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PubMed1997

The quality of life of patients with paranoid schizophrenia in London and Berlin.

This study compared the subjective and objective quality of life and needs of patients with paranoid schizophrenia between inner city areas in Berlin (69 patients) and London (75 patients). Quality of life was assessed by means of the Lancashire Quality of Life Profile (German version Berliner Lebensqualitatsprofi), and need was quantified using the Camberwell Assessment of Need (German version Berliner Bedurfnisinventar). The hypotheses tested were that although Berlin patients may rate more highly on objective quality of life measures, the subjective quality of life would be similar as patients would judge their quality of life against their local expectations. The findings supported the first part of the hypothesis as on the objective measures the Berlin group was significantly better off financially and in living conditions, and had significantly fewer material needs. However, despite having more severe psychopathology, the Berlin groups' scores on global subjective quality of life were also higher. On particular life domains, subjective quality of life did not always reflect objective measures and sometimes went in the reverse direction. We concluded that the relationship between subjective and objective quality of life is complex, and great caution must be exercised in making quality of life comparisons between different cultures.

Adolescent↗
PubMed1989

Estimates of the maximum time required to originate life.

Fossils of the oldest microorganisms exist in 3.5 billion year old rocks and there is indirect evidence that life may have existed 3.8 billion years ago (3.8 Ga). Impacts able to destroy life or interrupt prebiotic chemistry may have occurred after 3.5 Ga. If large impactors vaporized the oceans, sterilized the planets, and interfered with the origination of life, life must have originated in the time interval between these impacts which increased with geologic time. Therefore, the maximum time required for the origination of life is the time that occurred between sterilizing impacts just before 3.8 Ga or 3.5 Ga, depending upon when life first appeared on Earth. If life first originated 3.5 Ga, and impacts with kinetic energies between 2 x 10(34) and 2 x 10(35) were able to vaporize the oceans, using the most probable impact flux, we find that the maximum time required to originate life would have been 67 to 133 million years (My). If life first originated 3.8 Ga, the maximum time to originate life was 2.5 to 11 My. Using a more conservative estimate for the flux of impacting objects before 3.8 Ga, we find a maximum time of 25 My for the same range of impactor kinetic energies. The impact model suggest that it is possible that life may have originated more than once.

Earth, Planet↗
PubMed1995

Quality of life: an overview of the concept and measures.

This paper summarizes the concepts and measures of quality of life. Although numerous attempts have been made to conceptualize and operationalize quality of life, there has been no universally accepted standard for the study design, data collection and data analysis of studies that use quality of life as an outcome measure. Quality of life has been defined either as a measure of happiness and satisfaction with life, or goal achievement, or social utility. However, most studies conceptualize and measure quality of life as a composite that consists of several domains. There are two approaches to the measurement of quality of life, namely, the psychometric approach and the utility approach. A quality of life measure can be either generic or disease-specific. High reliability and validity are important criteria for a credible quality of life instrument. Published clinical studies which use quality of life as an outcome measure have to be assessed on the basis of the appropriateness of the study design, the validity of study results and the applicability of the quality of life measure to the specific patient group.

Humans↗
PubMed2006

Quality of life after treatment for incidental, unruptured intracranial aneurysms.

BACKGROUND: Discovering an intracranial aneurysm may profoundly affect the patient's quality of life. Patients living with unruptured and untreated aneurysms often report symptoms of anxiety and depression. There are few trials studying the quality of life after treatment of unruptured intracranial aneurysms. We aimed to compare the quality of life and symptoms of anxiety or depression after endovascular coiling or open surgery clipping of unruptured intracranial aneurysms, in patients with no prior subarachnoid haemorrhage. METHOD: 73 living patients were included. 44 had undergone open surgery clipping and 31 had undergone endovascular coiling within the last 5.5 years. We registered a number of parameters from medical records and the patients' current quality of life was assessed by a questionnaire. 63 of 73 (86.3%) returned our questionnaire, which included the Norwegian version of SF-36 and the Hospital Anxiety and Depression Scale (HAD). FINDINGS: Many patients treated for unruptured intracranial aneurysms have a relatively low quality of life. The low scores indicate that the patients experience limitations in their ability to work or accomplish desired activities due to perceived physical or mental handicaps. There were no significant differences between the open surgery group and the endovascular group when comparing quality of life parameters after treatment. A subgroup analysis of patients with a favourable functional outcome also showed reduced quality of life without any differences in the two treatment groups. There were no signs of improvement in quality of life over time. CONCLUSION: Quality of life after treatment does not seem to be a strong argument for choosing one modality of treatment over the other in patients with unruptured intracranial aneurysms. There are no significant differences in the quality of life of patients successfully treated using endovascular technique and patients who underwent craniotomy and clipping. We speculate that the low quality of life scores are due to factors unrelated to the aneurysms. The scores possibly reflect characteristics of a patient group where incidental aneurysms are more frequently diagnosed while undergoing extensive imaging procedures due to unrelated symptoms.

Activities of Daily Living↗
PubMed2006

Measurement of health-related quality of life in the early follow-up of colon and rectal cancer.

PURPOSE: Little is known about factors that affect health-related quality of life during the early follow-up of colorectal cancer. This study was designed to identify the factors that contribute to poor health-related quality of life after six weeks of follow-up and to compare the relative performance of instruments best suited to measure it. METHODS: A single-center, prospective study was designed to examine health-related quality of life after potentially curative surgery for colorectal cancer. Two condition-specific and two generic instruments (QLQ-C30, FACT-C, SF12 and EQ-5D) measured quality of life six weeks after discharge. Univariate and multivariate analyses were used to assess the impact of 16 treatment factors, demographic variables, and symptoms on seven global health-related quality of life scores. RESULTS: Questionnaires were obtained from 201 consecutive patients. Five factors were associated with poor health-related quality of life scores at six-week follow-up in the multivariate analysis: reduced preoperative performance status, stomas, diarrhea, constipation, and younger than aged 65 years. No instrument out performed the others. However, condition-specific instruments and those in which patients subjectively rated their overall health-related quality of life were better suited to detect health-related quality of life differences relating to the effects of colorectal cancer treatment. CONCLUSIONS: Younger patients, those with stomas, and those suffering from diarrhea or constipation are more likely to report poor health-related quality of life at six-week follow-up. The routine measurement of health-related quality of life using an instrument that includes a patient-rated scale together with condition-specific items could be used to detect patients at risk of poorer short-term health-related quality of life outcomes.

Adult↗
PubMed1996

Oral health and quality of life in New Zealand: a social perspective.

This study addresses the social dimensions of oral health by relating oral quality of life (i.e. dental symptoms, perceived oral well-being and oral functioning) to oral health status. We propose a conceptual model which postulates that socioeconomic status, oral health behavior and oral health status each influence oral quality of life. Using data from the New Zealand National Oral Health Survey, we describe and analyze oral health status and oral quality of life among children aged 12-13 and adults aged 35-44 and 65-74. The study demonstrates the impact of oral health problems on the oral quality of life of children, middle-aged adults and older adults in New Zealand. The majority have experienced at least one dental symptom in the past year. Some of them perceive poor oral health and also dislike the way their teeth/dentures look. Various aspects of their social and physical functioning are adversely affected by oral health problems. The results of multiple regression analyses of oral quality of life demonstrate that perceived general health is a consistent predictor of quality of life. Furthermore, the adults' oral quality of life is positively related to asymptomatic dental visits and negatively related by symptomatic dental visits. Children's oral quality of life is positively related to more frequent brushing and flossing. Oral health status is closely associated with oral quality of life for both adults and children. Analyzing the New Zealand oral quality of life data and reviewing previous research findings using a conceptual model provide the possibility for a more comprehensive and integrated understanding of oral quality of life issues.

Adolescent↗
PubMed1997

Quality of life issues among women with physical disabilities or breast cancer.

OBJECTIVE: The purpose of this study was to assess quality of life (QOL) and life satisfaction among women with physical disabilities or breast cancer, and to identify factors predictive of QOL and life satisfaction for women and men. QOL and life satisfaction differences were examined between women and men with physical disabilities and cancer, and between women with traumatic and chronic physical conditions. DESIGN: A cross-sectional design employing several QOL and life satisfaction measures was used. SAMPLE: Two hundred sixteen outpatient subjects (99 women, 117 men) with physical disabilities or cancer were studied. INSTRUMENTS: The Health Status Questionnaire-Short-Form 36 (SF-36), Functional Assessment of Cancer Therapy (FACT), Functional Living Index-Cancer (FLIC), and the Satisfaction With Life Scale (SWLS). RESULTS: Women with traumatic conditions (amputation, spinal cord injury) reported poorer physical functioning and well-being, whereas women in the chronic (postpolio, breast cancer) group reported poorer health status. No significant gender differences were found with respect to QOL or life satisfaction. Whereas functional and emotional well-being were the strongest predictors of overall QOL for both men and women, self-perceived general health significantly predicted QOL for women (p < .05) and social well-being significantly predicted QOL for men (p < .01). Among men, life satisfaction was best predicted by marital status (p < .05), general health (p < .05), and social well-being (p < .01). The resulting QOL models had adjusted R2 values of .77 and .76 for women and men, respectively. Among women with traumatic conditions, functional well-being best predicted QOL (p < .01). Life satisfaction for women with chronic conditions was best predicted by age, education, and spiritual well-being. CONCLUSION: QOL as measured by the impact of illness on an individual is best predicted by physical and functional well-being. Satisfaction with one's life was best predicted by functional ability. Although functional and physical ability were the best predictors for both QOL and life satisfaction, social functioning made significant and substantive contributions to these constructs. Spinal cord injury had the most impact on physical functioning, whereas prostate cancer had the least. Psychosocial functioning was most affected by amputation and least affected by prostate cancer.

Breast Neoplasms↗
PubMed2001

Healthy life expectancy in 191 countries, 1999.

We describe here the methods used to produce the first estimates of healthy life expectancy (DALE) for 191 countries in 1999. These were based on estimates of the incidence, prevalence, and disability distributions for 109 disease and injury causes by age group, sex, and region of the world, and an analysis of 60 representative health surveys across the world. We used Sullivan's method to compute healthy life expectancy for men and women in each WHO member country. Japan had the highest average healthy life expectancy of 74.5 years at birth in 1999. The bottom ten countries are all in sub-Saharan Africa, where the HIV-AIDS epidemic is most prevalent, resulting in DALE at birth of less than 35 years. Years of healthy life lost due to disability represent 18% of total life expectancy in the bottom countries, and decreases to around 8% in the countries with the highest healthy life expectancies. Globally, the male-female gap is lower for DALE than for total life expectancy. Healthy life expectancy increases across countries at a faster rate than total life expectancy, suggesting that reductions in mortality are accompanied by reductions in disability. Although women live longer, they spend a greater amount of time with disability. As average levels of health expenditure per capita increase, healthy life expectancy increases at a greater rate than total life expectancy.

Adolescent↗
PubMedDate not supplied

Letting go: family willingness to forgo life support.

OBJECTIVE: To describe the process of family decision making about life support in the critical care setting. DESIGN: Descriptive, exploratory. SETTING: A northeastern United States university-affiliated medical intensive care unit. SAMPLE: Thirty family members of 16 critically ill patients. RESULTS: Letting go or becoming willing to forgo life support involved three interrelated and complex processes: (1) family members sought out, obtained, and tried to understand information about the critical illness; (2) they reviewed the life story of the patient, seeking meaning in the patient's life and the critical illness; and (3) they struggled to maintain family roles and relationships. For most families, interpersonal and intrapsychic work during each process created a reframing of the issues related to the critical illness: (1) they came to believe that they had done all that could be done and were able then to relinquish the goal of recovery for acceptance of a peaceful death; (2) they reviewed the patients's life, finding some meaning and a sense that, given the situation, the patient would not want to continue on life support, and then they moved toward closure; and (3) they were able to bring about (at least within a small group of the closest family members) a sense of doing the "right thing", and they were able to develop some sense that forgoing life support for the ill relative would not destroy important family relationships. For a few other families this movement toward resolution did not occur, and although family members attempted to deal with the issues of life support, their efforts were fraught with conflict and prolongation of the end-of-life period. CONCLUSIONS: Little is known about the actual experience of family members as they are involved in life-support decision making. Identification of the needs of family members to work through the decision-making experience cognitively, emotionally, and morally is essential to communicating effectively about the ill relative's condition and to providing understanding and support to families involved in life-support decision making in the critical care unit.

Adult↗
PubMedDate not supplied

Quality of life in lung cancer patients: as an important prognostic factor.

Given that lung cancer is one of the common cancers world-wide, the implications of focusing on quality of life as well as survival require to be understood. We have carried out a study of the relationship between survival and quality of life in patients with lung cancer comparing patients those who lived with those who died within 3 months. The design of the study allowed every patient in a defined geographical area with a potential diagnosis of lung cancer to be studied from first outpatient consultation till after a definitive treatment has been given. Quality of life was measured using three standard questionnaires: the Nottingham Health Profile (NHP), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its lung cancer supplementary questionnaire (QLQ-LC13) in addition to a study specific questionnaire collecting data on demographic, social, clinical and performance status. The contribution of quality of life in relation to survival adjusted for known prognostic factors was determined using Cox's proportional hazard model. In all 129 lung cancer patients were interviewed, and 96 patients were alive at 3-months follow-up. Only 90 of 96 patients alive at 3-months follow-up were assessable. Descriptive analyses showed that those who were dead had more perceived health problems, greater level of symptoms and significant lower physical and role functioning and global quality of life at presentation. On the other hand, univariate analyses showed that patients' aggregate scores on the NHP, the functioning scores, and global quality of life scores alone were significant predictors of survival (P<0.03, P<0.04, P<0.04, respectively ). The multivariate analyses showed that pre-diagnosis global quality of life was the most significant predictor of the length of survival even after adjusting for known prognostic factors (age, P<0.04; extent of disease, P<0.03; global quality of life, P<0.02), while performance status, sex and weight loss were not. This study confirmed that pre-diagnosis quality of life was a significant predictor of survival. Indeed, pre-diagnosis quality of life should be considered as a clinical status which has to be established by physicians before treatment starts as it is such an important predictor of survival.

Adult↗
PubMed2002

[Measure of quality of life in patients with metastatic colorectal cancer: techniques and main results].

PURPOSE: Until the 1990s, the patient's duration of life was the main measure for determining the value of palliative chemotherapy for colorectal cancer. Quality of life recently appeared as a main end point. The aim of this article is to provide an overview of the instruments used to measure quality of life in patients with metastatic colorectal cancer, to review the published data and to analyse the bias and methodological problems. CURRENT KNOWLEDGE AND KEY POINTS: QoL is a multidimensional subjective concept, which can be measured using psychometric instruments. Quality of life measurement has a descriptive and prognostic value. Results from quality of life assessment in randomized trials have given useful information and help patients and physicians to choose between treatment options. More than half of the patients with palliative chemotherapy had at least stabilization of quality of life. Response to chemotherapy and side-effects influence quality of life. Quality of life assessment clearly requires methodological improvement. Missing data are a particularly difficult problem, which should be improved by a better organization. FUTURE PROSPECTS AND PROJECTS: Psychometric properties of EORTC QLQ-CR38 et FACT-C should be checked in French language. An international consensus on methods of measurement of quality of life in oncology is warranted to enhance compliance, to better interpret quality of life results et to optimize publications of precise quality of life data.

Colorectal Neoplasms↗
PubMed1999

Ethnicity and attitudes towards life sustaining technology.

The ethical and legal implications of decisions to withhold and withdraw life support have been widely debated. Making end-of-life decisions is never easy, and when the cultural background of doctor and patient differ, communication about these issues may become even more difficult. In this study, we examined the attitudes of people aged 65 and older from different ethnic groups toward foregoing life support. To this end, we conducted a survey of 200 respondents from each of four ethnic groups: European-American, African-American, Korean-American and Mexican-American (800 total), followed by in-depth ethnographic interviews with 80 respondents. European-Americans were the least likely to both accept and want life-support (p < 0.001). Mexican-Americans were generally more positive about the use of life-support and were more likely to personally want such treatments (p < 0.001). Ethnographic interviews revealed that this was due to their belief that life-support would not be suggested if a case was truly hopeless. Compared to European-Americans, Korean-Americans were very positive regarding life-support (RR = 6.7, p < 0.0001); however, they did not want such technology personally (RR = 1.2, p = 0.45). Ethnographic interviews revealed that the decision of life support would be made by their family. Compared to European-Americans, African-Americans felt that it was generally acceptable to withhold or withdraw life-support (RR = 1.6, p = 0.06), but were the most likely to want to be kept alive on life-support (RR = 2.1, p = 0.002). Ethnographic interviews documented a deep distrust towards the health care system and a fear that health care was based on one's ability to pay. We concluded that (a) ethnicity is strongly related to attitudes toward and personal wishes for the use of life support in the event of coma or terminal illness, and (b) this relationship was complex and in some cases, contradictory.

Black or African American↗
PubMed1996

Antihypertensive therapy and quality of life. Influence of blood pressure reduction, adverse events, and prior antihypertensive therapy.

Quality of life is an important attribute of antihypertensive therapy. Previous studies have not addressed the importance of a patient's prior pharmacotherapy on quality of life, which may serve as the basis of reference for a new therapy. Nor have previous studies compared commonly used quality of life instruments for consistency, or investigated whether improvement or worsening of quality of life correlates with adverse events or blood pressure reduction. Two hundred eighteen hypertensive patients with diastolic blood pressure (95 to 114 mm Hg) after a 4- to 5-week placebo washout period were enrolled in a randomized double-blind, parallel group dose-escalation trial to compare the effects of amlodipine (2.5 to 10 mg), bisoprolol (2.5 to 10 mg)/hydrochlorothiazide (HCTZ) 6.25, and enalapril (5 to 20 mg) on blood pressure, adverse events, and quality of life. Three quality of life instruments (General Well-Being Index, Vital Signs Quality of Life, Zung Self-Rating Depression Scale) were administered during original therapy, after placebo washout, and after 12 weeks of optimally titrated clinical trial pharmacotherapy. Our results demonstrated that removal from prior therapy had no detectable influence on subsequent evaluation of quality of life. The three quality of life instruments were consistent with the changes observed with the three therapies: a trend toward better quality of life with amlodipine and bisoprolol/HCTZ. Adverse events, but not systolic or diastolic blood pressure reduction correlated directly with changes in quality of life.

Adrenergic beta-Antagonists↗
PubMed2000

The impact of life events in female patients with fibromyalgia and in female healthy controls.

The aim was to investigate if female fibromyalgia patients (FMS) had experienced more negative life events than healthy women. Furthermore, the life events experienced in relation to onset of the FMS were evaluated. Another important area was to investigate the impact of the events experienced in the patients compared to healthy women. A new inventory was constructed to assess life events during childhood, adolescence and in adulthood as well as life events experienced in relation to the onset of the disorder. Forty female FMS patients and 38 healthy age-matched women participated in the study. During childhood or adolescence 51% of the patients had experienced very negative life events as compared to 28% of the controls. Conflict with parents was the most common life event. Before onset, 65% of the patients experienced some negative life event. Economic problems and conflicts with husband/partner were common. During the last year, 51% of the patients had life events which they experienced as very negative, compared to 24.5% of the controls (P < 0.01). Stressful life events in childhood/adolescence and in adulthood seem to be very common in FMS. Furthermore, the life events were experienced as more negative than the life events experienced by healthy controls.

Adult↗
PubMed2001

The quality of quality of life studies in general surgical journals.

BACKGROUND: There has been a tremendous increase in interest on quality of life in surgical research. An increase in interest does not necessarily translate into better research. This study evaluates surgical articles that claim to measure or make some conclusion on quality of life. STUDY DESIGN: All articles published in the calendar years 1996 and 1999 that purported to assess quality of life as end points or make some conclusion about quality of life were chosen for review from eight general surgical journals. Articles were assessed for use of a quality of life instrument, type of instrument, validation of the instrument, appropriateness of the instrument for the hypothesis, quality of statistical analysis, and adherence to the Gill and Feinstein criteria. RESULTS: Of the 18 articles published in 1996, 72% used a quality of life instrument. Eighteen instruments were used in 13 studies: 7 generic, 10 disease-specific, and 1 ad hoc. Forty-three percent were validated, 39% were appropriate for the study hypothesis, 39% had correct statistical analysis. The majority did not meet the Gill and Feinstein criteria. Of the 24 studies published in 1999, 63% used a quality of life instrument. Twenty-two instruments were used in 15 studies: 11 generic, 5 disease-specific, and 6 ad hoc. Fifty-five percent were validated, 45% were appropriate, 45% had correct statistical analysis. Once again, the majority did not meet the Gill and Feinstein criteria. CONCLUSIONS: Despite the emphasis on quality of life outcomes, a substantial number of studies made errors in conceptually defining quality of life and in use of quality of life instruments. Researchers and journal reviewers need to be better versed on the techniques of quality of life research.

General Surgery↗
PubMed1998

A mediational model of quality of life for individuals with severe mental health problems.

BACKGROUND: Despite the increasing importance of quality of life in the mental health field, the theoretical conceptualization of the construct remains poorly developed. A proposed mediational model of quality of life, which links subjective quality of life with self-related constructs, is examined with a group of long-term psychiatric hostel residents. The present study aims to develop a measure of quality of life based on the proposed model, to explore the data and their implications for service development and finally to conduct a preliminary analysis of the model's predictions. METHODS: A cross-sectional research design was employed. Quality of life interviews, using a modified version of Lehman's Quality of Life Interview, were carried out with 54 psychiatric residents in Greece. The model's predictions were examined by using a series of regression analyses. RESULTS: The results indicate that perceived improvements in lifestyle, greater autonomy and positive self-concept are significantly and directly associated with better quality of life. In contrast, a direct relationship between objective indicators and subjective quality of life was not found. CONCLUSIONS: The traditional two-part quality of life model that includes objective indicators of life circumstances and subjective indicators is extended to included the constructs of self-concept and perceived autonomy. The present extended mediational model of quality of life for individuals with long-term mental health problems appears to have important implications for the planning and delivery of mental health programmes.

Cross-Sectional Studies↗
PubMed1997

Assessment of quality of life with the Nottingham Health Profile among patients with coronary heart disease.

The aim was to describe the quality of life of people suffering from coronary artery disease. The patients had been treated with medication (n = 80), percutaneous transluminal coronary angioplasty (n = 100) and coronary artery bypass surgery (n = 100). Of the 280 patients, 189 were men and 91 women. The patients who participated in this study were seriously ill, as nearly half of them had three or more stenosed coronary arteries. Male patients were most numerous in the bypass surgery group and female patients in the angioplasty group. The quality of life was evaluated using the Nottingham Health Profile (NHP) instrument relation to an age- and sex-matched general population, the background factors and the severity of the coronary disease. The NHP questionnaire consists of 38 statements on health problems, making up six dimensions of subjective health: physical mobility, pain, sleep, energy, emotional reactions and social isolation. The health-related quality of life of coronary patients before the invasive procedures was significantly poorer on all the six dimensions than the quality of life in an age- and sex-matched general population. The most obvious differences were seen on the following dimensions: energy, pain, emotional reactions, sleep and physical mobility. The smallest differences occurred in social isolation. Both males and females had the lowest value for energy and social isolation in the youngest age group (35-54 years). The index values of emotional reactions in the two youngest groups were significantly higher among females than males, which reflects poor quality of life. The women in the age group of 35-54 years found the manifestation of a serious disease extremely hard to face. Our findings clearly suggest that while choosing the mode of treatment, the patient's quality of life should be considered along with the clinical severity of the disease, especially in the case of young women. From the societal and social points of view, the patient's symptoms and quality of life are even more important than the objective medical outcome. In clinical decision-making, the goal is to integrate the results of health-related quality of life assessments with clinical decisions, and this underlines the need to evaluate whether the treatment given is congruent with the patient's quality of life. On the basis of the present findings, the NHP instrument seems to be applicable to quality of life measurements among coronary patients. It does not, however, necessarily give an accurate and profound view of an individual's overall quality of life.

Aged↗
PubMed2004

Quality of life of clients with schizophrenia.

BACKGROUND: Because of the deinstitutionalization of mental health care in Hong Kong that has taken place since the 1980s, many people with mental health problems are being cared for in the community. The majority of clients have a diagnosis of schizophrenia, and many have a long duration of illness and multiple readmissions. There is concern about their quality of life. AIM: To investigate quality of life and related factors in clients with a diagnosis of schizophrenia in Hong Kong. DESIGN: A convenience sample was recruited from a psychiatric outpatient department. Structured face-to-face interviews were conducted using the Brief Psychiatric Rating Scale and the Hong Kong Chinese World Health Organization Quality of Life Scale-Brief Version. RESULTS: A total of 172 people participated in the study. Most of them were single and unemployed. They were least satisfied with their psychological health, financial situation, life enjoyment and sexual activity. Women (n = 91) reported less satisfaction with quality of life than men (n = 86). Unemployed people (n = 100) were less satisfied with their quality of life than the employed (n = 76). Higher levels of mental health problems and higher numbers of previous hospitalizations were associated with negative perceptions of quality of life. DISCUSSION: People with mental health problems had significantly less satisfaction with their quality of life than a sample from the general population in Hong Kong surveyed in a previous study. As well as experiencing distressing mental symptoms, they had many difficulties, such as financial problems, unemployment and lack of opportunities to participate in social activities, that resulted from stigma and discrimination. These had a great impact on their quality of life. STUDY LIMITATIONS: Because of the small sample size and its convenience nature, the findings may not be generalizable to all clients in Hong Kong. A generic instrument was used to measure quality of life, and this may not have been sensitive to certain aspects of mental health clients' lives. CONCLUSION: The findings suggest that there is a need to strengthen social and vocational rehabilitation for people with mental health problems in Hong Kong. A more holistic and intensive model of care is required to meet their complex needs. A larger and more diverse sample should be used in future research, and a quality of life measure specifically designed for people with mental health problems should be used.

Adolescent↗