Skip to main content

Advertisement

Log in

Viability of the World Health Organization quality of life measure to assess changes in quality of life following treatment for alcohol use disorder

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

Quality of life is an outcome often examined in treatment research contexts such as biomedical trials, but has been studied less often in alcohol use disorder (AUD) treatment. The importance of considering QoL in substance use treatment research has recently been voiced, and measures of QoL have been administered in large AUD treatment trials. Yet, the viability of popular QoL measures has never been evaluated in AUD treatment samples. Accordingly, the present manuscript describes a psychometric examination of and prospective changes in the World Health Organization Quality of Life measure (WHOQOL-BREF) in a large sample (N = 1383) of patients with AUD recruited for the COMBINE Study.

Methods

Specifically, we examined the construct validity (via confirmatory factor analyses), measurement invariance across time, internal consistency reliability, convergent validity, and effect sizes of post-treatment changes in the WHOQOL-BREF.

Results

Confirmatory factor analyses of the WHOQOL-BREF provided acceptable fit to the current data and this model was invariant across time. Internal consistency reliability was excellent (α > .9) for the full WHOQOL-BREF for each timepoint; the WHOQOL-BREF had good convergent validity, and medium effect size improvements were found in the full COMBINE sample across time.

Conclusions

These findings suggest that the WHOQOL-BREF is an appropriate measure to use in samples with AUD, that the WHOQOL-BREF scores may be examined over time (e.g., from pre- to post-treatment), and the WHOQOL-BREF may be used to assess improvements in quality of life in AUD research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.

    Book  Google Scholar 

  3. Anton, R. F., O’Malley, S. S., Ciraulo, D. A., Cisler, R. A., Couper, D., Donovan, D. M., … COMBINE Study Research Group. (2006). Combined pharmacotherapies and behavioral interventions for alcohol dependence: The COMBINE study: A randomized controlled trial. The Journal of the American Medical Association, 295(17), 2003–2017.

  4. Chen, F. F., Sousa, K. H., & West, S. G. (2005). Testing measurement invariance of second-order factor models. Structural Equation Modeling, 12(3), 471–492.

    Article  Google Scholar 

  5. Chen, K. H., Wu, C. H., & Yao, G. (2006). Applicability of the WHOQOL-BREF on early adolescence. Social Indicators Research, 79, 215–234. doi:10.1007/s11205-005-0211-0.

    Article  Google Scholar 

  6. Cheung, G. W., & Rensvold, R. B. (1999). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling, 9(3), 233–255.

    Google Scholar 

  7. Cheung, G. W., & Rensvold, R. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling, 9(2), 233–255. doi:10.1207/S15328007SEM0902_5.

    Article  Google Scholar 

  8. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Earlbaum Associates.

    Google Scholar 

  9. COMBINE Study Group. (2003). Testing combined pharmacotherapies and behavioral interventions in alcohol dependence: Rationale and methods. Alcoholism, Clinical and Experimental Research, 27(7), 1107–1122.

    Article  Google Scholar 

  10. Curran, P. J., McGinley, J. S., Baurer, D. J., Hussong, A. M., Burns, A., Chassin, L., ... Zucker, R. (2014). A moderated nonlinear factor model for the development of commensurate measures in integrative data analysis. Multivariate Behavioral Research, 49, 214–231. doi:10.1080/00273171.2014.889594.

  11. Derogatis, L. R. (1993). BSI. Brief Symptom Inventory. Administration, Scoring, and Procedures Manual (3rd ed.) National Computer Systems, Inc., Minneapolis, MN.

  12. Donovan, D. M., Anton, R. F., Miller, W. R., Longabaugh, R., Hosking, J. D., & Youngblood, M. (2008). Combined pharmacotherapies and behavioral interventions for alcohol dependence (The COMBINE Study): examination of posttreatment drinking outcomes. Journal of Studies on Alcohol and Drugs, 69, 5–13. doi:10.15288/jsad.2008.69.5.

    Article  PubMed  Google Scholar 

  13. Donovan, D. M., Bigelow, G. E., Brigham, G. S., Carroll, K. M., Cohen, A. J., Gardin, J. G., … Wells, E. A. (2012). Primary outcome indices in illicit drug dependence treatment research: Systematic approach to selection and measurement of drug use end-points in clinical trials. Addiction, 107(4), 694–708.

  14. Donovan, D., Mattson, M. E., Cisler, R. A., Longabaugh, R., & Zweben, A. (2005). Quality of life as an outcome measure in alcoholism treatment research. Journal of Studies on Alcohol, S15, 119–139.

    Article  Google Scholar 

  15. The EuroQol Group. (1990). EuroQol—a new facility for the measurement of health-related quality of life. Health Policy, 16, 199–208.

    Article  Google Scholar 

  16. Falk, D., Wan, X. Q., Liu, L., Fertig, J., Mattson, M., Ryan, M., … Litten, R. Z. (2010). Percentage of subjects with no heavy drinking days: Evaluation as an efficacy endpoint for alcohol clinical trials. Alcoholism: Clinical and Experimental Research, 34(12), 2022–2034. doi:10.1111/j.1530-0277.2010.01290.x.

  17. François, C., Rahhali, N., Chalem, Y., Sørensen, P., Luquiens, A., & Aubin, H. J. (2015). The effects of as-needed Nalmefene on patient-reported outcomes and quality of life in relation to a reduction in alcohol consumption in alcohol-dependent patients. PLoS ONE, 10(8), e0129289. doi:10.1371/journal.pone.0129289.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gliem, J. A., & Gliem, R. R. (2003). Calculating, interpreting, and reporting Cronbach’s Alpha reliability coefficient for Likert-type scales. In:Midwest Research to Practice Conference in Adult, Continuing, and Community Education, (pp. 82–88). http://www.ssnpstudents.com/wp/wp-content/uploads/2015/02/Gliem-Gliem.pdf.

  19. Hanley, J. A., & McNeil, B. J. (1982). The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology, 143, 29–36.

    Article  CAS  PubMed  Google Scholar 

  20. Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.

    Article  Google Scholar 

  21. IBM Corp. (2015). IBM SPSS Statistics for Windows. Version 23.0. Armonk, NY: IBM Corp.

  22. International Resource Center for Health Care Assessment. (1992). How to score the SF-36 short-form health survey. Boston, MA: The Health Institute.

    Google Scholar 

  23. Jaracz, K., Kalfoss, M., Górna, K., & Bączyk, G. (2006). Quality of life in polish respondents: Psychometric properties of the Polish WHOQOL-BREF. Scandinavian Journal of Caring Science, 20, 251–260.

    Article  Google Scholar 

  24. Kaskutas, L. A., Borkman, T. J., Laudet, A., Ritter, L. A., Witdbrodt, J., Subbaraman, M. S., ... Bond, J. (2014). Elements that define recovery: the experiential perspective. Journal of Studies on Alcohol and Drugs, 75, 999–1010. doi:10.15288/jsad.2014.75.999.

  25. Luquiens, A., Reynaud, M., Falissard, B., & Aubin, H. J. (2012). Quality of life among alcohol-dependent patients: How satisfactory are the available instruments? A systematic review. Drug and Alcohol Dependence, 125(3), 192–202. doi:10.1016/j.drugalcdep.2012.08.012.

    Article  CAS  PubMed  Google Scholar 

  26. Lucas-Carrasco, R., Laidlaw, K., & Power, M. J. (2011). Suitability of the WHOQOL-BREF and WHOQOL-OLD for Spanish older adults. Aging Mental Health, 15(5), 595–604. doi:10.1080/13607863.2010.548054.

    Article  PubMed  Google Scholar 

  27. Marlatt, G. A., & Witkiewitz, K. A. (2010). Harm reduction approaches to alcohol use: Health promotion, prevention, and treatment. Addictive Behaviors, 27(6), 867–886.

    Article  Google Scholar 

  28. Midanik, L. T., Greenfield, T. K., & Bond, J. (2007). Addiction sciences and its psychometrics: The measurement of alcohol-related problems. Addiction, 102(11), 1701–1710. doi:10.1111/j.1360-0443.2007.01886.x.

    Article  PubMed  Google Scholar 

  29. Miller, W. R., Tonigan, J. S., & Longabaugh, R. (1995). The drinker inventory of consequences (DrInC): An instrument for assessing adverse consequences of alcohol abuse. Test manual (Project MATCH Monograph Series, Vol. 4). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism.

  30. Moos, R. H., & Finney, J. W. (1983). The expanding scope of alcoholism treatment evaluation. American Psychologist, 38(10), 1036–1044. doi:10.1037/0003-066X.38.10.1036.

    Article  CAS  PubMed  Google Scholar 

  31. Muthén, L.K., & Muthén, B.O. (2012). Mplus users guide (Version 7).

  32. Neale, J., Finch, E., Marsden, J., Mitcheson, L., Rose, D, Strang, J., … Wykes, T. (2014). How should we measure addiction recovery? Analysis of service provider perspectives using online Delphi groups. Drugs: Education, Prevention and Policy, 21(4), 310–323. doi:10.3109/09687637.2014.918089.

  33. Ohaeri, J. U., Awadalla, A. W., El-Abassi, A. H. M., & Jacob, A. (2007). Confirmatory factor analytical study of the WHOQOL-Bref: Experience with Sudanese general population and psychiatric samples. BMC Medical Research Methodology, 7(1), 37. doi:10.1186/1471-2288-7-37.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Skevington, S. M., Lofty, M., & O’Connell, K. A. (2004). The World Health Organization’s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial a report from the WHOQOL Group. Quality of Life Research, 13(2), 299–310.

    Article  CAS  PubMed  Google Scholar 

  35. Skinner, H. A., & Allen, B. A. (1982). Alcohol dependence syndrome: Measurement and validation. Journal of Abnormal Psychology, 91, 199–209.

    Article  CAS  PubMed  Google Scholar 

  36. Tiffany, S. T., Friedman, L., Greenfield, S. F., Hasin, D. S., & Jackson, R. (2012). Beyond drug use: A systematic consideration of other outcomes in evaluations of treatments for substance use disorders. Addiction, 107, 709–718.

    Article  PubMed  Google Scholar 

  37. Tracy, E. M., Laudet, A., Min, M. O., Kim, H., Brown, S., Jun, M., et al. (2012). Prospective patterns and correlates of quality of life among women in substance abuse treatment. Drug and Alcohol Dependence, 124(3), 242–249. doi:10.1016/j.drugalcdep.2012.01.010.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Trompenaars, F. J., Masthoff, E. D., Van Heck, G. L., Hodiamont, P. P., & De Vries, J. (2005). Content validity, construct validity, and reliability of the WHOQOL-Bref in a population of Dutch adult psychiatric outpatients. Quality of Life Research, 14(1), 151–160. doi:10.1007/s11136-004-0787-x.

    Article  PubMed  Google Scholar 

  39. WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28, 551–558.

    Article  Google Scholar 

  40. Widaman K. F., Ferrer E., & Conger R. D. (2010). Factorial invariance within longitudinal structural equation models: measuring the same construct across time. Child Development Perspectives, 4(1), 10–18. doi:10.1111/j.1750-8606.2009.00110.x.

  41. Witkiewitz, K. (2013). “Success” following alcohol treatment: Moving beyond abstinence. Alcoholism, Clinical and Experimental Research, 37(S1), E9–E13. doi:10.1111/acer.12001.

    Article  PubMed  Google Scholar 

  42. World Health Organization. (2015). International classification of diseases, tenth revision, clinical modification (ICD-10-CM).

  43. Yao, G., & Wu, C. H. (2005). Factorial invariance of the WHOQOL-BREF among disease groups. Quality of Life Research, 14(8), 1881–1888. doi:10.1007/s11136-005-3867-7.

    Article  PubMed  Google Scholar 

  44. Zubaran, C., & Foresti, K. (2009). Quality of life and substance use: Concepts and recent tendencies. Current Opinion in Psychiatry, 22(3), 281–286. doi:10.1097/YCO.0b013e328328d154.

    Article  PubMed  Google Scholar 

Download references

Funding

 This research was supported by grants from the National Institute on Alcohol Abuse and Alcoholism (NIAAA; R01-AA022328, PI: Witkiewitz; F31-AA024959, PI: Kirouac; K01-AA023233, PI: Pearson).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Megan Kirouac.

Ethics declarations

This research was conducted via secondary data analyses and the multi-site parent study involving human subjects research underwent informed consent procedures approved by the host universities.

Conflicts of interest

My co-authors and I do not have any conflicts of interest that could inappropriately influence, or be perceived to influence, our work.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kirouac, M., Stein, E.R., Pearson, M.R. et al. Viability of the World Health Organization quality of life measure to assess changes in quality of life following treatment for alcohol use disorder. Qual Life Res 26, 2987–2997 (2017). https://doi.org/10.1007/s11136-017-1631-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-017-1631-4

Keywords

Navigation