Quality of Life in Psychiatry as an Ethical Duty: From the Clinical to the Societal Perspective

Abstract

It is the aim of this paper to discuss the ethical roots of the concept of quality of life and the historical background of its introduction into mental health service evaluation research. It will be argued that the original broad meaning of the quality of life concept has been brought closely in line with the clinical view, neglecting the ethical and the societal dimensions of this concept. In conclusion, expansion of the scope of quality of life research in psychiatry from a clinical to a societal perspective will be suggested. On the basis of this argument, seven research questions concerning the most important nonclinical factors influencing the quality of life of mentally ill patients will be formulated.

Quality of Life Measurement in Antidepressant Trials

“…Firstly, after the early enthusiasm resulting from deinstitutionalization and psychotropic drugs, it became clear that just being out of the hospital or getting medical treatment wasn’t a good enough outcome for most patients with severe mental illness [6]. Traditional outcome measures (hospital recidivism, symptom reduction) overemphasized therapeutic goals.…”

Quality of Life in Depression and Anxiety Disorders: An Exploratory Follow-Up Study after Intensive Inpatient Cognitive Behaviour Therapy

“…In psychiatry, the concept of quality of life (QOL) has gained increasing interest over the last decade [1,2]. This development was stimulated mainly by the introduction of psychotropic drugs of the 'second generation' (atypical neuroleptics, serotonin re-uptake inhibitors) which display fewer side effects and thus increase QOL of the patients.…”

The Service Provider and Medication Usage Grids: A New Method to Measure “Treatment as Usual” (TAU)

“…A review of the literature found no consistently used instruments for measuring medication usage even though many studies collected medication information. Additionally, the majority of the research focused on medication safety and efficacy but other areas related to medication usage by children have been neglected, such as the social and psychological experience of taking medications (Kilian and Angermeyer 1999). These are areas that may be significantly impacted by treatment or may impact clinical outcomes.…”

“…The review of available service utilization measures found several weaknesses of the instruments for use in clinical settings or in treatment research. As a result while developing the new Service Provider and Medication Usage Grids, the following issues were taken into consideration: (1) the unwieldiness of available service utilization instruments for both the researchers and families; (2) applicability for both research and clinical settings; (3) ease of reviewing and collecting information at follow-up visits (Kessler et al 1980); and (4) importance of collecting information about families' experiences with each service or medication (Kilian and Angermeyer 1999).…”