The construction and validation of the Assessment of Mental Health Related Quality of Life (PsyQoL) instrument

精神卫生是国家卫生重点领域之一，也是造成疾病负担的最大因素之一。世卫组织预测表明，到2020年，仅抑郁症的负担就将仅次于心血管疾病。目前正在开发治疗精神疾病的新方法，必须对其进行评估。目前的研究方法不允许将这些疗法的成本效益与其他医疗服务的成本效益进行准确比较，因为这需要衡量“效用”或“生活质量”。迄今为止开发的少数“通用”“生活质量仪器”在对不同疾病的“敏感性”（即检测变化的能力）上差别很大，而且没有一种仪器对精神健康状态的变化非常敏感。目前的计划是克服这一赤字。这将通过改进和扩大澳大利亚开发的一种工具来实现，即生活质量评估（akol）工具。这是迄今为止唯一使用正确的心理测量原理构建的工具，并且根据对患者在社会环境中发挥作用的能力的影响来描述健康状态。这种名为“心理健康量表”的新仪器将通过在现有仪器中加入一个心理健康“模块”和修改现有项目来提高仪器的灵敏度。所使用的方法将包括在描述健康状态和推导效用分数方面的几种方法创新。该项目将包括一项大规模的“验证”研究，其中包括人口“规范”的构建，以及心理质量和其他工具分数之间“汇率”的创建。该项目的重要意义在于，心理质量标准将允许有效和可靠地衡量健康状况，从而在心理和其他与健康有关的干预措施之间创造一个“公平的竞争环境”。

Mental Health is one of the national health priority areas as well as one of the largest contributors to burden of disease. WHO projections suggest that by 2020 the burden of depression alone will be second only to cardiovascular disease. New treatments for mental disorders are being developed which must be evaluated. Current research methods do not allow an accurate comparison of the cost effectiveness of these therapies with the cost effectiveness of other medical services as this requires the measurement of 'utility' or 'quality of life'. The small number of 'generic' 'quality of life instruments' developed to date vary significantly in their 'sensitivity' to different illnesses-their ability to detect change-and none is very sensitive to changes in mental health states. The present project is to overcome this deficit. This will be achieved by refining and expanding an instrument developed in Australia, the Assessment of Quality of Life (AQoL) instrument. This is the only instrument to date which was both constructed using correct psychometric principles of instrument construction and which describes health states in terms of the effect upon a patient's ability to function in a social environment. The new instrument called the PsyQoL will increase instrument sensitivity by including a mental health 'module' to the existing instrument and revising existing items. The methods used will include several methodological innovations in the description of health states and the derivation of utility scores. The project will include a large scale 'validation' study which will include the construction of population 'norms' and also the creation of 'exchange rates' between the PsyQoL and other instrument scores. The significance of the project is that the PsyQoL will allow valid and reliable measurement of health states in a way that creates a 'level playing field' between mental and other health related interventions.