Abstract
Background: Measuring Quality of Life (QoL) in mental health using self-reported items is important for evaluating the quality of service and understanding the person's experience of the care received.Objective: The aim of this research was to develop and validate a self-reported QoL instrument for inpatient and community mental health settings.Methods: Data were collected from diverse research sites in Canada, Belgium, Russia, Finland, Brazil, and Hong Kong, using the 37-item interRAI Quality of Life Survey for Mental Health and Addictions. The survey was administrated to 2,218 participants from inpatient and community mental health settings, assisted living, and the general community. We randomly divided the sample into a training and a test sample (70 and 30%, respectively). We conducted principal component analysis (PCA) and exploratory factor analysis (EFA) using the training sample to identify potential factor structure. Confirmatory factor analysis (CFA) models were then fitted to finalize and externally validate the measurement model using training and test data, respectively.Results: PCA, EFA, and CFA of the training sample collectively suggested a 23-item scale measuring four latent constructs: well-being and hope (8 items), relationship (7 items), support (5 items), and activity (3 items). This model was supported by the CFA of the test sample. The goodness-of-fit statistics root mean square error, comparative fit index and Tucker-Lewis index were 0.03, 1.00, and 0.99, respectively. Estimated Cronbach's alpha based on the test data was 0.92. Raw Cronbach's alpha values for the subscales were 0.86 for well-being and hope, 0.86 for relationship, 0.69 for support, and 0.72 for activity.Conclusions: The interRAI SQoL-MHA scale is a valid instrument to measure QoL in mental health settings. The instrument will support the evaluation of the quality of care and can also be used for future research to produce SQoL-MHA values on a quality adjusted-life-year scale, facilitating the evaluation of various mental health interventions.
Highlights
The past two decades have witnessed a major shift in mental health service policy from an emphasis on symptom reduction to a holistic consideration of recovery, social functioning, and quality of life (QoL) (1)
Several approaches exist for measuring QoL, including objective approaches, subjective approaches, and health-related QoL (HRQoL) (6)
Owing to the wide adoption of cost-effective analysis to inform resource allocation in health care, generic preference-based measures represented by EuroQoL-5D (EQ-5D) and SF-6D have become the most commonly used instruments worldwide (11)
Summary
The past two decades have witnessed a major shift in mental health service policy from an emphasis on symptom reduction to a holistic consideration of recovery, social functioning, and quality of life (QoL) (1). The need to disaggregate mental health outcomes by subpopulations to reflect the diverse needs of individuals with different socioeconomic and clinical characteristics has been highlighted (2) Another growing consensus is the importance of incorporating perspectives of mental health service users in evaluating clinical trials, services, and policies. Owing to the wide adoption of cost-effective analysis to inform resource allocation in health care, generic preference-based measures represented by EuroQoL-5D (EQ-5D) and SF-6D have become the most commonly used instruments worldwide (11). Both EQ-5D and SF-6D include a health state descriptive system and a utility scale used to calculate quality-adjusted life years (QALYs). Measuring Quality of Life (QoL) in mental health using self-reported items is important for evaluating the quality of service and understanding the person’s experience of the care received
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