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Assessing quality of life in schizophrenia

Mid Essex Community & Mental Health Trust, The Linden Centre, Woodlands Way, Chelmsford CMI 7LF

Reading Wilkinson et al (2000), I felt that their new questionnaire tends to measure symptoms rather than quality of life. Obviously the symptoms and side-effects scale measures symptoms but a number of items in the other two scales measure symptoms as well, for example, "I lack the energy to do things". The relationship between symptoms and quality of life is complex but issues such as the availability of money or quality of accommodation must have something to do with it and neither is covered in their questionnaire.

The authors state that in measuring quality of life the measure has to be subjective, which makes sense, but whether it has to be self-reported is questionable. The authors suggested greater honesty might be outweighed by the disadvantage that no help is available if there is confusion regarding an item. I can see no advantages in using this new tool over existing tools, such as the Manchester Short Assessment of Quality of Life (Priebe et al, 1999), which is similarly short and useful in clinical practice.

EDITED BY MATTHEW HOTOPF

REFERENCES

Priebe, S., Huxley, P., Knight, S., et al (1999) Application and results of the Manchester Short Assessment of Quality of Life (MANSA). International Journal of Social Psychiatry, 45, 7-12.

Wilkinson, G., Hesdon, B., Wild, D., et al (2000) Self-report quality of life measure for people with schizophrenia: the SQLS. British Journal of Psychiatry, 177, 42-46.[Abstract/Free Full Text]

Authors' reply

Oxford Outcomes, Bury Knowle Coach House, North Place, Old High Street, Headington OX3 9HY

G. Wilkinson

University Department of Psychiatry, Royal Liverpool University Hospital, Liverpool

EDITED BY MATTHEW HOTOPF

The Schizophrenia Quality of Life Scale (SQLS) is a measure of quality of life based on statements made by people with schizophrenia. We asked participants to state how their quality of life was affected by their mental health and the result was a mixture of symptoms, side-effects and psychosocial issues. Naturally, there is an overlap in the use of these terms, but our method elicits responses related to quality of life from a patient's perspective.

We believe that nobody can know their quality of life better than the person him- or herself. We have no reason to believe, on the basis of our findings, that people with schizophrenia are incapable of accurately representing their quality of life using the SQLS. It is of interest that we found that the people we interviewed voiced a variety of concerns, albeit not about possible financial and accommodation problems, which are, in any event, objective issues.

The measurement of quality of life is in the scientific domain and different methods, whether by questionnaire or interview, need to demonstrate reliability and validity. Thereafter, the choice of instrument requires a trade-off, representing a decision about the best instrument for a particular purpose. Factors such as ease of use, acceptability and cost must be considered.

In contrast to measures such as the Manchester Short Assessment of Quality of Life (MANSA), the SQLS has been specifically developed from interviews with people with schizophrenia, as opposed to being based on other measures. It was also developed as a measure for use in clinical trials and other research studies, as opposed to the assessment of community programmes, which is the case with the Lancashire Quality of Life Profile (Oliver et al, 1996), the measure from which the MANSA was derived. We would emphasise that the administration procedures contained in The User Manual for the SQLS (available from Oxford Outcomes) recommend, among other things, that the SQLS is completed in the presence of the researcher or is administered as an interview if the patient has difficulty with self-completion.

The SQLS has been very well received by colleagues both in the UK and internationally and the development of the instrument is continuing. It is clear to us from the response so far that the SQLS is recognised to fulfil a significant clinical and research need in relation to the assessment of quality of life in people with schizophrenia.

REFERENCES

Oliver, J.P.J., Huxley, P.J., Bridges, K., et al (1996) Quality of Life and Mental Health Services. London: Routledge

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