OBJECTIVE: The demand to measure the clinical outcomes of persons with
serious mental illness in the community is growing; however, there is no
consensus about how to do this task. This paper identifies challenges in
measuring the outcomes of persons with serious mental illness and reviews
selected instruments that measure the community functioning of this
population. METHODS: Papers in peer-reviewed psychiatric journals for the
years 1986 to 1996 were reviewed to select instruments that measure two or
more domains of community functioning and for which data on reliability and
validity have been published. Selected instruments were evaluated, focusing
on their format, content, item scoring, length, and original sample
population. RESULTS AND CONCLUSIONS: Challenges to measuring the community
functioning of persons with serious mental illness include the multiplicity
of domains that must be measured, the conflicting interests of various
stakeholders involved in care, the limitations of self-report data, and
other methodological problems. Nine instruments that met the study criteria
were selected from the literature. Three are self-report instruments, and
six are based on the report of an informant or independent rater. The
instruments vary in length and in their original sample population. The
content areas most consistently represented are self-care and social
relationships. Life satisfaction, health status, psychiatric symptoms, and
work skills are not consistently addressed. Individual instruments have
additional limitations, including the absence of behavioral anchors for
scale items and the lack of specificity to persons with serious mental
illness. Effort should be directed toward sharing data across settings,
measuring the effects of treatment interventions, and demonstrating the
predictive validity of outcome data.
Abstract Teaser