Many thanks to all who responded to my initial query...here's a selection of the
responses received:
I don't know what the best is but certainly in the area that i work (care of the
elderly) in the Nottingham Health Profile, and GHQ are adequate instruments
for measuring stress etc. If you are measuring outcomes relating to
caregivers there are specific instruments for them as well such as the Zarit
Scale. and many many others..........
D McDaid.
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Maybe you can find some helpful information in the following book which
describes different outcomes scales used in mental health:
Quality of Life in Mental Disorders, edited by Heinz Katsching, Hugh
Freeman and Norman Sartorius
John Wiley & Sons Ltd
Tel +44 1243 779777
Andrea Spannheimer
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> -----Original Message-----
> From: Malanos, Grace {MEDI~Dee Why}
> Sent: Friday, January 29, 1999 10:12 AM
> To: Just, Andrew {MEDI~Dee Why}
> Subject: RE: Outcome Scales
>
> There are a number of measures that have been used to assess QOL in
> patients with mental illness:
> * Satisfaction with Life Domains Scale
> * Lehman Quality of Life Interview
> * Lancaster Quality of Life Profile
> * Oregon Quality of Life Questionnaire
> * QWB (Quality of Well-Being Scale)
> * SF-36
> * Basis-32
>
> The SF-36 is a generic measure which may not be sensitive enough to
> detect differences and changes in all of the parameters relevant to a
> specific disease. Basis-32 is a disease-specific instrument which may
> be more sensitive to change than a generic measure. It is common for
> both types of measures (disease-specific and generic) to be included
> in a study.
>
> It should be noted that a measure without a mental health component
> may not necessarily neglect mental health. The impact of mental
> health may be represented in questions about role functioning (as in
> the SF-36). The SF-36 has been successfully used in the assessment of
> QOL of patients with major depression.
>
> Karl's question can not easily be answered without knowing the
> research question, the patient population, the method of
> administration, and the length of time available for administration of
> an instrument. My suggestion to Karl is to undertake a literature
> search to determine which instruments have been used successfully in
* previous studies for the indication and the population of interest.
> Another alternative is to undertake an OLGA (On-Line Guide to Quality
> of Life Assessment) search for a list of instruments that have been
> used in the target group of patients.
>
> For more information on Basis-32 and the SF-36, Karl could contact the
> Medical Outcomes Trust - http://www.outcomes-trust.org/
>
> Hope this helps.
>
> Grace
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Dear KarlThe answer to your question depends on what type of economic analysis youwish to undertake. If it is a cost-effectiveness analysis, then it would probably be better to go for something like the Lancashire quality of life profile as it is a more in-depth instrument than the EuroQol. If it is a cost-utility analysis (i.e. you want to compare QALYs for differenttreatments or conditions), then the EuroQol is the leading contender,although the SF-36 is also now capable of generating such an index score.The EuroQol was developed primarily with respect to somatic disorders sothere are concerns about its applicability/ sensitivity to change in mentalhealth care. I refer you to two articles in the journal Social Psychiatry andPsychiatric Epidemiology which may be of help: Lehman AF (1996). Measures of quality of life for people with severe andpersistent mental disorders. SPPE, 31, 78-88.Chisholm D, Healey A, Knapp MRJ (1997). QALYs and mental health care. SPPE,32, 68-75.Regards, ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Daniel ChisholmSenior LecturerCentre for the Economics of Mental Health (CEMH)Institute of Psychiatry7 Windsor WalkLondon SE5 8BBTel: + 44 (0)171 919 3503Fax: + 44 (0)171 701 7600email: IoP address: [log in to unmask] </cgi-bin/cframes/compose?disk=209.185.130.44_d128&login=karl_kantor&f=33793&curmbox=ACTIVE&_lang=&mailto=1&[log in to unmask]&msg=MSG917629789.2&start=28465&len=2260&src=&type=x> Also: [log in to unmask] </cgi-bin/cframes/compose?disk=209.185.130.44_d128&login=karl_kantor&f=33793&curmbox=ACTIVE&_lang=&mailto=1&[log in to unmask]&msg=MSG917629789.2&start=28465&len=2260&src=&type=x>
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Karl,
You asked about SF-36 / Basis in mental health applications. Assuming that the second of these is specific to MH then your choice might be influenced by whether your analysis is from a clinical(only), from an economic perspective (only) or both.
In a clinical mode you might prefer to operate with a measure that has a demonstrable clinical pedigree, of which there are hundreds from which to choose. In addition to the condition-specific measures that abound in MH, several of the generic measures have been used - including SF-36,
QWB and EQ-5D. You might however want to select a generic measure that enable you to capture information that reflected patient self-assessment of their health status, and in a UK context you'd want to exclude the QWB. We have used both SF-36 and EQ-5D alongside GHQ-12 and Hospital Anxiety Depression Scale, and a colleague has similar twin-track data
with SF-36/EQ-5D and SCL-90.
In a pragmatic world, your selection might be influenced by other considerations - such as whether anyone else has used the measure recently, or whether there is a (declared or undeclared) consensus that a particular measure is as good as 'standard', or whether NOT having a particular measure would jeopardise future reporting or publication.
If your analysis is now (or may later) involve an economic evaluation, then your choice will be constrained by the need to represent health outcomes in terms of a single index. Hence all profile measures (whether generic or condition-specific) can be put to one side since by definition they fail this test. NHP for example, was designed so as to resist 'conversion' into a single total score, although some folk persist in abusing this in practice. SF-36 in its original format and SF/18 / 20 and 2) fail the test for similar reasons. Your choice for generic measures rapidly reduces to QWB / HUI or EQ-5D, of which only the latter is calibrated in terms of UK population preference weights.
So in summary.
Q. How do you choose ?
A. It all depends on what purpose you want to use the data for
BUT
.... in the UK / for NHS reporting / for economic evaluation
.... you ought to give serious consideration to using EQ-5D as a minimum
Paul Kind
Centre for Health Economics
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