# Moving beyond global scores: the added value of clinical dimensions for assessing HRQoL in mental disorders

## TL;DR

This study shows that adding mental health-specific clinical dimensions improves the understanding of well-being in people with mental disorders beyond generic quality of life measures.

## Contribution

The study demonstrates that clinical mental health dimensions significantly enhance the explanatory power of generic HRQoL instruments.

## Key findings

- Adding clinical dimensions increased the explained variance in self-rated health by 8.4% and life satisfaction by 17.3%.
- Two factors derived from clinical dimensions were not captured by the generic EQ-5D-5L instrument.
- The 'Psychological distress' factor, combining generic and clinical dimensions, was crucial for the improvement in model performance.

## Abstract

Health-Related Quality of Life (HRQoL) is an important outcome in health services research, but the suitability of generic HRQoL instrument for mental health populations is debated. This study investigates how clinical mental health dimensions (Norse Feedback, NF) supplement the generic HRQoL instruments (EuroQol five-dimensions five-level, EQ-5D-5 L) to explain their subjective well-being, defined by self-rated health (EuroQol Visual Analogue Scale, EQ-VAS) and life satisfaction.

In a cross-sectional study, 307 adults in specialized mental health treatment in Norway completed the EQ-5D-5 L and the modified NF. We compared a baseline regression model using only EQ-5D-5 L dimensions with a comprehensive model using factors derived from an Exploratory Factor Analysis of all 33 combined dimensions: 5 from EQ-5D-5 L and 28 from NF.

Factor analysis yielded five factors, two of which (‘Behavioral problems/externalizing’ and ‘Social/life stability’) consisted exclusively of clinical dimensions not captured by the EQ-5D-5L. A comprehensive model using these factor scores significantly improved explanatory power over a baseline EQ-5D-5L model. The adjusted R² increased by 8.4% points for EQ-VAS (from 23.5 to 31.9%) and by 17.3% points for life satisfaction (from 41.1% to 58.4%). The dominant ‘Psychological distress’ factor was key to this improvement, integrating the single EQ-5D-5L ‘Anxiety/depression’ dimension with eleven clinical dimensions like Internal avoidance and Hopelessness.

While the EQ-5D-5 L is valuable, its assessment of well-being in this population is significantly enhanced by incorporating some clinical dimensions. Particularly, mental health-specific dimensions such as Internal avoidance, Intrusive memories, Self-contempt and Hopelessness played crucial roles to understand the gap between generic HRQoL and their sense of overall well-being.