Concept of Quality of Life

Critically discuss the concept of Quality of Life, including its application and value in understanding mental health burdens

More than a billion people worldwide are affected by mental and substance use disorders. These disorders accounted for 7% of global disease burden as per DAILYs measurement and 19% of all years lived with disability (Rehm, & Shield, 2019).  Young people are disproportionately affected as the onset is in the first thirty years of life (Leijdesdirff et al., 2020). According to the World Health Organization (2018), 33% of years are lost in disability in 15-29 year olds. Patients with mental health issues suffer reduced quality of life. Quality of life (QOL) is defined as “an individual’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns” (WHO 1995). The WHO recognizes that individuals are reporting as much disability from chronic mental illness as from physical illnesses and that mental disorders are impacting on their activities of daily living, personal relationships, occupational functioning and ability to communicate (Martel & Fuchs, 2013). The focus of this paper to critically discuss quality of life to gain better understanding of mental health burdens and to highlight the value and limitations of the application of HRQOL Measures.

Definition of QOL

QOL is a very amorphous concept with no single universal definition. QOL encompasses all the facets of human experience and determinants of quality of life are both objective and subjective (Larsen, 2018). The distinctiveness of each individual’s experiences, circumstances and stages of life lead to positive and negative subjective determinants of life quality. Furthermore, one’s quality of life is based on objective factors like good health, economic and social conditions, life satisfaction, personal life, community environment ad living arrangement (Berghöferet al., 2020). According to the World Health Organization (WHO 1995), quality of life refers to “an individual’s perception of his or her place in the world, the cultural context and value system in which she or he lives, and all of this in relation to his or her expectations, norms and concerns.” This complex concept is influenced by physical, social and psychological component. The Quality of Life Group recognizes six domains quality of life: degree of independence, psychological aspects, physical aspects, activities of daily life, the environment, the spiritual realm, and social relations (The WHOQOL Group 1996).

The concept of QOL is multidimensional and difficult to define and the healthcare system decided to a health-related focus on QOL (Eloff, 2019). Most scholarships in the healthcare and medical fields are associated with health status that HRQOL has become critical in clinical and mental health investigations. HRQOL reflects the way people perceive and respond to their health status. It encompasses comprehensive subjective evaluations of negative and positive facets of life (Eloff, 2019).  By including all crucial facets of QOL, HRQOL has produced a new focus on a more positive concept of health (Lin, Lin & Fan, 2012).

HRQOL focuses on quality of life which is affected by mental and physical health (CDC 2016a).  HRQOL considers both multidimensionality and subjective nature of quality of life. It encompasses several components, including a person’s level of independence, psychological and psychological state and social relationships, priorities and preferences in life (Lin et al., 2012). These components are health related to the degree they are affected by injury, illness and treatment (Lin et al., 2012). Comprehending the interconnections and distinctions of self-perceived health, quality of life, and health-related quality of life is critical to patient-centered care and improved patient outcomes. In addition to that, application of frameworks to the concept of quality of life is important in comprehending the burden of chronic condition imposes on the patient during the disease trajectory.

Mental disorders rank among the leading cause of most disabling health conditions in relation to disability-adjusted life years (DALY) (Connell, O’Cathain, & Brazier, 2014). Several studies have reported clinically reduced QOL in patients with severe mental illnesses (Morton, Michalak, & Murray, 2017; Saarni et al. 2010).  Buchanan and Huang (2010) reported lower quality of life in patients with multiple sclerosis and caregivers.  Patients with severe mental illnesses like depression and schizophrenia are likely to suffer lower QOL (Hsiao, Lu, & Tsa, 2017, Maat, Fett, & Derks 2012). These disorders cause functional impairment, resulting in work impairment and lost wages, with related economic, societal and personal burdens (Kennedy et al., 2014; Montgomery et al. 2013). For example, depression interferes with domestic life, interpersonal activities, accompanied with adverse outcomes in marital disruption, low education, unstable employment, and risk of secondary illness (Kamenov et al., 2016). People with severe mental disorders have unique HRQOL issues which are further affected by negative symptoms, altered insight and coping. In one qualitative study to establish domains of quality of life critical to people with mental issues, respondents with severe mental illness found it hard to answer whether mental or physical health problems impacted their quality of life more (Connell et al., 2014).

Multiple sclerosis causes lower quality of life of patients and caregivers. Buchanan and Huang (2010) gathered data from the national survey of informal caregiver and studied characteristics related to burden among male informal caregivers. The results showed an association between greater burden among informal male caregivers and greater hours per week providing assistance and greater restriction on the ability of caregiver to carry out daily activities because of helping the individual with MS. The findings highlighted the strong association that exist between caregiver burden and the Mental Component Summary of the SF-8.

In a 2011 published report, Argyrion et al described 35 caregivers and similar number of MS patients. caregivers endured high degree of anxiety than depression. the findings indicated psychological burden on study group to the extent of the deterioration of their quality of life. Sivertsen et al. (2015) performed a systematic review of 74 studies on depression that revealed the relationship between and low quality of life. In a related study, Chang et al. (2015) revealed that even mild depressive symptoms lower quality of life among older people.

QALYs are widely employed metrics in health economics. QALY is used to measure disease burden in a population so as health initiative and services may be allocated or planned to address the health problem burdening the individual and society (Abdin et al. 2020). QALY losses which are attributed to chronic health conditions include mental and physical disorders. These conditions are linked to significant QALY losses and marked reduction in quality of life. While they are commonly used, QALYs has some limitations.  The adaption of patients to certain symptoms can conceal the effect of chronic disability. It is also challenging to allocate a single utility score to those conditions that cause a wide arrange of clinical manifestations.

DALY measures assess the disability and early mortality related to the disease of interest. However, the use of DALY is controversial, particularly in measuring utilities. DALYs tend to underestimate the burden of disease for sexes. Additionally, DALYs measure the disease burden without factoring socioeconomic or cultural differentiation of tested population (Pettitt et al. 2016). It also deviates from Paretian welfare economics in which each person is deemed the best judge of their own welfare.

Many instruments are employed to assess health-related quality of life (HRQOL), measure HRQOL change over time, evaluate quality of care in managed care plans and other elements that characterize HRQOL. Generic measures, which evaluate health-related quality of life (Connell, O’Cathain, & Brazier, 2014). The use of generic preference-based quality of life measures, such as the 36-item Short Form Health Survey (SF-6D) and EuroQOL (EQ-5D), to measure quality of life has become very popular (Connell et al., 2014).  They assess a variety of domains of life which can be negatively impacted by ill-health. The use of EQ-5D allows utilities to be compared with other patient populations. However, this measurement is not specific for health issues, which renders it less sensitive to disease-specific effects (Connell et al., 2014). SF-6 and EQ-5D offer patient-based determination of quality of life and may be employed to compare perceptions of mental, social and physical health among patients with varied conditions, different disease stages, before or after disease treatment (Connell et al., 2014).

Value of HRQOL

HRQOL measures may be employed to evaluate varied methods of symptom management as well as effects of mental health services by incorporating indices like mortality rates, incidence and prevalence rates and response rates. HRQOL measures are also useful in understanding the perspective of the patent regarding the mental illness. Additionally, they help in understanding the normal process of disease adjustment and for evaluating interventions.

Limitations

The use of generic preference-based quality of life measures have been found to inappropriate for persons with severe mental health issues such as bi-polar disorder and psychosis. These measures have been developed for use to assess physical illness and therefore focus more on disability and pain at the expense of mental health. Additionally, quality of life measures are usually generated from the mental health practitioners’ perspective rather than factoring in what persons with mental illness perceive to be essential to their quality of life. The views of health service consumers ought to play a core role in the development of patient-reported outcomes measures.

HRQOL measures are applied to different mental conditions. HRQOL instruments are being used to assess the ripple impact of mental condition and symptoms on all facets of life. However, they have been criticized for lacking measurement feasibility and conceptual clarity (Lin et al., 2012). It is important to operationalize and define HRQOL. Furthermore, Self-reporting of HRQOL can lead recall bias. Additionally, health profiles do not generate a single preference score to determine QALY

Conclusion

The purpose of this paper was to discuss the concept of quality of life and its application in the light of mental health conditions. Quality of life measures focus on the domains of physical social and psychological components. Quality of life data is used in the assessment of treatment regimes in health survey. More specifically, quality of life data is applied in the economic evaluation of healthcare, such as performing cost-utility analysis. The EQ-5D measures self-care, mobility, pain, depression/anxiety, and usual activities. The dimensions are further split into sublevels of patient perceived concerns from which health profile (health state) can be derived.

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