patient samples

For the use of subjective quality of life as an evaluation criterion, it should be known if measures are reliable, to what extent they are influenced by other variables and whether differences and similarities can be detected across treatment situations. Quality of life profiles (Berliner Lebensqualitatsprofil/Lancashire Quality of Life Profile) of 440 schizophrenic patients (from Berlin, Germany and from Wales, UK) were examined. Reliabilities differed between life domains and groups. The influence of other variables was moderate and varied between the groups. Several significant differences between subsamples could be shown between in-patients with a shorter present stay and out-patients. In addition, interesting similarities in profile patterns between in-patients with a longer stay (> or = 2 years) and out-patients can be found. Being admitted to a psychiatric hospital seems to have an influence on the level and structure of subjective quality of life for some time. Being in a psychiatric hospital for a longer time seems to coincide with a stabilization of level and structure of subjective quality of life. Future reports on subjective quality of life should include diagnostically homogeneous sampling and control the correlation with psychopathology. Further research is needed to clarify the impact of other variables (e.g. length of stay, cognitive variables, treatment features) on patients satisfaction in different settings.

Do different subjective evaluation criteria reflect distinct constructs

Four subjective evaluation criteria--self-rated symptoms, subjective quality of life, self-rated needs, and patients assessment of treatment--were examined to determine whether they reflect distinct constructs and to what extent they are correlated. The four criteria were assessed in 90 newly admitted schizophrenia patients, 170 long-term-hospitalized schizophrenia patients, 154 patients with alcoholism admitted for the short term, and 68 patients with alcoholism in long-term rehabilitation, using identical instruments. The four criteria show substantial intercorrelations, except for assessment of treatment in the two acute treatment groups. One general factor explains between 43% and 55% of the variance in each group. Factor scores are associated with observer-rated psychopathology and objective data. The four criteria overlap in different patient groups, except in the assessment of treatment in acute groups. The use of more than one subjective criterion should occur only with specific hypotheses. A better theoretical framework is needed to explain the differences between and interrelationships of subjective evaluation criteria.

Do long-term hospitalised patients benefit from discharge into the community?

Objective The study investigated whether long-stay patients would benefit from discharge into the community in Berlin, Germany. Method In a prospective controlled study, all long-term hospitalised psychiatric patients from a defined catchment area were assessed using established standardised instruments. Quality of life, treatment satisfaction, needs and psychopathology were re-assessed in 63 non-discharged patients 1.5 years later, and in 65 resettled patients 1 year after discharge. Results Discharged patients were younger and had spent less time in psychiatric hospitalisation. Whilst patients who remained in hospital care did not show significant changes over time, discharged patients did. Changes in subjective quality of life and total number of needs – but not in psychopathology, unmet needs, and treatment satisfaction – were significantly more favourable in resettled patients as compared to the control group. Conclusion The findings are in line with other studies and suggest that long-stay patients can benefit from discharge into the community, particularly with respect to their quality of life. Positive changes in the process of deinstitutionalisation seem not dependent on the specific national context, and also apply to younger patients who have not yet spent 10 or more years in psychiatric hospitals.

Zur Messung von Veränderungen der subjektiven Lebensqualität bei chronisch schizophrenen Patienten

ZusammenfassungDie subjektive Lebensqualität einer Gruppe chronisch schizophrener, ambulant behandelter Patienten wurde mit dem Berliner Lebensqualitätsprofil im Abstand von 1xa01/2 Jahren (n=50) und von 4–6 Wochen (n=47) untersucht. Systematische therapeutische Interventionen fanden nicht statt. Stabilität und Konstanz der Werte entsprachen für den längeren Zeitraum Ergebnissen aus der Allgemeinbevölkerung. Die statistischen Kennwerte des kürzeren Intervalls belegten gute methodische Voraussetzungen für Veränderungsmessungen für den Summenscore des Profils und die allgemeine Lebenszufriedenheit. Im Gegensatz zu Querschnittsbefunden und dem längeren Bebachtungszeitraum finden sich für das kürzere Intervall keine bedeutsamen gemeinsamen Veränderungen in der psychopathologischen Bewertung und subjektiven Lebensqualität.SummarySubjective quality of life in a group of chronic schizophrenia outpatients was assessed within 1xa01/2 years (n=50) and 4–6 weeks (n=47) using the Berliner Lebensqualitätsprofil (German version of the Lancashire Quality of Life Profile). There had been no systematic therapeutic interventions meanwhile. Stability and constancy for the longer interval was similar to results in the general population. The statistics for the shorter interval justify in particular use of the profile’s total score and general well-being for the measurement of change. In contrast to cross-sectional data and the longer observation period, no significant common variation between psychopathological symptoms and subjective quality of life could be found for the shorter period.

The impact of the interviewer-interviewee relationship on subjective quality of life ratings in schizophrenia patients.

Subjective quality of life (SQOL) ratings are usually based on interviews. This study examined in which way patients ratings differ depending on whom they are interviewed by. SQOL was assessed in 78 schizophrenia patients in an out patient clinic and in sheltered living arrangements. Using patients randomly allocated to two interview situations: one group was interviewed by external researchers, the other group by their case managers. On average, more favourable ratings were elicited by case managers. Some of the differences were statistically significant and substantial in size. Yet, opposing differences were also found regarding some life domains in one group. It may be concluded that a significant impact of the interviewer-interviewee relationship on SQOL ratings may exist, but that it is not consistent, unidirectional and uniform regarding life domains and across different settings and samples.