Quality of life of people with mental health problems: a synthesis of qualitative research
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Quality of life of people with mental health problems: a synthesis of qualitative research Janice Connell1*, John Brazier2, Alicia O’Cathain1, Myfanwy Lloyd-Jones2 and Suzy Paisley3
Abstract Purpose: To identify the domains of quality of life important to people with mental health problems. Method: A systematic review of qualitative research undertaken with people with mental health problems using a framework synthesis. Results: We identified six domains: well-being and ill-being; control, autonomy and choice; self-perception; belonging; activity; and hope and hopelessness. Firstly, symptoms or ‘ill-being’ were an intrinsic aspect of quality of life for people with severe mental health problems. Additionally, a good quality of life was characterised by the feeling of being in control (particularly of distressing symptoms), autonomy and choice; a positive self-image; a sense of belonging; engagement in meaningful and enjoyable activities; and feelings of hope and optimism. Conversely, a poor quality life, often experienced by those with severe mental health difficulties, was characterized by feelings of distress; lack of control, choice and autonomy; low self-esteem and confidence; a sense of not being part of society; diminished activity; and a sense of hopelessness and demoralization. Conclusions: Generic measures fail to address the complexity of quality of life measurement and the broad range of domains important to people with mental health problems. Keywords: Quality of life, Mental health, Well-being, Ill-being, Functioning, Outcomes
Introduction There has been a shift in mental health services from an emphasis on treatment focused on reducing symptoms, based on a narrow notion of health and disease, to a more holistic approach which takes into consideration both wellbeing and functioning [1]. Mental health services in the United Kingdom, for example, are now being planned and commissioned based on psychological formulations addressing a person’s wider well-being, need, and functional outcome alongside, or sometimes in place of, diagnostic categories and clinical ideas of cure and outcome [2]. At the same time, there has been an increasing use of generic measures of health related quality of life like EQ-5D and SF-36 in assessing the benefits of health care interventions in order to inform decisions about provision and reimbursement (eg National Institute for Health and Clinical Excellence) [3] and for assessing patient reported outcomes [4]. It is claimed these generic measures are appropriate for * Correspondence: [email protected] 1 Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK Full list of author information is available at the end of the article
both physical and mental health conditions; however some argue they are not suitable for people with severe mental health problems, particularly psychosis [5,6]. One of the challenges of using the concept ‘quality of life’ as a basis for outcome measurement is that it can be
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