Quality of Life: Expanding the Scope of Clinical Significance

Department of Psychiatry, University of Pennsylvania, Philadelphia 19104, USA.
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 07/1999; 67(3):320-31. DOI: 10.1037/0022-006X.67.3.320
Source: PubMed


Clinical researchers have turned their attention to quality of life assessment as a means of broadening the evaluation of treatment outcomes. This article examines conceptual and methodological issues related to the use of quality of life measures in mental health. These include the lack of a good operational definition of the construct, the use of subjective versus objective quality of life indicators, and the nature of the relationship between symptoms and quality of life judgments. Of special concern is the ability of quality of life measures to detect treatment-related changes. The authors review the application of quality of life assessment across diverse patient groups and therapies and provide recommendations for developing comprehensive, psychometrically sophisticated quality of life measures.

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    • "While enhancing happiness, well-being, and lifesatisfaction (i.e., Quality of Life) has historically been placed to the periphery of clinical attention, it is increasingly being recognized as important target in clinical investigation and patient care, particularly in terms of person-centered care [1] [2]. This broader outlook follows from the notion that one derives health and wellness not solely through the amelioration of symptoms or disease, but through participation in valued and meaningful activities and relationships that make life worth living [1] [3] [4] [5] [6]. A number of definitions of QOL exist, but for the most part QOL represents a broad range of culturally-valued experiences and life circumstances that comprise work, love, and play and the individual's sense of satisfaction with those experiences and current position in life [2] [7]. "
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    • "One hypothesis is that the link between real life circumstances and life satisfaction may depend on how one appraises those circumstances (Eng et al., 2005; Frisch, 1998; Michalos, 1991). Subjective life satisfaction is the accumulation of cognitive judgments comparing one's actual life with one's ideal life (Frisch, 1994; Gladis et al., 1999; McAlinden and Oei, 2006). Using CBT to reduce negative thinking, challenge catastrophic future predictions , and increase positive modes of thinking may have a positive impact on patients' subjective satisfaction with life. "
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    ABSTRACT: Background This study aimed to explain how quality of life changes during psychotherapy, using a cognitive-behavioural theoretical framework, and examined whether changes in symptoms or changes in cognitions were more influential with regard to quality of life change. Three different hypotheses were tested that might explain the mechanisms by which quality of life changes during group cognitive-behaviour therapy (CBT) for anxiety and depression. Methods 127 outpatients with anxiety and/or depression enrolled in a four-week group CBT programme participated. Measures of anxiety and depression symptoms, cognitive change, and quality of life were administered at baseline and post-treatment. Baseline to post-treatment change scores were calculated and entered into multiple regression analyses. Results Reductions in anxiety and depression symptoms were related to increases in quality of life, whereas cognitive changes were not consistently related to changes in quality of life. Limitations The main limitation was that the study׳s design was not able to assess whether changes in cognitions or symptoms preceded changes in quality of life, as all variables were measured at the same two points in time. Conclusions These results provided evidence that quality of life changes as a result of or, simultaneously with, symptom change. It appears that group CBT does not improve quality of life through strategies designed to change patients׳ cognitions.
    Journal of Affective Disorders 10/2014; 168:72–77. DOI:10.1016/j.jad.2014.06.040 · 3.38 Impact Factor
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    • "Mental health comorbidities worsen outcomes of chronic medical diseases,[4] possibly due to influence of poor mental health on self-care[5] and disease management.[6] Among patients with chronic diseases, comorbid depression may influence a wide range of outcomes, from symptoms perception,[5] quality of life[7] and medication adherence[8] to service utilization and mortality.[9] Depression may have a negative impact on the outcome of medical illness through biological pathways such as inflammation. "
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    ABSTRACT: This study was aimed to investigate the main and buffering effects of positive religious coping on the association between the number of chronic medical conditions and major depressive disorder (MDD) among African Americans, Caribbean Blacks and Non-Hispanic Whites. This cross-sectional study used data from the National Survey of American Life, 2001 and 2003. This study enrolled 3,570 African Americans, 1,438 Caribbean Blacks and 891 Non-Hispanic Whites. Number of chronic conditions and positive religious coping were independent variables, 12-month MDD was the outcome and socio-economic characteristics were controls. We fitted the following three ethnic-specific logistic regressions for data analysis. In Model I, we included the number of chronic conditions and controls. In Model II, we added the main effect of religious coping. In Model III, we included an interaction between religious coping and number of chronic conditions. Based on Model I, number of chronic conditions was associated with higher odds of 12-month MDD among all race/ethnic groups. Model II showed a significant and negative association between religious coping and MDD among Caribbean Blacks (odds ratio [OR] =0.55, 95% confidence Interval [CI] =0.39-0.77), but not African Americans or Hispanic Whites. Model III suggested that, only among Caribbean Blacks, the effect of chronic medical conditions on MDD is smaller in the presence of high positive religious coping (OR for interaction = 0.73, 95% CI = 0.55-0.96). Although the association between multiple chronic conditions and MDD may exist regardless of race and ethnicity, race/ethnicity may shape how positive religious coping buffers this association. This finding sheds more light onto race and ethnic differences in protective effects of religiosity on mental health of populations.
    International journal of preventive medicine 04/2014; 5(4):405-13.
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