7-
APPLICATION
AND
RESULTS
OF
THE
MANCHESTER
SHORT
ASSESSMENT
OF
QUALITY
OF
LIFE
(MANSA)
S.
PRIEBE,
P.
HUXLEY,
S.
KNIGHT
&
S.
EVANS
SUMMARY
Background
Based
on
experiences
and
empirical
evidence
gained
in
studies
using
the
Lancashire
Quality
of
Life
Profile
(LQLP),
the
Manchester
Short
Assessment
of
Quality
of
Life
(MANSA)
has
been
developed
as
a
condensed
and
slightly
modified
instrument
for
assessing
quality
of
life.
Its
properties
have
been
tested
in
a
sample
of
community
care
patients.
Method
Fifty-five
randomly
selected
patients
on
the
Care
Programme
Approach
were
interviewed
using
the
LQLP,
the
MANSA
and
the
Brief
Psychiatric
Rating
Scale.
Results
Correlations
between
subjective
quality
of
life
scores
on
MANSA
and
LQLP
were
all
0.83
or
higher
(0.94
for
the
satisfaction
mean
score).
Cronbach’s
alpha
for
satisfaction
ratings
was
0.74,
and
association
with
psychopathology
was
in
line
with
results
for
LQLP
as
reported
in
the
literature.
Conclusions
The
MANSA
is
a
brief
instrument
for
assessing
quality
of
life
focusing
on
satisfaction
with
life
as
a
whole
and
with
life
domains.
Its
psychometric
properties
appear
satisfactory.
INTRODUCTION
In
the
last
10
years,
quality
of
life
in
people with
mental
illness
has
become
a
popular
construct
and
an
important outcome
criterion
in
evaluative
research.
Various
instruments
have
been
developed
for
measuring
it.
In
most
of
them,
satisfaction
with
life
in
general
and
with
life
domains
plays
a
central
role
and
is
assessed
on
Likert
type self
rating
scales
(Orley
et al.
1998).
Based
on
Lehman’s
original
work
in
the
US,
Oliver
et
al.
(1991/92)
established
the
Lancashire
Quality of
Life
Profile
(LQLP) which
has
been
widely used
in
Europe
(Priebe
et
al.
1995;
Oliver
et
czl.
1997).
Several
research
centres
now
have
huge
data
bases,
e.g.
in
Manchester,
Berlin, London
and
Verona.
In
samples
with
severe
mental
illness,
subjective
quality
of
life
ratings
obtained
by the
LQLP
have been
shown
to
be
sufficiently
reliable
(Kaiser
&
Priebe,
1998),
to
have
a
discriminative
ability
between
different
samples
and
treatment
settings
eft
al.
1997;
Kaiser
et
al.
1997;
Priebe
al.
1998a,b), and
to
be
sensitive
to
change (Holloway
&
Carson,
1998;
Hoffmann
et
al.
1998;
Priebe et
al.
in
press
a).
Yet,
research
has
also
revealed
some
shortcomings
of
the
LQLP:
Overall,
it
takes
approxi-
mately 30
minutes
to
administer
what
is
too
long for
some
purposes;
some
incorporated
parts
such
as
the
affect-balance-scale
assess
mainly
psychopathology
which
should
be
assessed
by
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8
specific
scales;
most
importantly,
there
are
many
items
in
the
LQLP
that
have
not
been
found
to
be
relevant
for
discriminating
between
samples
or
for
demonstrating
change.
Regarding
the
objective
variables,
there
are
various
items
with
insufficient
variance.
In
addition,
there
is
no
clear
way
to
sum
up
single
item
scores
for
each
domain
nor
has
an
overall
score
been
established.
Shortcomings
of
the
subjective
variables
in
the
LQLP
relate
to
inconsistency
in
the
language
used
i.e.
&dquo;how
do
you
feel
about ...?&dquo;
versus
’how
satisfied
are
you
with ...?&dquo;,
that
the
question
about
satisfaction
with
family
is
equivocal
because
it
is
unclear
which
part
of
the
family
is
referred
to
while
some
life
domains
are
assessed
by
one
question
and
others
by
more
than
one
question
which
complicates
statistical
analysis
and
interpretation
of
findings.
Finally,
it
was
widely
felt
that
a
question
on
the
domain
of
sexual
life
is
missing.
Based
on
experiences
gained
in
several
thousand
quality
of
life
interviews
and
on
the
results
of
systematic
studies,
we
therefore
developed
the
Manchester
Short
Assessment
of
Quality
of
Life
(MANSA),
a
brief
and
modified
version
of
the
LQLP
that
has
been
intended
to
take
into
account
all
of
the
above
mentioned
shortcomings
(see
Appendix
and
Priebe
et
al.
in
press
b).
Objective
questions
that
in
previous
studies
have
neither
discriminated
between
settings
or
groups
nor
have
been
sensitive
to
change,
were
eliminated.
Subjective
questions
were
reduced
to
one
item
per
life
domain
and
put
in
a
consistent
language
rating
patients’
satisfaction.
The
MANSA
consists
of
three
sections:
(1)
Personal
details
that
are
supposed
to
be
consistent
over
time
(date
of
birth,
gender,
ethnic
origin,
and
diagnosis).
(2)
Personal
details
that
may
potentially
vary
over
time
and
have
to
be
re-documented
if
change
has
occurred
(education;
employment
status
including
kind
of
occupation
and
working
hours
per
week;
monthly
income;
state
benefits;
living
situation
including
number
of
children,
people
the
patient
lives
with,
and
type
of
residence).
(3)
Only
16
questions
are
to
be
asked
every
time
the
instrument
is
applied.
Four
of
these
questions
are
termed
objective
and
to
be
answered
with
yes
or no.
Twelve
questions
are
strictly
subjective.
The
objective
items
assess
the
existence
of
a
&dquo;close
friend&dquo;,
number
of
contacts
with
friends
per
week,
accusation
of
a
crime
and
victimisation
of
physical
violence.
The
subjective
questions
obtain
satisfaction
with
life
as
a
whole,
job (or
sheltered
employ-
ment,
or
training/education,
or
unemployment/retirement),
financial
situation,
number
and
quality of
friendships,
leisure
activities,
accommodation,
personal safety,
people
that
the
patient lives
with
(or
living
alone),
sex
life,
relationship
with
family,
physical
health,
and
mental
health.
A
manual
outlines
explanation
of
questions and
their
operationalisation
(also
see
Priebe
et
czl.
in
press
b).
Like
in
the
LQLP,
satisfaction
is
rated
on
7-point
rating
scales
(
=
negative
extreme,
7 =
positive
extreme).
In
a
sample of
community
care
patients
we
applied
the
MANSA
and
examined
correlations
with
LQLP
scores
and
with
psychopathology.
METHOD
Data
was
collected
within
a
review
of
the
Care
Programme
Approach
and
care
management
by
the
School
of
Psychiatry
at
the
University
of Manchester.
Local
authorities
were
asked
to
select
at
random
approximately
20
patients
aged
between
18
and
65
who
are
on
the
Care
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9
Programme
Approach
and
receiving
services
under
the
Community
and
Mental
Health
legislation.
For
the
purpose
of
this
study,
quality
of
life
was
assessed
in
all
patients
who
were
interviewed
in
three
localities,
i.e.
two
inner
city
and
one
metropolitan
borough
using
the
LQLP
as
well
as
the
MANSA.
Psychopathology
was
assessed
on
the
24
item
version
of
the
Brief
Psychiatric
Rating
Scale
(BPRS;
Ventura et
al.
1993).
All
interviews
were
done
by
one
experienced
researcher
who
was
not
involved
in
the
patients’
care.
RESULTS
Fifty-five
patients
(19
women,
36
men)
were
interviewed.
Mean
(±
s.d.)
age
of
patients
was
40.9
±
14.9
years.
The
diagnosis
was
schizophrenia
in
38
patients,
bipolar-affective
psychosis
in 8
patients,
first
or
recurrent
episode
of
depression
in
6
patients,
obsessive
compulsive
disorder
in
2
patients,
and
anxiety
disorder
in
1
patient.
Mean
BPRS
total
score
was
33.4
±
7.4.
Twenty
patients
were
from
ethnic
minorities.
One
patient
was
employed,
47
unemployed
and
7
retired.
Administration
of
the
MANSA
took
between
3
and
5
minutes.
In the
MANSA,
33
patients
said
they
did
not
have
’a
close
friend&dquo;,
and
39
had
not
visited
or
been
visited
by
a
friend
within
the
last
week.
Two
patients
each
reported
having
been
accused
of
a
crime
or
having
been
victims
of
physical
violence
within
the
last
year.
Means
of
single
satisfaction
scores
varied
between
4.09
± 1.17
(life
as
a
whole
today)
and
5.18
z
0.82
(family).
The
mean
score
of
all
satisfaction
items
was
4.56
±
0.51.
Table
1
shows
Pearson’s
correlations
between
satisfaction
ratings
in
the
MANSA
and
the
LQLP.
All
coefficients
are
above
0.82,
including
those
regarding
domains
that
are
assessed
by
two
or
more
items
in
the
LQLP
and
by
only
one
in
the
MANSA.
,
Correlations
of
MANSA
subjective
quality
of
life
mean
score
with
BPRS
total
score
was
r
=
-0.49
(p
<
0.001)
and
with
the
BPRS
sub
score
anxiety/depression
r
=
-0.42
(p
<
0.01).
Cronbach’s
alpha
for
the
satisfaction
ratings
in
MANSA
was
0.74.
Table
1
Correlations
between
satisfaction
ratings
on
LQLP
and
on
MANSA
’mean of
two
items
in
LQLP,
Zmean of
six
items
in
LQLP,
*p
=<
0.001
for
each
correlation
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10
DISCUSSION
The
high
correlations
of
MANSA
and
LQLP
scores
suggest
a
concurrent
validity
for
the
MANSA
in
addition
to
a
face
and
construct
validity.
Internal
consistency
of
satisfaction
ratings
seems
reasonable,
and
associations
with
psychopathology
are
in
line
with
results
for the
LQLP
reported
in
the
literature
(Kaiser
et
at.
1997;
Priebe et
al.
1998a,b).
Thus,
the
MANSA
appears
a
viable
and
valid
instrument
to
obtain
condensed
and
accurate
quality
of
life
data,
and
it
is
brief
enough
to
be
included
in
a
minimum
data
set.
It
should
be
taken
into
account,
however,
that
the
MANSA
shares
conceptual
and
methodological
limitations
with
the
LQLP
and
other
similar
instruments.
Although
it
assesses
some
objective
indicators
of
quality
of
life,
its
focus
is
clearly
on
subjective
ratings.
The
underlying
concept
of
quality
of
life
is
a
generic
and
not
a
disease
specific
one.
All
questions
allow
comparisons
with
the
general
population,
and
are
not
specifically
illness
or
symptom
related.
If
in
research
or
routine
evaluation
the
interest
is
in
more
specific
symptom-related
measures,
other
scales
should
be
used
in
addition
to
or
instead
of
the
MANSA.
The
same
holds
true
if
other
related
but
nevertheless
distinct
constructs
such
as
social
functioning
are
to
be
assessed.
In
evaluative
studies,
psychopathology
should
be
assessed
and
controlled
for
as
an
influential
factor.
Mean
satisfaction
scores
may
serve
as
a
non-specific
outcome
criterion.
Satisfaction
ratings
with
single
life
domains
should
be used
for
testing
domain
specific
and
a
priori
stated
hypotheses,
and
for
generating
such
hypotheses
if
mean
scores
reveal
significant
differences.
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1
1
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