Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada.
Bipolar Disord. 2010 Nov;12(7):727-40. doi: 10.1111/j.1399-5618.2010.00865.x.
There is wide recognition that symptom ratings alone are inadequate to measure outcomes in bipolar disorder (BD), and quality of life (QoL) has been proposed as an important separable construct. Although a literature on QoL in BD exists, there is no disorder-specific measure of QoL in BD. In 2004, we embarked upon a four-year mixed-method program of research to develop such a measure that could function as an outcome tool in clinical trials of pharmacological or psychosocial treatment interventions, longitudinal monitoring, or routine clinical care.
The project was informed by standard protocols for the development of disorder-specific QoL measures. Two phases of scale development were pursued across four empirical studies. Item generation involved a qualitative investigation of individuals with BD, family members, and field experts (Study 1), as well as a literature review. Item reduction analyses were conducted using an intensive small-N design with affected individuals (Study 2), a large field sample (Study 3), and a final small-N item reduction study, again involving individuals with the disorder and field experts (Study 4).
Initial field testing of the Quality of Life in Bipolar Disorder (QoL.BD) scale supports use of the instrument as a feasible, reliable and valid disorder-specific QoL measure for BD. Internal reliability of the QoL.BD is impressive, test-retest reliability is appropriate, and the direction and magnitude of correlations with external measures are as expected. As a new instrument, the QoL.BD must be compared against existing options for measuring QoL in this population. Significantly, data suggest that the greater specificity of the QoL.BD relative to the Quality of Life Enjoyment and Satisfaction Questionnaire renders the new instrument more sensitive to clinical change in BD.
Quality of life scales can provide important information additional to that provided by traditional assessments of outcome in BD. Our intensive, mixed-method development of the QoL.BD has produced a useful additional measure of well-being for this complex and often disabling condition.
人们普遍认识到，仅通过症状评分不足以衡量双相情感障碍 (BD) 的结果，并且生活质量 (QoL) 已被提议作为一个重要的可分离结构。尽管 BD 中存在关于 QoL 的文献，但没有专门针对 BD 的 QoL 测量方法。2004 年，我们开始了一项为期四年的混合方法研究计划，旨在开发这样一种衡量标准，该标准可作为药物或心理社会治疗干预、纵向监测或常规临床护理临床试验的结果工具。
该项目是根据特定疾病的 QoL 测量方法的标准协议制定的。通过四项实证研究，进行了两个阶段的量表开发。项目启动涉及对 BD 患者、家庭成员和领域专家的定性研究（研究 1），以及文献回顾。通过使用受影响个体的密集小 N 设计（研究 2）、大型现场样本（研究 3）以及再次涉及该疾病患者和领域专家的最终小 N 项目缩减研究（研究 4）进行项目缩减分析。
对双相情感障碍生活质量 (QoL.BD) 量表的初步现场测试支持将该工具作为一种可行、可靠和有效的 BD 特定疾病 QoL 测量方法。QoL.BD 的内部信度令人印象深刻，重测信度适当，与外部测量的相关性的方向和幅度均符合预期。作为一种新的仪器，QoL.BD 必须与该人群中用于衡量 QoL 的现有选择进行比较。重要的是，数据表明，与生活质量满意度问卷相比，QoL.BD 的特异性更高，使得新仪器对 BD 中的临床变化更为敏感。
生活质量量表可以提供比传统 BD 结果评估更重要的信息。我们对 QoL.BD 的密集、混合方法开发产生了一种针对这种复杂且经常使人丧失能力的疾病的有用的幸福感附加衡量标准。
