Toward an understanding of the quality of life construct: validity and reliability of the WHOQOL-Bref in a psychiatric sample

Abstract

Purpose: The current study sought to explore the factor structure of the WHOQOL-Bref in a sample of adults with mental illness. Methods: The study sample consisted of 403 participants recruited from inpatients and outpatients mental health care facilities. Factorial construct validity was assessed through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency of domains was performed using Cronbach’s alpha. Results: While four of the five factors were conceptually similar to the original WHOQOL-Bref, our results suggest an alternative 5-domain model (psychological, physical, socialrelationships, environment and level of independence) with good-fit and adequate internal consistency. Thus, the level of independence domain was added to the four domains of the WHOQOL-Bref, since it demonstrates to be a theoretical autonomous domain, as proposed by the WHOQOL-100. Conclusions: The WHOQOL-Bref has shown to be an appropriate measure for the assessment of QOL in psychiatric samples; thus, a valuable tool to be incorporated as part of the routine clinical evaluation and monitoring, as well as an important indicator of treatment outcome and research. Our findings suggest a conceptual distinction between the physical health domain and level of independence in this short version of the WHOQOL. Meanwhile, although additional challenges are posed regarding the dimensionality of the WHOQOL-Bref, future research should reexamine the construct validity of this instrument in other samples of psychiatric consumers.