Quality-of-life instruments for severe chronic mental illness. Implications for pharmacotherapy.

The care of persons with severe chronic mental illness is one of the most pervasive and neglected public health problems in the US. Increasingly, researchers are focusing on the effectiveness of care and quality of life in these patients. This article reviews the status of quality-of-life (QOL) research in mental health published until 1993. It describes conceptual and methodological approaches, reviews QOL instruments developed for persons with severe chronic mental illness, and discusses the implications for pharmacotherapy. Consistent methods, definitions and models must be developed to make QOL research more applicable to the evaluation of pharmaceuticals. Standardisation of approach is necessary to facilitate meta-analyses and to increase our understanding of how pharmacotherapy can improve quality of life for persons with severe chronic mental illness. QOL data cannot stand alone. Its use is limited by the reality that psychopathology affects quality of life, and quality of life affects psychopathology. For the foreseeable future, evaluation of pharmacotherapy in severe chronic mental illness will require combined measurement of quality of life and psychopathological symptoms.