‘Hey,how’s it going?’ The practical value of assessing quality of life in mental illness

To the Editor

Quality of life (QOL) assessment is growing in prominence as we re-focus treatment targets to improve well-being. Perceived life satisfaction (subjective quality of life [sQOL]) is generally a self-report assessment of how satisfied a patient is with their life situation. This contrasts with quantifiable measures of functioning such as number of daily activities. sQOL critically provides a clearer understanding of how the illness affects the patient on a personal level. In chronic mental illnesses, where symptom management is often a more realistic target than a cure, accurate gauging of patient well-being over time is critical. This is particularly pertinent for determining the effects of symptom fluctuations and intervention efficacy while factoring in heterogeneity of patients.

sQOL measurement can be a valuable outcome when assessing the effects of pharmaceutical treatments, as well as other interventions such as cognitive behavioural therapy, cognitive remediation and vocational rehabilitation. While reductions in impairments (both physical and mental) are a desirable treatment outcome, it would be equally important to assess how treatment recovery translates to an individual’s daily life and their personal experience of it. sQOL is also aligned with the Minimum Clinically Important Difference model, providing a qualitative assessment of quantitative change (e.g. symptom scores) that improves interpretability and sensitivity in patient management. The assessment of sQOL would thus give an added dimension to the true value of these therapies to the patient.

sQOL assessment at regular intervals would be particularly beneficial for long-term patient management plans, especially the development of individualised treatment programmes. This is particularly relevant to community-dwelling outpatients, as research has shown that QOL scores are predictive of relapse rates in schizophrenia (Boyer et al., 2013), and further that good sQOL is a critical factor in treatment adherence and long-term prognosis (Karamatskos et al., 2012). Notably, self-reported sQOL assessments have demonstrated reliability and validity in patients with severe mental illness (Voruganti et al., 1998). Consequently, QOL assessment need not be a tedious clinician-driven process and should be considered a valuable addition to the psychiatric toolkit. The EUROHIS-QOL 8-item Index and the World Health Organization QOL (WHOQOL)-BREF are well regarded for this purpose.

We encourage broader use of sQOL assessment in clinical populations. At the therapeutic level, gauging sQOL will provide a convenient springboard to engaging and building rapport with a patient. It could also increase a patient’s perceptions of agency in the relationship, enabling them to share in the process and crystallise the notion of patient as person.