ÁÍÁÓÊÏÐÇÓÇ

ÁÑ×ÅÉÁ ÅËËÇÍÉÊÇÓ ÉÁÔÑÉÊÇÓ 2001, 18(3):239–253

REVIEW ARCHIVES OF HELLENIC MEDICINE 2001, 18(3):239–253

Ì. Ïéêïíüìïõ,
Ðïéüôçôá æùÞò êáé øõ÷éêÞ õãåßá Ì. Êïêêþóç,
Å. Ôñéáíôáöýëëïõ,
ÅííïéïëïãéêÝò ðñïóåããßóåéò, Ã. ×ñéóôïäïýëïõ
êëéíéêÝò åöáñìïãÝò êáé áîéïëüãçóç
Øõ÷éáôñéêÞ ÊëéíéêÞ,
Ç Ýííïéá ôçò ðïéüôçôáò æùÞò ôéò ôåëåõôáßåò äåêáåôßåò Ý÷åé ðñïóåëêýóåé ôï ÐáíåðéóôÞìéï Áèçíþí,
ÁéãéíÞôåéï Íïóïêïìåßï, AèÞíá
åíäéáöÝñïí åñåõíçôþí óôï ÷þñï ôçò õãåßáò êáé åéäéêüôåñá óôï ÷þñï ôçò
øõ÷éêÞò õãåßáò, èåùñþíôáò ùò åðßêåíôñï ðáñáìÝôñïõò üðùò ç øõ÷ïëïãéêÞ
åõåîßá êáé ç éêáíïðïßçóç áðü ôç æùÞ. Ç Ýííïéá «ðïéüôçôá æùÞò» äåí Ý÷åé á-
,
êüìá êáèïñéóôåß ì Ýíá óõãêåêñéìÝíï êáé ïìïéüìïñöï ôñüðï, ìå áðïôÝëå-
Quality of life and mental health.
óìá íá õðÜñ÷ïõí áêüìç ðïëëÝò åííïéïëïãéêÝò áóÜöåéåò. Ç èåþñçóç ôçò
Conceptional approaches and clinical
ðïéüôçôáò æùÞò ìðïñåß íá åßíáé õðïêåéìåíéêÞ, üðïõ áîéïëïãåßôáé áðü ôï ßäéï
and assessment issues
ôï Üôïìï ìå êñéôÞñéá õðïêåéìåíéêÜ, áëëÜ êáé áíôéêåéìåíéêÞ, üðïõ êáèïñßæå- Abstract at the end of the article
ôáé áðü ôçí åêôßìçóç ôùí åîùôåñéêþí óõíèçêþí. Ôá ðáñáäïóéáêÜ èåùñçôé-
êÜ ìïíôÝëá ðïéüôçôáò æùÞò âáóßæïíôáé êõñßùò óå áíôéêåéìåíéêïýò êáé õðï-
êåéìåíéêïýò äåßêôåò, áëëÜ êáé óôï óõíäõáóìü áíÜìåóÜ ôïõò. Èåùñåßôáé ü- ËÝîåéò åõñåôçñßïõ
ìùò üôé ðñÝðåé åðéðëÝïí íá äéåñåõíçèïýí êáé ïé åóùôåñéêÝò øõ÷ïëïãéêÝò
Aîéïëüãçóç
äéåñãáóßåò ôïõ áôüìïõ ðïõ åðåíåñãïýí ùò äéáìåóïëáâçôéêïß ìç÷áíéóìïß ãéá
Ðïéüôçôá æùÞò
ôçí õðïêåéìåíéêÞ åêôßìçóç ôçò ðïéüôçôáò æùÞò. Ç ðïéüôçôá æùÞò ÷ñçóéìï-
Øõ÷éêÞ õãåßá
ðïéåßôáé óÞìåñá åêôåôáìÝíá ùò äåßêôçò áîéïëüãçóçò ôùí èåñáðåõôéêþí ðá-
ñåìâÜóåùí êáé óôñáôçãéêþí ðïõ Ý÷ïõí ùò óôü÷ï ôç âåëôßùóç ôçò øõ÷éêÞò
õãåßáò. Ç ðïéüôçôá æùÞò Ý÷åé ìåëåôçèåß éäéáßôåñá óôçí ðåñßðôùóç ôùí á-
óèåíþí ðïõ ðÜó÷ïõí áðü ìéá óïâáñÞ êáé ÷ñïíßá øõ÷éêÞ äéáôáñá÷Þ êáé åéäé-
êÜ ôçò ó÷éæïöñÝíåéáò, êõñßùò ëüãù ôçò áíáðçñßáò êáé áíéêáíüôçôáò ðïõ áõ-
ôÞ åðéöÝñåé óôï Üôïìï, áëëÜ êáé ëüãù ôçò áíáãêáéüôçôáò ãéá áíÜðôõîç å-
íüò ïëïêëçñùìÝíïõ ðëáéóßïõ ðáñï÷Þò øõ÷ïêïéíùíéêþí õðçñåóéþí ãéá ôçí
êÜëõøç ôùí ðïëëáðëþí áíáãêþí ôùí ÷ñüíéùí øõ÷éáôñéêþí áóèåíþí. Áíá-
öïñéêÜ ìå ôéò ëïéðÝò øõ÷éêÝò äéáôáñá÷Ýò, ãéá ìåí ôçí ðåñßðôùóç ôçò êáôÜ-
èëéøçò öáßíåôáé üôé ç êáôáèëéðôéêÞ óõìðôùìáôïëïãßá êáé ç õðïâáèìéóìÝíç
ðïéüôçôá æùÞò åßíáé Ýííïéåò ôáõôüóçìåò, åíþ ãéá ôéò áã÷þäåéò äéáôáñá÷Ýò
áõôÝò ó÷åäüí êáèïëéêÜ õðïâáèìßæïõí ôçí ðïéüôçôá æùÞò, óå ìåñéêÝò üìùò
Ýñåõíåò ðáñïõóéÜæïíôáé äéáöïñåôéêÜ ó÷Þìáôá ðïéüôçôáò æùÞò áíÜëïãá ìå
ôç äéáãíùóôéêÞ êáôçãïñßá, åíþ óå Üëëåò äåí åìöáíßæïíôáé óçìáíôéêÝò äéá-
öïñÝò áíÜìåóÜ ôïõò. Ç áîéïëüãçóç ôçò ðïéüôçôáò æùÞò ãßíåôáé ìå ôç ÷ñÞ-
óç øõ÷ïìåôñéêþí åñãáëåßùí, êõñßùò åñùôçìáôïëïãßùí. Ôá ðåñéóóüôåñá üñ-
ãáíá åîåôÜæïõí ôçí ðïéüôçôá æùÞò óöáéñéêÜ, áîéïëïãþíôáò äéÜöïñåò ðëåõ-
ñÝò Þ äéáóôÜóåéò ôïõ áôüìïõ, üðùò ç ëåéôïõñãéêüôçôá óôïí êïéíùíéêü, ïé-
êïãåíåéáêü, óåîïõáëéêü êáé åñãáóéáêü ôïìÝá, ç øõ÷ïëïãéêÞ åõåîßá, êáèþò
êáé ÷áñáêôçñéóôéêÜ ôïõ ðåñéâÜëëïíôïò ðïõ èåùñïýíôáé üôé êáèïñßæïõí ùò
Ýíá âáèìü ôçí ðïéüôçôá æùÞò, üðùò ôï öõóéêü ðåñéâÜëëïí, ç ðïéüôçôá ôïõ
÷þñïõ óôÝãáóçò, ïé ïéêïíïìéêïß ðüñïé êáé ïé åõêáéñßåò ãéá áðáó÷üëçóç, øõ-
÷áãùãßá êáé åêðáßäåõóç. Ôá ôåëåõôáßá ÷ñüíéá áíáðôý÷èçêáí åñãáëåßá ðïõ
åßíáé åîåéäéêåõìÝíá êáé áðåõèýíïíôáé óå áóèåíåßò ðïõ ðÜó÷ïõí áðü ìéá óõ-
ãêåêñéìÝíç øõ÷éêÞ íüóï, åîåôÜæïíôáò ôçí ðïéüôçôá æùÞò óå óõíÜñôçóç ìå
ôçí õãåßá êáé ôéò ðïëëáðëÝò åðéðôþóåéò ôçò íüóïõ Þ ôçò èåñáðåßáò. ÐïëëÜ,
ðÜíôùò, åßíáé ôá ìåèïäïëïãéêÜ ðñïâëÞìáôá ðïõ ðñïêýðôïõí êáé áðáéôïýí
åíäåëå÷Þ äéåñåýíçóç óôçí áîéïëüãçóç ôçò ðïéüôçôáò æùÞò óôéò øõ÷éêÝò äéá-
ôáñá÷Ýò.
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1. Ç ÅÍÍÏÉÁ «ÐÏÉÏÔÇÔÁ ÆÙÇÓ»
Óõ÷íÜ ëÝãåôáé üôé ôï êüóôïò ôïõ áíèñþðéíïõ ðüíïõ
äåí åßíáé ìåôñÞóéìï. Ôþñá ðéá üìùò åßíáé, êáèþò áñ-
êåôÝò åêöÜíóåéò ôïõ áíèñþðéíïõ ðüíïõ (Þ ôçò áðïõ-
óßáò ôïõ) ìðïñåß íá ìåôñçèïýí. Ìéá áðü ôéò ðñïóåããß-
óåéò óå áõôü ôï äýóêïëï, áëëÜ ü÷é ðëÝïí áêáôüñèùôï
Ýñãï, ÷ñçóéìïðïéåß ôçí Ýííïéá ôçò «ðïéüôçôáò æùÞò». Ç
Ýííïéá ôçò ðïéüôçôáò æùÞò áíáðôý÷èçêå êõñßùò óôéò Êïé-
íùíéêÝò ÅðéóôÞìåò, åöáñìüóôçêå üìùò êáé óå Üëëá å-
ðéóôçìïíéêÜ ðåäßá, üðùò óôçí ÉáôñéêÞ êáé óôï ÷þñï ôçò
õãåßáò ãåíéêüôåñá ùò êáèçìåñéíü ðïèçôü åðßôåõãìá.
Ç ðïéüôçôá æùÞò Ý÷åé áðáó÷ïëÞóåé áðü áñ÷áéüôáôïõò
÷ñüíïõò ôïõò ¸ëëçíåò öéëïóüöïõò. Ï ÁñéóôïôÝëçò, ï
ìåãáëýôåñïò óôï÷áóôÞò ôçò Áñ÷áéüôçôáò, öéëüóïöïò, èå-
ìåëéùôÞò ðïëëþí åðéóôçìþí êáé äçìéïõñãüò ôçò Ëïãé-
êÞò, ìå ôç ëÝîç «åõäáéìïíßá», üðùò ôçí áíÝëõå óôéò öé-
ëïóïöéêÝò ôïõ ìåëÝôåò, áðÝäéäå ðñïöáíþò ü,ôé êáé ï ü-
ñïò «ðïéüôçôá æùÞò». Óôï óýããñáììÜ ôïõ «ÇèéêÜ Íéêï-
ìÜ÷åéá» áíáðôýóóåôáé áðü ôïí ÁñéóôïôÝëç ç öéëïóïöé-
êÞ áíÜëõóç ôçò ëÝîçò åõäáéìïíßá êáé ïñßæåôáé ùò «Ýíá
åßäïò (ëïãéêÞò) øõ÷éêÞò åíÝñãåéáò óôá ìÝôñá ôçò ôÝëåé-
áò áñåôÞò». ÄçëáäÞ, óôçí Ýííïéá áõôÞ õðÜñ÷åé óõãêå-
ñáóìüò ôçò óõíáéóèçìáôéêÞò-øõ÷éêÞò êáôÜóôáóçò ôïõ
áôüìïõ êáé åíüò åßäïõò «ëïãéêÞò åíÝñãåéáò».1 Èåùñåß-
ôáé ëïéðüí áðü ôï öéëüóïöï ç åõäáéìïíßá ùò ôï «ôÝëåéï
êáé áõôÜñêåò áãáèü», ðïõ áðïôåëåß ôïí ôåëéêü óêïðü
ôùí ðñÜîåùí ôïõ áíèñþðïõ. Ï öéëüóïöïò õðïóôçñßæåé
üôé «ïé ðåñéóóüôåñïé ó÷åäüí óõìöùíïýí, äéüôé êáé ôï
ðëÞèïò ôùí áðëþí áíèñþðùí üóï êáé ïé ìïñöùìÝíïé
ðáñáäÝ÷ïíôáé üôé ôï óðïõäáéüôåñï áãáèü åßíáé ç åõ-
äáéìïíßá êáé èåùñïýí ðùò ç ðïéüôçôá æùÞò (åõ æçí) êáé
ç åõçìåñßá (åõ ðñÜôôåéí) åßíáé ôï ßäéï ðñÜãìá ìå ôçí åõ-
äáéìïíßá».2
Ðñüóöáôá, ç åõäáéìïíßá ìåôáöñÜóôçêå ìå ôç ëÝîç åõ-
ôõ÷ßá. Åíôïýôïéò, üðùò áíáöÝñåé ï George Bernard
Shaw (1900), «ç (Ýííïéá) æùÞ áöÞíåé ìåãáëïðñåðþò
ðïëý ðßóù ôçí (Ýííïéá) åõôõ÷ßá... Ç åõôõ÷ßá äåí åßíáé
áíôéêåéìåíéêüò óêïðüò ôçò æùÞò, åßíáé ç ßäéá áõôïóêï-
ðüò êáé ç ãåííáéüôçôá óõíßóôáôáé óôç äéÜèåóç ðïõ Ý÷åé
êÜðïéïò íá èõóéÜóåé ôçí åõôõ÷ßá ãéá ìéá ðéï ïõóéáóôé-
êÞ ðïéüôçôá æùÞò».3
Ç Ýííïéá «ðïéüôçôá æùÞò» äåí Ý÷åé êáèïñéóôåß ìå Ýíá
óõãêåêñéìÝíï êáé ïìïéüìïñöï ôñüðï êáé Ýôóé óõíá-
íôïýìå ðïëëÝò åííïéïëïãéêÝò áóÜöåéåò. Óôéò äåêáåôßåò
ôïõ 1960 êáé 1970, êïéíùíéêïß åðéóôÞìïíåò, öéëüóïöïé
êáé ðïëéôéêïß Üñ÷éóáí íá åðéäåéêíýïõí åíäéáöÝñïí ãéá
ôéò Ýííïéåò «ðïéüôçôá æùÞò» êáé «åðßðåäï æùÞò». Ôï åí-
äéáöÝñïí áõôü åêäçëþèçêå óôçí ðñïóðÜèåéá ôùí åéäé-
êþí íá áíôéìåôùðßóïõí ðñïâëÞìáôá ðïõ ðñïêáëïýíôáé
áðü ôéò áíéóüôçôåò êáôáíïìÞò ôùí ðüñùí êáé áöïñïýí
Ì. ÏÉÊÏÍÏÌÏÕ êáé óõí
ôï ãåíéêü «åõ æçí» ôçò êïéíùíßáò, óå óõó÷åôéóìü êáé ìå
ôéò áíçóõ÷ßåò ðïõ ãåííÜ ç ðñïïäåõôéêÞ áýîçóç ôïõ ðëç-
èõóìïý óõãêñéíüìåíç ìå ôï ñõèìü áíÜðôõîçò ôùí öôù-
÷þí ÷ùñþí.4 Åðßóçò, ç ðñïþèçóç êáé ðñïáãùãÞ ôïõ
êñÜôïõò ðñüíïéáò Ý÷åé õðïêéíÞóåé Ýñåõíåò ó÷åôéêÝò ìå
ôç äéáìüñöùóç êáé ÷ñÞóç êïéíùíéêþí äåéêôþí, ðïõ å-
ðé÷åéñïýí íá áðïôõðþóïõí ôçí ðïéüôçôá ôùí åñãáóéá-
êþí óõíèçêþí, ôçí ïéêïãåíåéáêÞ æùÞ, ôçí áîéïðïßçóç
ôïõ åëåýèåñïõ ÷ñüíïõ êáé ãåíéêüôåñá ôï êïéíùíéêü åõ
æçí. ¸ôóé, ç ðïéüôçôá æùÞò Ý÷åé åñìçíåõèåß áðü ïñé-
óìÝíïõò óõããñáöåßò ùò ç äõíáôüôçôá äéÜèåóçò ðüñùí
ðñïò êÜëõøç ôùí êïéíùíéêþí áíáãêþí êáé ç ýðáñîç
ôùí ðáñáìÝôñùí åêåßíùí ðïõ ó÷åôßæïíôáé ìå ôçí êïé-
íùíßá êáé ôï ðåñéâÜëëïí. Óå áõôÞ ôçí êáôçãïñßá ôùí
óõããñáöÝùí áíÞêåé ï McCall (1975), ðïõ õðïóôçñßæåé
üôé «ç ðïéüôçôá æùÞò óõíßóôáôáé óôçí ýðáñîç êáé óôç äõ-
íáôüôçôá ðñüóâáóçò ðñïò ôéò áðáñáßôçôåò åêåßíåò óõí-
èÞêåò ðïõ åîáóöáëßæïõí ôçí åõôõ÷ßá óå ìéá äåäïìÝíç
êïéíùíßá Þ ðåñéï÷Þ».5 ¢ëëïé óõããñáöåßò ôïíßæïõí ôçí
õðïêåéìåíéêÞ åêôßìçóç ôïõ áôüìïõ áíáöïñéêÜ ìå ôçí
ðïéüôçôá æùÞò êáé ôï åõ æçí.6
¼ðùò åßíáé åìöáíÝò, óôïõò ðáñáðÜíù ïñéóìïýò ôçò
ðïéüôçôáò æùÞò ðáñáôçñåßôáé Ýíáò äéá÷ùñéóìüò ìåôáîý
ôùí «áíôéêåéìåíéêþí» êáé «õðïêåéìåíéêþí» ðáñáìÝôñùí.
Åíôïýôïéò, ïé Zautra êáé Goodhard (1979) ôïíßæïõí ôçí
áíáãêáéüôçôá ôïõ óõíäõáóìïý ôùí äýï áõôþí ðáñáìÝ-
ôñùí. Õðïóôçñßæïõí üôé ç ðïéüôçôá æùÞò ïñßæåôáé «ùò ôï
íá åßíáé ç æùÞ êáëÞ êáé áîéïëïãåßôáé ìå êñéôÞñéá õðï-
êåéìåíéêÜ áëëÜ êáé áíôéêåéìåíéêÜ, ðïõ êáèïñßæïíôáé á-
ðü ôçí åêôßìçóç ôùí åîùôåñéêþí óõíèçêþí. ¸ãêõñïé
äåßêôåò ãéá ôïí ðñïóäéïñéóìü ôçò ðïéüôçôáò æùÞò åßíáé
ç õãåßá, ôï öõóéêü ðåñéâÜëëïí, ç ðïéüôçôá ôïõ ÷þñïõ
óôÝãáóçò êáé Üëëåò õëéêÝò ðñïûðïèÝóåéò».7 Áñãüôåñá
êáé åéäéêüôåñá óôïí ôïìÝá ôçò øõ÷éêÞò õãåßáò, êáé ï
Lehman, ãéá ôçí áðïóáöÞíéóç êáé ôïí åííïéïëïãéêü
ðñïóäéïñéóìü ôçò Ýííïéáò áõôÞò, èåùñåß áðáñáßôçôï ôï
óõíäõáóìü áíôéêåéìåíéêþí êáé õðïêåéìåíéêþí ðáñáãü-
íôùí êáé äåéêôþí.8
Óôçí ÉáôñéêÞ, ï üñïò «ðïéüôçôá æùÞò» áðåõèýíåôáé óå
üëåò åêåßíåò ôéò áíèñþðéíåò áíÜãêåò ðïõ óõ÷íÜ Ý÷ïõí
ðáñáìåëçèåß áðü ôï óýóôçìá õãåßáò êáé êïéíùíéêÞò ðñü-
íïéáò. Ìéá áéôßá ðïõ ðñïêÜëåóå ôï åíäéáöÝñïí ãéá ôçí
ðïéüôçôá æùÞò óôçí ÉáôñéêÞ, ìå Ýìöáóç óôçí õðïêåéìå-
íéêÞ áíôßëçøç ôïõ áóèåíïýò, Þôáí ç áõîáíüìåíç äõ-
óöïñßá óôéò äåêáåôßåò ôïõ 1960 êáé 1970 áðü ôçí ðëåõ-
ñÜ ôùí ÷ñçóôþí ôùí õðçñåóéþí õãåßáò ãéá ôéò èåñá-
ðåõôéêÝò ðáñåìâÜóåéò, üðùò åßíáé ç öáñìáêåõôéêÞ á-
ãùãÞ. Ìéá óõãêåêñéìÝíç ðëåõñÜ ôçò äõóöïñßáò áõôÞò
áöïñïýóå ôï üôé óôéò ðñïóðÜèåéåò ðáñÜôáóçò ôïõ ÷ñü-
íïõ åðéâßùóçò åðßêåíôñï áðïôÝëåóáí áðïêëåéóôéêÜ ïé
èåñáðåõôéêÝò áíÜãêåò, ÷ùñßò ç ÉáôñéêÞ íá ëÜâåé óïâá-
ÐÏÉÏÔÇÔÁ ÆÙÇÓ ÊÁÉ ØÕ×ÉÊÇ ÕÃÅÉÁ
ñÜ õðüøç ôéò Üëëåò âáóéêÝò áíèñþðéíåò áíÜãêåò ôïõ
áóèåíïýò, üðùò ç øõ÷éêÞ ôïõ åõåîßá, ç áõôïíïìßá êáé
ç áßóèçóç üôé áíÞêåé óå ìéá êïéíùíéêÞ ïìÜäá Þ óå Ý-
íá êïéíùíéêü óýíïëï. Áõôü ôï èÝìá Þñèå áñ÷éêÜ óôï
ðñïóêÞíéï óôïí ôïìÝá ôçò Ïãêïëïãßáò, üðïõ ï ðñï-
âëçìáôéóìüò Þôáí åÜí êÜðïéïò èá Ýðñåðå íá áðïðïéç-
èåß ôç ìåãáëýôåñç äéÜñêåéá ôçò æùÞò ãéá ÷Üñç ìéáò êá-
ëýôåñçò ðïéüôçôáò æùÞò. Ï ßäéïò ðñïâëçìáôéóìüò ßó÷õ-
óå êáé óôïí ôïìÝá ôçò Øõ÷éáôñéêÞò êáé óõãêåêñéìÝíá
óôçí ðåñßðôùóç ôçò èåñáðåßáò ôçò ó÷éæïöñÝíåéáò ìå êëá-
óéêÜ íåõñïëçðôéêÜ. ¸ôóé êáé åäþ õðÜñ÷ïõí ðåñéðôþ-
óåéò áóèåíþí ðïõ ðñïôéìïýí íá Ý÷ïõí øåõäáéóèÞóåéò
êáé åðþäõíåò ðáñáëçñçôéêÝò éäÝåò, ðáñÜ íá õðïöÝñïõí
áðü åîùðõñáìéäéêÜ óõìðôþìáôá, ðïõ áðïôåëïýí ôéò ðëÝ-
ïí óõíçèéóìÝíåò áíåðéèýìçôåò åíÝñãåéåò ôùí êëáóéêþí
áíôéøõ÷ùóéêþí öáñìÜêùí. Ïé áíåðéèýìçôåò áõôÝò å-
íÝñãåéåò, Üëëùóôå, äåí åßíáé ìüíï äõóÜñåóôåò ãéá ôïí
áóèåíÞ, áëëÜ êáé óõíôåßíïõí óôï óôéãìáôéóìü, áöïý ãß-
íïíôáé åýêïëá ïñáôÝò áðü ôï êïéíùíéêü ôïõ ðåñéâÜë-
ëïí.4 Óôéò ìÝñåò ìáò, ï üñïò «ðïéüôçôá æùÞò» óôçí Éá-
ôñéêÞ ÷ñçóéìïðïéåßôáé áðü üóïõò ðñïóðáèïýí íá åí-
óùìáôþóïõí óôç èåñáðåõôéêÞ ðáñÝìâáóç ôéò åìðåéñßåò
ðïõ Ý÷ïõí ïé áóèåíåßò, ÷ñçóéìïðïéþíôáò ôéò õðïêåéìå-
íéêÝò åêôéìÞóåéò ôïõò ãéá ôçí ðïéüôçôá ôçò æùÞò ôïõò.
Ðïëëïß Ý÷ïõí ðñïóðáèÞóåé íá ìïñöþóïõí äéáöï-
ñåôéêïýò ïñéóìïýò óôéò äýï Ýííïéåò, ôçí Ýííïéá ôçò «õ-
ãåßáò» êáé áõôÞí ôçò «ðïéüôçôáò æùÞò», ìå óõãêåñáóìü
ôïõò, Ý÷ïíôáò ùò åðßêåíôñï ðáñáìÝôñïõò üðùò ç åõôõ-
÷ßá êáé ç éêáíïðïßçóç áðü ôç æùÞ. Ìå ôçí áðïõóßá, ëïé-
ðüí, åíüò ãåíéêÜ áðïäåêôïý ïñéóìïý, ðïëëïß åñåõíç-
ôÝò õðïóôçñßæïõí üôé ïé ðåñéóóüôåñïé Üíèñùðïé, ôïõ äõ-
ôéêïý êõñßùò êüóìïõ, ãíùñßæïõí êáëÜ ôçí Ýêöñáóç
«ðïéüôçôá æùÞò» êáé åíóôéêôùäþò êáôáëáâáßíïõí ôé ðå-
ñéëáìâÜíåé áõôÞ ç Ýííïéá. Ç ðñïóåêôéêÞ üìùò ðáñáôÞ-
ñçóç öáíåñþíåé üôé ç ðïéüôçôá æùÞò óçìáßíåé äéáöï-
ñåôéêÜ ðñÜãìáôá ãéá äéáöïñåôéêïýò áíèñþðïõò, ðïõ á-
ðïäßäïõí ìÜëéóôá êÜèå öïñÜ êáé Üëëç óçìáóßá, áíÜ-
ëïãá ìå ôï åêÜóôïôå áíôéêåßìåíï ôïõ åíäéáöÝñïíôüò
ôïõò. ¸ôóé, óôï ðëáßóéï ôùí êëéíéêþí åöáñìïãþí äåí
õðÜñ÷åé óõíÞèùò éäéáßôåñï åíäéáöÝñïí ãéá ôçí ðïéüôç-
ôá æùÞò ìå ôçí ðëáôéÜ ôçò Ýííïéá, áëëÜ åíäéáöÝñåé ðå-
ñéóóüôåñï ç áîéïëüãçóç åêåßíùí ôùí ðëåõñþí ðïõ å-
ðçñåÜæïíôáé áðü ôçí áóèÝíåéá Þ ôç èåñáðåßá ôçò. Ç á-
îéïëüãçóç áõôÞ, âåâáßùò, ìðïñåß íá åðåêôáèåß êáé íá
áöïñÜ ôéò ðáñáìÝôñïõò åêåßíåò ðïõ èåùñïýíôáé üôé åß-
íáé Ýììåóá áðïôåëÝóìáôá ôçò åðßäñáóçò ôçò íüóïõ, ü-
ðùò åßíáé ç áíåñãßá Þ ç ïéêïíïìéêÞ äõóðñáãßá. Ãéá íá
äéá÷ùñßóïõìå ôçí ðïéüôçôá æùÞò ìå ôç ãåíéêÞ ôçò Ýí-
íïéá áðü ôçí ðïéüôçôá æùÞò ðïõ áöïñÜ ôéò áðáéôÞóåéò
ôçò ÉáôñéêÞò êáé ôùí êëéíéêþí åöáñìïãþí, ÷ñçóéìïðïé-
åßôáé ï üñïò «ðïéüôçôá æùÞò óå ó÷Ýóç ìå ôçí õãåßá»
241
(health-related quality of life, HRQL). ÁëëÜ êáé áõôüò ï
üñïò åíÝ÷åé áóÜöåéåò êáé åßíáé ó÷åôéêÜ äýóêïëï íá
ðñïóäéïñéóôïýí ôá óôïé÷åßá ðïõ ôïí óõíèÝôïõí. Åßíáé
ãåíéêÜ ðáñáäåêôü üôé ïé ðëåõñÝò ðïõ óõíèÝôïõí ôçí Ýí-
íïéá ôçò ðïéüôçôáò æùÞò óå ó÷Ýóç ìå ôçí õãåßá ðïéêßë-
ëïõí áðü ìåëÝôç óå ìåëÝôç. ÃåíéêÜ, ç ðïéüôçôá æùÞò óå
ó÷Ýóç ìå ôçí õãåßá ìðïñåß íá ðåñéëáìâÜíåé èÝìáôá ü-
ðùò ç õãåßá ãåíéêÜ, ôá óùìáôéêÜ óõìðôþìáôá, ç óõíáé-
óèçìáôéêÞ, ãíùóôéêÞ, êïéíùíéêÞ êáé óåîïõáëéêÞ ëåé-
ôïõñãéêüôçôá, êáèþò êáé Ýííïéåò õðáñîéáêïý ðåñéå÷ï-
ìÝíïõ.3
Ðñüóöáôá, ï Lehman (ðïõ áó÷ïëÞèçêå åéäéêüôåñá
ìå ôïí ôïìÝá ôçò øõ÷éêÞò õãåßáò) õðïóôçñßæåé üôé ôï èÝ-
ìá ôçò ðïéüôçôáò æùÞò, áí êáé ïñßæåôáé ðïéêéëïôñüðùò,
ðåñéëáìâÜíåé ôñåéò èåìåëéþäåéò äéáóôÜóåéò: (á) ôï ôé ôï
Üôïìï åßíáé éêáíü íá êÜíåé, (â) ôçí ðñüóâáóÞ ôïõ óå
ðüñïõò êáé åõêáéñßåò, þóôå íá ìðïñåß íá ÷ñçóéìïðïé-
Þóåé ôïõò ðüñïõò áõôïýò ãéá ôçí åðßôåõîç ôùí åíäéá-
öåñüíôùí ôïõ êáé (ã) ôï áßóèçìá ôçò øõ÷éêÞò åõåîßáò
ðïõ âéþíåé ôï Üôïìï. Ïé äýï ðñþôåò äéáóôÜóåéò ôïõ ü-
ñïõ èåùñïýíôáé ùò áíôéêåéìåíéêïß äåßêôåò ôçò ðïéüôç-
ôáò æùÞò, åíþ ç ôñßôç äéÜóôáóç ôïõ üñïõ èåùñåßôáé üôé
åìðßðôåé óôçí êáôçãïñßá ôùí õðïêåéìåíéêþí äåéêôþí.8
Óôçí Ýííïéá áõôÞ ôçò ðïéüôçôáò æùÞò, ðïõ êáèïñßæåôáé
áðü ôéò ôñåéò áõôÝò äéáóôÜóåéò, ðåñéëáìâÜíïíôáé êáé êÜ-
ðïéïé óõãêåêñéìÝíïé ôïìåßò ôçò æùÞò, üðùò åßíáé ç õ-
ãåßá (ãåíéêÜ), ç ïéêïãåíåéáêÞ æùÞ, ïé êïéíùíéêÝò ó÷Ý-
óåéò, ç åñãáóßá, ç ïéêïíïìéêÞ êáôÜóôáóç ôïõ áôüìïõ
êáé ôï âéïôéêü ôïõ åðßðåäï.
2. ÐÏÉÏÔÇÔÁ ÆÙÇÓ ÊÁÉ ØÕ×ÉÊÇ ÕÃÅÉÁ
Óýìöùíá ìå ôïí Ðáãêüóìéï Ïñãáíéóìü Õãåßáò, øõ-
÷éêÞ õãåßá åßíáé ç êáôÜóôáóç ôçò óõíáéóèçìáôéêÞò åõ-
åîßáò, üðïõ ôï Üôïìï ìðïñåß íá æåé êáé íá åñãÜæåôáé ìå
Üíåóç ìÝóá óôçí êïéíüôçôá êáé íá éêáíïðïéåßôáé áðü ôá
ðñïóùðéêÜ ôïõ ÷áñáêôçñéóôéêÜ êáé åðéôåýãìáôá. Ç Ja-
hoda Ý÷åé éäéáßôåñá áó÷ïëçèåß ìå ôïí ïñéóìü ôçò øõ÷é-
êÞò õãåßáò (1958) êáé ç èÝóç ôçò Ýãéíå äåêôÞ áðü ôçí
¸êèåóç ôçò Joint Commission on Mental Illness and
Health. Ïñßæåé, ëïéðüí, ôç èåôéêÞ øõ÷éêÞ õãåßá ùò ìéá
êáôÜóôáóç éóïññïðßáò ðïõ ðåñéêëåßåé åöôÜ ÷áñáêôçñé-
óôéêÜ: (á) ôçí åðßãíùóç áðü ôï Üôïìï ôçò ôáõôüôçôÜò
ôïõ, (â) ôç äõíáôüôçôá ôïõ áôüìïõ íá åßíáé áõôïäýíá-
ìï, (ã) ôç äõíáôüôçôá áíôßóôáóçò óôï stress (ìéá óýíèå-
óç ôçò ðñþôçò êáé äåýôåñçò éäéüôçôáò), (ä) ôç äõíáôü-
ôçôá ôïõ áôüìïõ íá åßíáé åíåñãçôéêü êáé áíåîÜñôçôï á-
ðü êïéíùíéêÝò åðéññïÝò, (å) ôçí éêáíüôçôá íá åëÝã÷åé ôï
ðåñéâÜëëïí, (óô) ôçí éêáíüôçôá íá áãáðÜ, íá åñãÜæåôáé
êáé íá äéáóêåäÜæåé êáé (æ) ôç äõíáôüôçôá íá åðéëýåé ôá
ðñïâëÞìáôÜ ôïõ.9 Áðü ôïõò ïñéóìïýò, ëïéðüí, ôçò ðïé-
242
üôçôáò æùÞò, ðïõ Ý÷ïõí äéáôõðùèåß, êáé ôçò øõ÷éêÞò õ-
ãåßáò, åßíáé öáíåñü ðüóï áíáðüóðáóôá óõíäåäåìÝíåò
åßíáé ïé äýï áõôÝò Ýííïéåò êáé ðüóï áíáðüóðáóôá å-
ìðëÝêïíôáé óôçí êïéíùíéêÞ áðïêáôÜóôáóç ôùí øõ÷éêÜ
áóèåíþí.
Ç ðñþôç óçìáíôéêÞ êáé ôåêìçñéùìÝíç áíáöïñÜ óôçí
ðïéüôçôá æùÞò èåùñåßôáé üôé Ýãéíå áðü ôïí Elkinton, ï
ïðïßïò åðéóçìáßíåé ôñßá óôïé÷åßá ðïõ óõíèÝôïõí ôçí
ðïéüôçôá æùÞò: ôçí øõ÷éêÞ åõåîßá, ôçí éêáíïðïßçóç (ôçí
áñìïíßá ðïõ âéþíåé ôï Üôïìï), áëëÜ êáé ôç ó÷Ýóç ðïõ
õðÜñ÷åé ìåôáîý ôïõ áôüìïõ êáé ôïõ ðåñéâÜëëïíôïò (áñ-
ìïíßá ìåôáîý áôüìïõ êáé ðåñéâÜëëïíôïò).10 Ãéá ôçí å-
êôßìçóç ôçò ðïéüôçôáò æùÞò ôùí ðáó÷üíôùí áðü øõ÷é-
êÝò äéáôáñá÷Ýò åßíáé áðáñáßôçôç ç óõìâïëÞ êïéíùíéêþí
äåéêôþí ðïõ áöïñïýí ôïõò ðåñéâáëëïíôéêïýò ðáñÜãï-
íôåò (êïéíùíéêïýò êáé õëéêïýò). Ç áîéïëüãçóç ôÝôïéùí
ðáñáãüíôùí, üðùò åßíáé ç êïéíùíéêÞ õðïóôÞñéîç, ôï å-
ðßðåäï ôçò áõôïíïìßáò, ïé ïéêïíïìéêïß ðüñïé êáé ïé óõí-
èÞêåò äéáâßùóçò, åßíáé áíáãêáßá, ãéáôß ïé ðáñÜãïíôåò
áõôïß åßíáé óôåíÜ óõíäåäåìÝíïé ìå ôçí øõ÷ïðáèïëïãßá.4
Ïé Katschnig êáé Angermeyer (1997), åðåîåñãáæüìå-
íïé ôï èÝìá «ç ðïéüôçôá æùÞò óôçí êáôÜèëéøç»,11 Ý÷ïõí
áíáðôýîåé Ýíá ðëáßóéï äñÜóçò ãéá ôçí åêôßìçóç ôçò ðïé-
üôçôáò æùÞò óå êáôáèëéðôéêïýò áóèåíåßò, ðïõ åíôïðßæåé
êáé åðåîåñãÜæåôáé ôïõò ðáñÜãïíôåò åêåßíïõò ðïõ áðï-
ôåëïýí ôá óõíèåôéêÜ óôïé÷åßá ôçò Ýííïéáò ðïéüôçôá æù-
Þò, üðùò ôï áßóèçìá ôçò øõ÷ïëïãéêÞò åõåîßáò ðïõ âéþ-
íåé ôï Üôïìï, ôçí áßóèçóç ôçò éêáíïðïßçóçò, ôç ëåé-
ôïõñãéêüôçôá ôïõ áôüìïõ êáé åîùôåñéêÝò ðåñéâáëëïíôé-
êÝò åðéäñÜóåéò. Ôï ó÷Þìá áõôü åßíáé åöáñìüóéìï êáé
óå Üëëåò äéáãíùóôéêÝò êáôçãïñßåò. Óôçí áíÜðôõîÞ ôïõò
áõôÞ, ïé Katschnig êáé Angermeyer ðñïôåßíïõí üôé ïé äñÜ-
óåéò ðïõ áíáëáìâÜíïíôáé ãéá ôç âåëôßùóç ôçò ðïéüôç-
ôáò æùÞò ðñÝðåé íá äéáöïñïðïéïýíôáé áíÜëïãá ìå ôïõò
ùò Üíù ðáñÜãïíôåò, äçëáäÞ Üëëåò äñÜóåéò èåùñåßôáé
üôé åðåíåñãïýí óôçí øõ÷ïëïãéêÞ åõåîßá ôïõ áôüìïõ
(ð.÷. áíôéêáôáèëéðôéêÜ), Üëëåò óôç ëåéôïõñãéêüôçôÜ ôïõ
(ð.÷. åêðáßäåõóç êïéíùíéêþí äåîéïôÞôùí) êáé Üëëåò ó÷å-
ôßæïíôáé ìå ôéò ðåñéâáëëïíôéêÝò óõíèÞêåò (ð.÷. ðáñï÷Þ
÷ñçìÜôùí-ïéêïíïìéêþí ðüñùí).
Áñãüôåñá, ï Lehman (1988) äéáìüñöùóå ôï üñãáíï
åêôßìçóçò ôçò ðïéüôçôáò æùÞò ìå ôßôëï «ÓõíÝíôåõîç Ðïé-
üôçôáò ÆùÞò», ðïõ Ý÷åé ó÷åäüí áðïêëåéóôéêÜ ÷ñçóéìï-
ðïéçèåß êáé ÷ïñçãçèåß óå Üôïìá ìå óïâáñÝò øõ÷éáôñé-
êÝò äéáôáñá÷Ýò. Ó' áõôü ôï üñãáíï ÷ñçóéìïðïéåß ùò ìå-
ôáâëçôÝò áöåíüò ìåí ôá ðñïóùðéêÜ ÷áñáêôçñéóôéêÜ ôïõ
áôüìïõ êáé áöåôÝñïõ áíôéêåéìåíéêïýò äåßêôåò ôçò ðïéü-
ôçôáò æùÞò, ðïõ áíáöÝñïíôáé óôéò ðñáãìáôéêÝò åìðåé-
ñßåò ôïõ áôüìïõ óå ó÷Ýóç ìå óçìáíôéêïýò ôïìåßò ôçò
æùÞò ôïõ êáé õðïêåéìåíéêïýò äåßêôåò ôçò ðïéüôçôáò æù-
Þò ðïõ ó÷åôßæïíôáé ìå ôá åðßðåäá éêáíïðïßçóçò ôïõ á-
Ì. ÏÉÊÏÍÏÌÏÕ êáé óõí
ôüìïõ üóïí áöïñÜ ôïõò ðáñáðÜíù óçìáíôéêïýò ôïìåßò
ôçò æùÞò ôïõ.12,13
Ôï åñþôçìá ðïõ ôßèåôáé åßíáé ðþò ïé áíôéêåéìåíéêÝò
óõíèÞêåò óõó÷åôßæïíôáé ìå ôéò õðïêåéìåíéêÝò áíôéëÞ-
øåéò, ðïõ ðáñáôßèåíôáé óôá ðáñáðÜíù ìïíôÝëá, êáé á-
ðü ðïéïõò ðñüóèåôïõò ðáñÜãïíôåò åðçñåÜæåôáé áõôÞ ç
óõó÷Ýôéóç.14 Ôñßá èåùñçôéêÜ ìïíôÝëá Ý÷ïõí áíáðôõ÷èåß
ùò áðÜíôçóç óôï ðáñáðÜíù åñþôçìá: (á) ôï ìïíôÝëï
ôçò éêáíïðïßçóçò, (â) ôï ìïíôÝëï ðïõ åßíáé óõíäõáóìüò
ôçò óçìáóßáò (ðïõ Ý÷åé ãéá ôï Üôïìï ìéá óõãêåêñéìÝíç
ðëåõñÜ ôçò æùÞò ôïõ) êáé ôçò éêáíïðïßçóçò êáé (ã) ôï
ìïíôÝëï ôçò ëåéôïõñãéêüôçôáò óå êïéíùíéêïýò ñüëïõò.
Ôï ìïíôÝëï ôçò éêáíïðïßçóçò áíáðôý÷èçêå áðü ôïõò
Lehman et al (1982)15 êáé áðü ôïõò Baker êáé Intagli-
ata (1982)6 ìå áíáöïñÜ óôï Ýñãï ôùí Campbell, Con-
verse êáé Rodgers (1976)16 êáé óôï Ýñãï ôùí Andrews
êáé Whitney (1976).17 Ï Lehman, óôï èåùñçôéêü áõôü
ìïíôÝëï, âáóßóôçêå ðñïöáíþò óôçí õðüèåóç üôé ôá å-
ðßðåäá éêáíïðïßçóçò ðïõ âéþíåé ôï Üôïìï ó÷åôéêÜ ìå
äéÜöïñïõò ôïìåßò ôçò æùÞò ôïõ åîáñôþíôáé áðü ôï áí ïé
óõíèÞêåò äéáâßùóÞò ôïõ óõìâáäßæïõí ìå ôéò áíÜãêåò
êáé ôéò åðéèõìßåò ôïõ. Óýìöùíá üìùò ìå ôïõò Anger-
meyer êáé Kilian (1997), ìå ôï ìïíôÝëï áõôü äåí ìðï-
ñåß íá äéáóöáëéóôåß üôé ïé ó÷åôéêÝò ìåôñÞóåéò åîáóöá-
ëßæïõí Ýãêõñï äåßêôç ôçò ðïéüôçôáò æùÞò ôïõ áôüìïõ.
¸ôóé, áí êÜðïéïò áóèåíÞò áéóèÜíåôáé óå ìåãÜëï âáè-
ìü éêáíïðïßçóç ãéá êÜðïéá óõãêåêñéìÝíç ðëåõñÜ ôçò
æùÞò ôïõ, õðÜñ÷ïõí ôñåéò ðéèáíÝò åêäï÷Ýò: Ðñþôïí,
ìðïñåß íá óçìáßíåé ðñÜãìáôé üôé ðñáãìáôïðïéïýíôáé ïé
åðéèõìßåò ôïõ áíáöïñéêÜ ìå ôïí ôïìÝá áõôü, äåýôåñïí,
ìðïñåß ï óõãêåêñéìÝíïò ôïìÝáò íá ìçí áîéïëïãåßôáé á-
ðü ôï Üôïìï ùò ôüóï óçìáíôéêüò êáé Ýôóé íá ìçí åðç-
ñåÜæåôáé ôï åðßðåäï éêáíïðïßçóçò ôïõ áôüìïõ êáé, ôñß-
ôïí, ìðïñåß ôï Üôïìï íá Ý÷åé ðñïóáñìüóåé ôéò áíÜãêåò
êáé åðéèõìßåò ôïõ áíÜëïãá ìå ôéò åõêáéñßåò ðïõ ðáñÝ-
÷ïíôáé óôï óõãêåêñéìÝíï ôïìÝá.18
Ôï äåýôåñï ìïíôÝëï, ðïõ åßíáé ï óõíäõáóìüò ôçò óç-
ìáóßáò êáé ôçò éêáíïðïßçóçò, åßíáé áðüññïéá ôïõ ðñï-
âëçìáôéóìïý ðïõ ðñïÝêõøå êáôÜ ôç èåùñçôéêÞ áíÜðôõîç
ôïõ ìïíôÝëïõ ôçò éêáíïðïßçóçò. ¸ôóé, ãéá Ýíá Üôïìï
÷áìçëïý åðéðÝäïõ öéëïäïîéþí åðáããåëìáôéêÞò åîÝëéîçò,
ïé åõêáéñßåò ðïõ ôïõ ðñïóöÝñïíôáé ãéá ðñïáãùãÞ äåí
áðïôåëïýí Ýíá óçìáíôéêü êñéôÞñéï ãéá ôçí åêôßìçóç ôçò
éêáíïðïßçóÞò ôïõ óôïí åñãáóéáêü ôïìÝá, åíþ ãéá êÜ-
ðïéïí Üëëïí, ðïõ Ý÷åé ìåãÜëåò öéëïäïîßåò ó÷åôéêÜ ìå
ôïí ôïìÝá áõôüí, ïé äéáèÝóéìåò åõêáéñßåò ãéá ðñïáãù-
ãÞ áðïôåëïýí ôï ðéï óçìáíôéêü êñéôÞñéï. Ôï ìïíôÝëï
áõôü, óýìöùíá ìå ôïõò Angermeyer êáé Kilian, åíþ å-
ðéóçìáßíåé ôç óðïõäáéüôçôá ôùí ðñïóùðéêþí áîéþí êáé
ðñïôéìÞóåùí, äåí åîåôÜæåé ôï åíäå÷üìåíï üôé ïé ðéèá-
íÝò ðéÝóåéò ðïõ äÝ÷åôáé ôï Üôïìï áðü ôï ðåñéâÜëëïí ôï
ÐÏÉÏÔÇÔÁ ÆÙÇÓ ÊÁÉ ØÕ×ÉÊÇ ÕÃÅÉÁ
áíáãêÜæïõí ðïëëÝò öïñÝò, ãéá íá áðïöýãåé Þ íá ìåé-
þóåé êÜðïéá ãíùóôéêÞ áóõìöùíßá, íá õðïôéìÜ ôïõò óôü-
÷ïõò åêåßíïõò ðïõ êáôÜ ôç ãíþìç ôïõ åßíáé áíÝöéêôï íá
ðñáãìáôïðïéçèïýí.18
Ôï ôñßôï ìïíôÝëï, ôçò ëåéôïõñãéêüôçôáò óå êïéíùíéêïýò
ñüëïõò, áíáðôý÷èçêå áðü ôïõò Bigelow et al (1982).19
Ôï èåùñçôéêü áõôü ìïíôÝëï âáóßæåôáé óôç «èåùñßá ôùí
áíáãêþí» ôïõ Maslow (1954) êáé óôç «èåùñßá ôùí ñü-
ëùí».20 ÓõãêåêñéìÝíá, ôï ìïíôÝëï áõôü âáóßæåôáé óôç èå-
ùñßá üôé «ç åõôõ÷ßá êáé ç éêáíïðïßçóç åðçñåÜæïíôáé á-
ðü ôéò êïéíùíéêÝò êáé ðåñéâáëëïíôéêÝò óõíèÞêåò ðïõ á-
ðáéôïýíôáé ãéá ôçí êÜëõøç ôùí âáóéêþí áíèñþðéíùí á-
íáãêþí». Ï Maslow äéáêñßíåé ìéá óåéñÜ áíèñþðéíùí á-
íáãêþí, ðïõ ôéò êáôáôÜóóåé éåñáñ÷éêÜ óå ðõñáìßäá. ¸-
ôóé, îåêéíþíôáò áðü ôéò âáóéêÝò áíÜãêåò, ðïõ åßíáé ïé
ïñãáíéêÝò êáé ïé áíÜãêåò áóöÜëåéáò, êáé óõíå÷ßæïíôáò
óå áíþôåñåò âáèìßäåò, ìå ôçí áíÜãêç ôïõ íá áíÞêåé êÜ-
ðïéïò óå ìéá ïìÜäá êáé ôçí áíÜãêç ôçò åêôßìçóçò, êá-
ôáëÞãåé óôçí «áõôïðñáãìÜôùóç», ðïõ ôïðïèåôåßôáé óôçí
êïñõöÞ ôçò ðõñáìßäáò êáé óõíßóôáôáé óôçí åíåñãïðïß-
çóç üëùí ôùí éêáíïôÞôùí ôïõ áôüìïõ, ôçí êáôáíüçóç
êáé áðïäï÷Þ ôïõ åáõôïý ôïõ, êáèþò êáé ôçí åíáñìüíé-
óç ôùí óôïé÷åßùí ôçò óõìðåñéöïñÜò ôïõ.21 Ïé êïéíùíé-
êïß ñüëïé åßíáé ðñüôõðá äñÜóçò, ôá ïðïßá áðïññÝïõí
áðü ôçí êïéíùíéêÞ èÝóç ðïõ Ý÷åé ôï Üôïìï óå Ýíá óõ-
ãêåêñéìÝíï êïéíùíéêü ðëáßóéï. Óôá üñãáíá ðïõ Ý÷ïõí
áíáðôõ÷èåß ãéá íá áîéïëïãÞóïõí ôç ëåéôïõñãéêüôçôá óôá
ðëáßóéá ôùí êïéíùíéêþí ñüëùí äéáöáßíåôáé Ýíá éêáíï-
ðïéçôéêü åðßðåäï óõíáßíåóçò, üóïí áöïñÜ óôçí êáôÜ-
ôáîç ôùí ñüëùí ðïõ ìðïñåß ôï Üôïìï íá äéáäñáìáôßóåé
óôç æùÞ ôïõ. Ïé ñüëïé áõôïß áöïñïýí ôï åðÜããåëìá, ôï
íïéêïêõñéü, ôï ãÜìï êáé ôç óõíôñïöéêüôçôá, ôç ìçôñü-
ôçôá Þ ðáôñüôçôá, ôçí ïéêïãÝíåéá, ôéò êïéíùíéêÝò ó÷Ý-
óåéò, ôç óõììåôï÷Þ óôá êïéíùíéêÜ äñþìåíá êáé ôçí áõ-
ôïöñïíôßäá.22 Ó÷åôéêÜ ìå ôçí åöáñìïãÞ ôïõ ìïíôÝëïõ
ôçò ëåéôïõñãéêüôçôáò óå êïéíùíéêïýò ñüëïõò ãéá ôçí å-
êôßìçóç ôçò ðïéüôçôáò æùÞò ôùí øõ÷éêÜ áóèåíþí Ý÷ïõí
ôåèåß êÜðïéïé ðñïâëçìáôéóìïß. ¼ðùò ðåñéãñÜöåôáé áðü
ôïí Parsons (1951) óôçí áíÜëõóÞ ôïõ ãéá ôï êïéíùíéêü
óýóôçìá, ïé ðåñéóóüôåñåò óýã÷ñïíåò êïéíùíßåò Ý÷ïõí
èåóìïèåôÞóåé ôï «ñüëï ôïõ áóèåíïýò» (sick role) ùò óç-
ìáóéïëïãéêü ðñüôõðï, ãéá ôá ìÝëç ôçò êïéíùíßáò ðïõ
äåí ìðïñïýí íá áíôåðåîÝëèïõí óôéò áðáéôÞóåéò ôùí óõ-
íçèéóìÝíùí ñüëùí, ëüãù ôçò áóèÝíåéÜò ôïõò.23
Óýìöùíá ìå ôïõò Angermeyer êáé Kilian, åðåéäÞ ôá
Üôïìá ìå øõ÷éêÝò äéáôáñá÷Ýò Ý÷ïõí óõãêåêñéìÝíåò á-
íÜãêåò ëüãù ôçò íüóïõ ôïõò, üðùò áíÜãêç ãéá ðñï-
óôáóßá, ãéá åðéäüìáôá, ãéá öÜñìáêá, èåñáðåßåò ê.Ü., åß-
íáé õðï÷ñåùìÝíá íá áíôåðåîÝëèïõí óôéò áðáéôÞóåéò ôïõ
«ñüëïõ ôïõ áóèåíïýò», äçëáäÞ íá æçôïýí ôç âïÞèåéá
êÜðïéïõ åéäéêïý êáé íá ðñïóáñìüæïíôáé óôéò ïäçãßåò ôïõ,
íá óõììïñöþíïíôáé ìå ôç èåñáðåßá êáé, ôï ðéï óçìá-
243
íôéêü, íá ãíùóôïðïéïýí ôçí áíéêáíüôçôÜ ôïõò, þóôå íá
åîáóöáëßæïõí ôéò áðáñáßôçôåò ðáñï÷Ýò. ¸ôóé, ãéá ôïí
ðñïóäéïñéóìü ôçò Ýííïéáò ôçò ðïéüôçôáò æùÞò ìå âÜóç
ôï èåùñçôéêü ìïíôÝëï ôùí ñüëùí, èá ðñÝðåé íá óõ-
ìðåñéëçöèïýí êáé èÝìáôá ðïõ áöïñïýí ôéò áíÜãêåò ôùí
áôüìùí ìå øõ÷éêÝò äéáôáñá÷Ýò, óå ó÷Ýóç ìå ôçí áóèÝ-
íåéÜ ôïõò. Ãéá ôç äéåîïäéêÞ åêôßìçóç ôçò ðïéüôçôáò æù-
Þò ôùí áôüìùí ìå øõ÷éêÝò äéáôáñá÷Ýò ðñïôåßíåôáé áðü
ôïõò Angermeyer êáé Kilian Ýíá äõíáìéêü ìïíôÝëï ðñï-
óÝããéóçò.18 Ôï ìïíôÝëï áõôü âáóßæåôáé óôçí õðüèåóç ü-
ôé ç õðïêåéìåíéêÞ èåþñçóç ôçò ðïéüôçôáò æùÞò åßíáé ôï
áðïôÝëåóìá ìéáò óõíå÷éæüìåíçò äéáäéêáóßáò ðñïóáñ-
ìïãÞò, êáôÜ ôçí ïðïßá ôï Üôïìï ïöåßëåé óõíå÷þò íá
óõìâéâÜæåé ôéò äéêÝò ôïõ åðéèõìßåò êáé ôïõò äéêïýò ôïõ
óôü÷ïõò áöåíüò ìåí ìå ôéò ðåñéâáëëïíôéêÝò óõíèÞêåò
êáé áöåôÝñïõ ìå ôçí éêáíüôçôÜ ôïõ íá áíôåðåîÝñ÷åôáé
óôéò êïéíùíéêÝò áðáéôÞóåéò ðïõ óõíäÝïíôáé ìå ôçí åê-
ðëÞñùóç ôùí áíùôÝñù óôü÷ùí. Óýìöùíá ìå ôï ìïíôÝ-
ëï áõôü, ç éêáíïðïßçóç äåí èåùñåßôáé ôï áðïôÝëåóìá,
áëëÜ ï êéíçôÞñéïò ìï÷ëüò üëçò áõôÞò ôçò äéáäéêáóßáò.
Áðü ôá åõñÞìáôá åñåõíþí ãéá ôçí ðïéüôçôá æùÞò, ðïõ
âáóßæïíôáé óôçí åêôßìçóç ôçò õðïêåéìåíéêÞò éêáíïðïßç-
óçò, öáßíåôáé üôé ðïëëïß Üíèñùðïé, áêüìá êáé üôáí õ-
ðÜñ÷åé øõ÷éêÞ áóèÝíåéá, Ý÷ïõí ôçí éêáíüôçôá íá äéá-
ôçñïýí ôï åðßðåäï éêáíïðïßçóçò ó÷åôéêÜ óôáèåñü, ìÝ-
óù ãíùóôéêþí êáé âïõëçôéêþí äñáóôçñéïôÞôùí, áêüìá
êáé üôáí óõíå÷þò áëëÜæïõí ïé ðåñéâáëëïíôéêÝò óõíèÞ-
êåò. ¼ôáí, äçëáäÞ, ôï Üôïìï íïéþèåé äõóáñÝóêåéá ãéá-
ôß õðÜñ÷åé ìéá áóõìöùíßá ìåôáîý ôùí áîéþí ôïõ êáé ôùí
óõíèçêþí äéáâßùóçò, ìðïñåß íá ìåéþóåé áõôÞ ôç äõóá-
ñÝóêåéá Þ ìåôáâÜëëïíôáò ôéò ðåñéâáëëïíôéêÝò óõíèÞêåò
Þ áëëÜæïíôáò ôéò áîßåò êáé ôéò ðñïôéìÞóåéò ôïõ. ¸ôóé, ìå
ôç ìÝôñçóç ôïõ åðéðÝäïõ éêáíïðïßçóçò ùò äåßêôç åêôß-
ìçóçò ôçò ðïéüôçôáò æùÞò, üðùò áîéïëïãåßôáé áðü õðï-
êåéìåíéêÞ óêïðéÜ, äåí åßíáé åöéêôü íá ðñïâïýìå óôç äéá-
öïñïðïßçóç ôçò ðïéüôçôáò æùÞò åíüò áôüìïõ, ðïõ, åíþ
æåé óå Üó÷çìåò óõíèÞêåò, ìåéþíåé ôéò ðñïóäïêßåò ôïõ ü-
óï ÷ñåéÜæåôáé ãéá íá åßíáé éêáíïðïéçìÝíï, áðü ôçí ðïé-
üôçôá æùÞò åíüò Üëëïõ áôüìïõ ðïõ íïéþèåé éêáíïðïéç-
ìÝíï ìå ôç æùÞ ôïõ, åðåéäÞ ðñáãìáôéêÜ Ý÷ïõí åðéôåõ÷èåß
ïé óôü÷ïé êáé ïé ðñïóäïêßåò ôïõ. Åðßóçò, áðü åèíïãñá-
öéêÝò ìåëÝôåò, üðùò ôïõ Estroff (1981),24 åßíáé öáíåñü
üôé ç ðïéüôçôá æùÞò ôùí øõ÷éêÜ áóèåíþí, üðùò åêôéìÜ-
ôáé áðü õðïêåéìåíéêÞ óêïðéÜ, åîáñôÜôáé óçìáíôéêÜ áðü
ôï âáèìü óôïí ïðïßï ôá Üôïìá áõôÜ ìðïñïýí íá éêáíï-
ðïéïýí ôéò áíÜãêåò åêåßíåò ðïõ ó÷åôßæïíôáé ìå ôçí á-
óèÝíåéá, ÷ùñßò íá åðçñåÜæåôáé ç éêáíïðïßçóç ôùí ãåíé-
êþí âáóéêþí áíáãêþí ôïõò. ÐïëëÝò öïñÝò, üôáí ôï Ü-
ôïìï êÜíåé ÷ñÞóç ôùí äéêáéùìÜôùí ðïõ Ý÷åé ùò áóèå-
íÞò, åðéâáñýíåôáé ìå ôéò áñíçôéêÝò êïéíùíéêÝò óôÜóåéò.
¸ôóé, áíôéìåôùðßæåé ôï äßëçììá Þ íá ðáñáéôçèåß áðü ôá
äéêáéþìáôá áõôÜ Þ íá äå÷èåß ôï óôéãìáôéóìü êáé ôçí êïé-
íùíéêÞ õðïôßìçóç. Åßíáé áðáñáßôçôï, ëïéðüí, ãéá ôçí å-
244
êôßìçóç ôçò ðïéüôçôáò æùÞò ôùí áôüìùí ìå øõ÷éêÝò äéá-
ôáñá÷Ýò, óýìöùíá ìå ôï äõíáìéêü áõôü ìïíôÝëï, íá óõí-
äõáóôïýí ìåôñÞóåéò ðïõ áöïñïýí (á) ôçí ðïéüôçôá ôùí
ãåíéêþí óõíèçêþí äéáâßùóçò ôïõ áôüìïõ óå óõíÜñôç-
óç ìå ôçí éêáíïðïßçóç ôùí âáóéêþí áíáãêþí ôïõ, ðïõ
åßíáé ïé öõóéïëïãéêÝò áíÜãêåò, ç áíÜãêç ãéá áíÜðôõîç
óõíáéóèçìáôéêþí ó÷Ýóåùí, ç áíÜãêç ãéá êïéíùíéêÞ á-
ðïäï÷Þ, ç áíÜãêç ãéá åðßôåõîç ôùí óôü÷ùí êáé ç óýë-
ëçøç ôçò ðñáãìáôéêüôçôáò (íüçìá), êáé (â) ôï âáèìü ôçò
õðïêåéìåíéêÞò éêáíïðïßçóçò ìå ìéá óå âÜèïò áíÜëõóç
ôïõ óõóôÞìáôïò èåþñçóçò êáé áîéþí ôïõ áôüìïõ, ðïõ
ìïñöïðïéåßôáé ü÷é ìüíï áðü ôï êáíïíéóôéêü óýóôçìá ôçò
êïéíùíßáò óôçí ïðïßá æåé, áëëÜ êáé áðü ôá ðñïóùðéêÜ
÷áñáêôçñéóôéêÜ êáé ôéò áôïìéêÝò åìðåéñßåò ôïõ.18
3. ÐÏÉÏÔÇÔÁ ÆÙÇÓ ÊÁÉ Ó×ÉÆÏÖÑÅÍÅÉÁ
3.1. ÌïíôÝëá ôçò ðïéüôçôáò æùÞò
óôç ÷ñïíßá êáé óïâáñÞ øõ÷éêÞ äéáôáñá÷Þ
Ôéò ôåëåõôáßåò äýï äåêáåôßåò, ç Ýñåõíá ãéá ôçí åêôß-
ìçóç ôçò ðïéüôçôáò æùÞò ôùí øõ÷éêÜ áóèåíþí åðéêå-
íôñþèçêå êõñßùò óôá Üôïìá ðïõ ðÜó÷ïõí áðü ÷ñüíéåò
øõ÷éêÝò äéáôáñá÷Ýò êáé åéäéêÜ áðü ó÷éæïöñÝíåéá. Ôï êý-
ñéï åíäéáöÝñïí ãéá ôá èÝìáôá ðïéüôçôáò æùÞò óôçí Êëé-
íéêÞ Øõ÷éáôñéêÞ óçìáôïäïôÞèçêå ìå ôéò áëëáãÝò óôï óý-
óôçìá ðáñï÷Þò öñïíôßäáò ãéá ôïõò óïâáñÜ øõ÷éêÜ ðÜ-
ó÷ïíôåò, ðïõ Þôáí áðïôÝëåóìá áöåíüò ôçò åéóáãùãÞò
êáé ôçò åõñÝùò äéáäåäïìÝíçò ÷ñÞóçò íÝùí áíôéøõ÷ù-
óéêþí öáñìÜêùí êáé áöåôÝñïõ ðïéêßëùí Üëëùí ðáñåì-
âÜóåùí êáé ðñïãñáììÜôùí óôçí êïéíüôçôá ìå óôü÷ï ôü-
óï ôç âåëôßùóç ôçò øõ÷ïðáèïëïãßáò üóï êáé ôçí êïé-
íùíéêÞ åðáíÝíôáîç ôùí áóèåíþí êáé ôïí áðïóôéãìáôéóìü
ôçò øõ÷éêÞò äéáôáñá÷Þò. Áíáðôý÷èçêáí Ýôóé Ýííïéåò êáé
åöáñìüóôçêáí ìÝôñá ãéá ôçí ðïéüôçôá æùÞò ùò áðïôÝ-
ëåóìá ôùí õðçñåóéþí øõ÷éêÞò õãåßáò,25 ÷ùñßò üìùò á-
êüìç íá Ý÷åé áíáðôõ÷èåß Ýíá éêáíïðïéçôéêü èåùñçôéêü
ìïíôÝëï ãéá ôçí ðïéüôçôá æùÞò óôç ÷ñïíßá êáé óïâáñÞ
øõ÷éêÞ äéáôáñá÷Þ. ¼ðùò õðïóôçñßæåé ç ÆÞóç, «ôá ðá-
ñáäïóéáêÜ èåùñçôéêÜ ìïíôÝëá ðïéüôçôáò æùÞò, ðïõ âá-
óßæïíôáé óå áíôéêåéìåíéêïýò êáé õðïêåéìåíéêïýò äåßêôåò,
Ý÷ïõí âñåèåß áíåðáñêÞ, êáèþò ôüóï ïé êïéíùíéêï-äç-
ìïãñáöéêÝò ìåôáâëçôÝò üóï êáé ïé áíôéêåéìåíéêïß äåßêôåò
åñìçíåýïõí Ýíá ìéêñü ðïóïóôü ìåôáâëçôüôçôáò ôçò ðïé-
üôçôáò æùÞò».26 Ôá èåùñçôéêÜ ìïíôÝëá ðïõ Ý÷ïõí áíá-
ðôõ÷èåß ìÝ÷ñé óÞìåñá äåí óõíôåëïýí óôçí áðïóáöÞíé-
óç ôçò óõó÷Ýôéóçò ðïõ õðÜñ÷åé ìåôáîý ôùí áíôéêåéìåíé-
êþí óõíèçêþí êáé ôçò õðïêåéìåíéêÞò åêôßìçóçò ôùí
óõíèçêþí áõôþí. ¸ôóé, óýìöùíá ìå ôçí Barry,27 åßíáé
áðáñáßôçôï íá äéåñåõíçèïýí ïé åóùôåñéêÝò øõ÷ïëïãéêÝò
äéåñãáóßåò ðïõ åðåíåñãïýí ùò äéáìåóïëáâçôéêïß ìç÷á-
íéóìïß ãéá ôçí õðïêåéìåíéêÞ åêôßìçóç ôçò ðïéüôçôáò æù-
Þò. Óå ðñüóöáôç ìåëÝôç ôùí ÆÞóç, Barry êáé Cochrane
Ì. ÏÉÊÏÍÏÌÏÕ êáé óõí
ðñïôåßíåôáé Ýíá «äéáìåóïëáâçôéêü ìïíôÝëï ãéá ôçí ðïé-
üôçôá æùÞò» (mediational model of quality of life) ãéá Ü-
ôïìá ìå óïâáñÞ øõ÷éêÞ äéáôáñá÷Þ. Óôï ìïíôÝëï áõôü
ôïíßæåôáé ç óçìáóßá ôùí äéáìåóïëáâçôéêþí ìç÷áíéóìþí
ðïõ áíáöÝñïíôáé óå åóùôåñéêÝò øõ÷ïëïãéêÝò êáôáóôÜ-
óåéò ôïõ áôüìïõ, üðùò åßíáé ôï «áßóèçìá åëÝã÷ïõ», ç
«áõôï-åéêüíá» êáé ç «áõôï-áðïôåëåóìáôéêüôçôá», óôç äéá-
äéêáóßá ôçò õðïêåéìåíéêÞò åêôßìçóçò ôçò ðïéüôçôáò æù-
Þò, ðïõ åðçñåÜæåôáé êáé áðü ãíùóôéêïýò ìç÷áíéóìïýò,
üðùò åßíáé ôá åðßðåäá ðñïóäïêéþí êáé åðéäéþîåùí êáé
ôá ðñüôõðá êïéíùíéêÞò óýãêñéóçò.28
¸íá Üëëï ìïíôÝëï ãéá ôçí áîéïëüãçóç ôçò ðïéüôçôáò
æùÞò óôïõò áóèåíåßò ìå ó÷éæïöñÝíåéá åéóÞ÷èç áðü ôïõò
Skantze et al (1990),29 ïé ïðïßïé ðåñéÝãñáøáí ôçí ðïé-
üôçôá æùÞò ùò ìéá äõíáìéêÞ Ýííïéá ðïõ åðçñåÜæåôáé ôü-
óï áðü ôéò äéáöïñÝò áíÜìåóá óôéò ðñïóùðéêÝò ðñïó-
äïêßåò êáé ôéò åëðßäåò, üóï êáé áðü ôçí õðïêåéìåíéêÞ
ðñáãìáôéêüôçôá ôïõ áôüìïõ êáé åßíáé áðáñáßôçôï íá ìå-
ëåôçèåß ìÝóá óôï öõóéêü, êïéíùíéêü êáé ðïëéôéóìéêü ôçò
ðëáßóéï, ðïõ õðïäçëþíåé óôçí ðñïêåéìÝíç ðåñßðôùóç
êáé ôï åðßðåäï æùÞò ôùí áóèåíþí. Ç ðïéüôçôá æùÞò äåí
åßíáé ðáñÜ ç ðñïóùðéêÞ åêôßìçóç ôïõ áóèåíïýò ãéá ôç
æùÞ ôïõ êáé óõíåðþò ìðïñåß íá ïñéóôåß ìüíï óå Ýíá õ-
ðïêåéìåíéêü ðëáßóéï. ÂáóéóìÝíïé óôá áðïôåëÝóìáôá ôùí
ìåëåôþí ôïõò, ïé ßäéïé åñåõíçôÝò ðñïôåßíïõí üôé ç ðñï-
óùðéêÞ áîéïëüãçóç ôùí áóèåíþí ãéá ôç æùÞ ôïõò å-
îáñôÜôáé ðåñéóóüôåñï áðü ôï äéêü ôïõò «åóùôåñéêü êü-
óìï» ðáñÜ áðü ôïí «åîùôåñéêü êüóìï», åíþ, áíôßèåôá,
ôï «åðßðåäï æùÞò» ðñïûðïèÝôåé ôçí ýðáñîç åíüò åîù-
ôåñéêïý áîéïëïãçôÞ ôçò êáôÜóôáóçò æùÞò ôïõ áóèåíïýò
êáé óõíåðþò ìåôñéÝôáé áíôéêåéìåíéêÜ.30
¸íá ìåßæïí æÞôçìá ðïõ ôßèåôáé åßíáé ôï êáôÜ ðüóï ïé
áóèåíåßò ìå ó÷éæïöñÝíåéá, åîáéôßáò ôçò Ýëëåéøçò åíáé-
óèçóßáò êáé ôùí äéáôáñá÷þí óôéò áíþôåñåò ãíùóôéêÝò
ëåéôïõñãßåò, åßíáé éêáíïß íá åêôéìÞóïõí ôçí øõ÷éêÞ ôïõò
åõåîßá êáé íá êÜíïõí áõôïáîéïëüãçóç ôçò ðïéüôçôáò æù-
Þò ôïõò.27 Óå áõôü ôï ðíåýìá, ïé Lehman et al (1993)31
åðéóçìáßíïõí ôï æÞôçìá ôçò åãêõñüôçôáò ôùí ìåôñÞóå-
ùí ðÜíù óå èÝìáôá ðïéüôçôáò æùÞò, ðïõ ãßíïíôáé áðü
ôïõò ßäéïõò ôïõò áóèåíåßò ðïõ ðÜó÷ïõí áðü ìéá óïâá-
ñÞ êáé ÷ñïíßá øõ÷éêÞ äéáôáñá÷Þ. Ïé Browne et al
(1996)32 èåùñïýí üôé ç êëéíéêÞ áîéïëüãçóç ôùí áíá-
öïñþí ôùí ßäéùí ôùí øõ÷éêÜ áóèåíþí ðÜíù óå èÝìá-
ôá ðïéüôçôáò æùÞò åßíáé åöéêôÞ, ðáñÜ ôï üôé ïé áðáéôÞ-
óåéò ôïõò åðçñåÜæïíôáé êõñßùò áðü ôçí øõ÷ùóéêÞ óõ-
ìðôùìáôïëïãßá ôïõò áëëÜ êáé áðü ôéò éäéïóõãêñáóéáêÝò
ôïõò áðüøåéò êáé áîßåò.
¸ñåõíåò ðïõ ó÷åôßæïíôáé ìå ôçí éêáíïðïßçóç áðü ôçí
ðïéüôçôá ôçò æùÞò óå ÷ñüíéïõò øõ÷éáôñéêïýò áóèåíåßò
Ý÷ïõí äåßîåé ðïéêßëá åðßðåäá éêáíïðïßçóçò-äõóáñÝ-
óêåéáò óå äéáöïñåôéêïýò ôïìåßò ôçò æùÞò. Ïé Skantze et
ÐÏÉÏÔÇÔÁ ÆÙÇÓ ÊÁÉ ØÕ×ÉÊÇ ÕÃÅÉÁ
al (1990) ðñïóäéüñéóáí ôïõò ðáñáêÜôù ôïìåßò, ðïõ á-
íáöÝñïíôáé ìå ìåãáëýôåñç óõ÷íüôçôá ùò ìç éêáíïðïé-
çôéêïß: åñãáóßá êáé äñáóôçñéüôçôåò, ðñïóùðéêÞ æùÞ êáé
øõ÷éêÞ õãåßá, êïéíùíéêÝò åðáöÝò êáé ïéêïíïìéêÞ êáôÜ-
óôáóç,29 åíþ óå áñêåôÝò Ýñåõíåò âñÝèçêå ï ïéêïíïìé-
êüò ôïìÝáò íá áíáöÝñåôáé ìå ôá ìåãáëýôåñá åðßðåäá
äõóáñÝóêåéáò.33,34
Åßíáé ãåãïíüò üôé ç ðïéüôçôá æùÞò ÷ñçóéìïðïéåßôáé óÞ-
ìåñá åêôåôáìÝíá ùò äåßêôçò áîéïëüãçóçò ôùí èåñá-
ðåõôéêþí ðáñåìâÜóåùí êáé óôñáôçãéêþí ðïõ óôï÷åýïõí
óôç âåëôßùóç ôçò øõ÷éêÞò õãåßáò ôùí áññþóôùí êáôÜ ôç
äéáäéêáóßá ôçò áðïáóõëïðïßçóçò, ôçò ÝíôáîÞò ôïõò óôçí
êïéíüôçôá êáé ôçò øõ÷ïêïéíùíéêÞò ôïõò áðïêáôÜóôáóçò.
ÁíáöïñéêÜ ìå ôéò èåñáðåõôéêÝò ðáñåìâÜóåéò, ïé Awad
et al (1997)35 áíÝðôõîáí Ýíá «óõíèåôéêü ìïíôÝëï ðïéü-
ôçôáò æùÞò ãéá ôïõò áóèåíåßò ìå ó÷éæïöñÝíåéá ðïõ äÝ-
÷ïíôáé èåñáðåßá ìå áíôéøõ÷ùóéêÜ» êáé ïñßæïõí ôçí ðïé-
üôçôá æùÞò ùò ôçí õðïêåéìåíéêÞ áíôßëçøç ôïõ áðïôå-
ëÝóìáôïò ðïõ ðñïêýðôåé áðü ôçí áëëçëåðßäñáóç áíÜ-
ìåóá óå ôñåéò êáèïñéóôéêïýò ðáñÜãïíôåò: ôç óïâáñü-
ôçôá ôùí øõ÷ùóéêþí óõìðôùìÜôùí, ôéò áíåðéèýìçôåò å-
íÝñãåéåò ôùí áíôéøõ÷ùóéêþí öáñìÜêùí êáé ôï åðßðåäï
ôùí øõ÷ïêïéíùíéêþí åðéäüóåùí. ÁõôÞ ç áëëçëåðßäñá-
óç ìðïñåß âåâáßùò íá åðçñåáóôåß êáé áðü Üëëïõò ðá-
ñÜãïíôåò, üðùò åßíáé ç ðñïóùðéêüôçôá, ïé áîßåò, ïé óôÜ-
óåéò, áëëÜ êáé ïé äéÜöïñåò ðçãÝò õðïóôÞñéîçò êáé ôï
êïéíùíéêü äßêôõï.
3.2. ÈåñáðåõôéêÝò ðáñåìâÜóåéò êáé ðïéüôçôá æùÞò
óôïõò áóèåíåßò ìå ó÷éæïöñÝíåéá
ÐïëëÝò ìåëÝôåò Ýãéíáí ãéá íá êáôáäåßîïõí ôçí åðß-
äñáóç ôçò öáñìáêïèåñáðåßáò ìå íåõñïëçðôéêÜ óôçí
ðïéüôçôá æùÞò áóèåíþí ìå ó÷éæïöñÝíåéá. ÖÜíçêå Ýôóé
üôé áóèåíåßò ðïõ åßíáé óå áãùãÞ ìå êëïæáðßíç Þ ìå ôá
íÝá Üôõðá áíôéøõ÷ùóéêÜ ôïõ ôýðïõ ôçò ñéóðåñéäüíçò Þ
ôçò ïëáíæáðßíçò, ðáñïõóéÜæïõí êáëýôåñïõò äåßêôåò ðïé-
üôçôáò æùÞò óå ó÷Ýóç ìå ôïõò áóèåíåßò ðïõ ðáßñíïõí
êëáóéêÜ íåõñïëçðôéêÜ. Ç äéáöïñÜ áõôÞ áðïäßäåôáé á-
öåíüò ìåí óôçí áðåõèåßáò äñÜóç ôùí íÝùí öáñìÜêùí
óôç âåëôßùóç êõñßùò ôùí áñíçôéêþí óõìðôùìÜôùí ôçò
ó÷éæïöñÝíåéáò, áöåôÝñïõ äå óôéò óáöþò ëéãüôåñåò áíå-
ðéèýìçôåò åíÝñãåéåò ðïõ ðñïêáëïýí êáé óôç âåëôßùóç
ôçò «óõììüñöùóçò» óôç èåñáðåßá.36–38 ÁíáöïñéêÜ, å-
îÜëëïõ, ìå ôç ó÷Ýóç áíÜìåóá óôéò áíåðéèýìçôåò åíÝñ-
ãåéåò êáé ôçí ðïéüôçôá æùÞò, ïé Sullivan et al (1992) âñÞ-
êáí ìéá óçìáíôéêÞ áñíçôéêÞ óõó÷Ýôéóç áíÜìåóá óôï å-
ðßðåäï ðïéüôçôáò æùÞò êáé óôïí áñéèìü ôùí áíåðéèý-
ìçôùí åíåñãåéþí áðü ôá öÜñìáêá.39 Ïìïßùò, ïé Browne
et al (1996) âñÞêáí üôé ïé áóèåíåßò ìå üøéìç äõóêéíç-
óßá åß÷áí ÷áìçëüôåñç ðïéüôçôá æùÞò óõãêñéíüìåíïé ìå
ôïõò áóèåíåßò ÷ùñßò üøéìç äõóêéíçóßá.32 Ãéá ôïõò øõ-
245
÷éêÜ áóèåíåßò, üìùò, äåí åßíáé ìüíï ç éáôñéêÞ öñïíôß-
äá ðïõ åíäéáöÝñåé, äçëáäÞ ç øõ÷éáôñéêÞ ðáñáêïëïý-
èçóç êáé ç öáñìáêåõôéêÞ áãùãÞ, áëëÜ êáé ç êïéíùíé-
êÞ óôÞñéîç, äçëáäÞ ç äéáìïíÞ óå îåíþíåò Þ ðñïóôá-
ôåõüìåíá äéáìåñßóìáôá êÜôù áðü áîéïðñåðåßò óõíèÞ-
êåò, ç ïéêïíïìéêÞ õðïóôÞñéîç, ç êïéíùíéêÞ áóöÜëåéá,
ç åíóùìÜôùóç óôçí ïéêïãÝíåéá êáé ôçí êïéíüôçôá, ç øõ-
÷áãùãßá, êáèþò êáé ç áðáó÷üëçóç Þ ç åñãáóßá.12
ÁíáöïñéêÜ ìå ôïõò ÷þñïõò èåñáðåßáò, ç ðëåéïøçößá
ôùí ìåëåôþí13,15,32,34 óõìöùíåß üôé ôßèåôáé èÝìá äéáöï-
ñïðïßçóçò ôçò ðïéüôçôáò æùÞò áíÜìåóá óôïõò äéáöï-
ñåôéêïýò ÷þñïõò êáé Ý÷åé âñåèåß üôé üóï ëéãüôåñï ðå-
ñéïñéóôéêüò åßíáé ï ÷þñïò, ôüóï ìåãáëýôåñï åßíáé ôï áß-
óèçìá ôçò éêáíïðïßçóçò. Óýìöùíá ìå ìéá ìåãÜëç ìå-
ëÝôç ôïõ ðñïãñÜììáôïò TAPS óôç ÌåãÜëç Âñåôáíßá, óå
÷ñüíéïõò áóèåíåßò ðïõ ìÝ÷ñé ðñüôéíïò äéÝìåíáí óå Ü-
óõëá, Ý÷åé ðáñáôçñçèåß óçìáíôéêÞ âåëôßùóç óôçí ðïéü-
ôçôá æùÞò ôïõò áðü ôç óôéãìÞ ðïõ ìåôáöÝñèçêáí óå äï-
ìÝò óôçí êïéíüôçôá. ÓõãêåêñéìÝíá, ïé áóèåíåßò áõôïß å-
êôßìçóáí óå ðïëý ìåãÜëï âáèìü ôéò åëåýèåñåò óõíèÞ-
êåò äéáâßùóçò óôá ïéêïôñïöåßá êáé ïé ðåñéóóüôåñïé å-
îÝöñáóáí ôçí åðéèõìßá íá óõíå÷éóôåß ç ðáñáìïíÞ ôïõò
óå áõôÜ.40 Ðáñüëá áõôÜ, Üëëåò Ýñåõíåò Ýäåéîáí üôé á-
óèåíåßò ìå ó÷éæïöñÝíåéá, üôáí ìåôáêéíçèïýí áðü ôï øõ-
÷éáôñéêü íïóïêïìåßï óå äïìÝò óôçí êïéíüôçôá, äåí á-
íáöÝñïõí ôçí ãéá ðïëëïýò áíáìåíüìåíç éêáíïðïßçóç
óôçí ðïéüôçôá ôçò æùÞò ôïõò ðáñÜ ôç âåëôßùóç ôùí óõí-
èçêþí äéáâßùóçò êáé åîçãïýí üôé ðéèáíüí áõôü íá ï-
öåßëåôáé óôçí åëëéðÞ áíÜðôõîç åíüò êïéíùíéêïý äéêôý-
ïõ õðïóôÞñéîçò.41 Óçìáíôéêïß åñåõíçôÝò, åîÜëëïõ, üðùò
ïé Baker êáé Intagliata (1982),42 åðéóçìáßíïõí ôçí áíá-
ãêáéüôçôá ôçò åêôßìçóçò ôçò ðïéüôçôáò æùÞò ãéá ôçí á-
îéïëüãçóç êïéíïôéêþí õðïóôçñéêôéêþí óõóôçìÜôùí êáé
äéêôýùí êáé ðñïâÜëëïõí ôïõò åîÞò ëüãïõò ãéá ôçí á-
íáãêáéüôçôá áõôÞ:
á. ¸ìöáóç äßíåôáé óôçí Üíåóç ìÜëëïí ðáñÜ óôç èå-
ñáðåßá (comfort rather than cure), áöïý, óôçí ðåñß-
ðôùóç ôùí ÷ñüíéùí øõ÷éêÜ áóèåíþí, Ý÷åé ãåíéêÜ äéá-
ðéóôùèåß üôé äåí áðïôåëåß ñåáëéóôéêü óôü÷ï íá ðåñé-
ìÝíåé êáíåßò õøçëÜ åðßðåäá áðïêáôÜóôáóçò êáé êïé-
íùíéêÞò ëåéôïõñãéêüôçôáò
â. ÐñïãñÜììáôá ðïõ ðáñÝ÷ïõí óýíèåôåò ðáñåìâÜóåéò
ðñïûðïèÝôïõí ôçí ýðáñîç ðïëõäéÜóôáôùí ìåôáâëç-
ôþí ãéá ôçí áîéïëüãçóç ôïõ áðïôåëÝóìáôïò (complex
programs require complex outcome measures) êáé ìü-
íï ç ðïëõäéÜóôáôç Ýííïéá ôçò ðïéüôçôáò æùÞò åðé-
ôñÝðåé ôçí áîéïëüãçóç ôïõ áðïôåëÝóìáôïò ôÝôïéùí
óýíèåôùí ðáñåìâÜóåùí
ã. ¸ìöáóç äßíåôáé óôçí éêáíïðïßçóç ôïõ ðÜó÷ïíôá
(keeping the customer happy) êáé ç âåëôßùóç ôçò ðïé-
246
üôçôáò ôçò æùÞò ôïõ Ý÷åé ùò áðïôÝëåóìá ôçí éêáíï-
ðïßçóç áõôÞ
ä. Ç åðáíåìöÜíéóç ôçò Üðïøçò ðåñß ïëéóôéêÞò ðñï-
óÝããéóçò ôçò õãåßáò (reemergence of the holistic per-
spective)
å. Ç ðñïþèçóç ôçò ðïéüôçôáò æùÞò èåùñåßôáé äåßãìá Ü-
óêçóçò êáëÞò ðïëéôéêÞò (QïL is good politics)
ÊÜíïíôáò, ôÝëïò, ìéá áíáóêüðçóç äéáöüñùí åñåõ-
íþí15,38,40,43 áíáöïñéêÜ ìå ôçí ðïéüôçôá æùÞò óôïõò á-
óèåíåßò ìå ó÷éæïöñÝíåéá, Ý÷ïõí âñåèåß óçìáíôéêÝò äéá-
öïñÝò óôç ìåèïäïëïãßá ðïõ Ý÷åé åöáñìïóôåß, ãåãïíüò
ðïõ êáèéóôÜ äýóêïëç ìéá ðéèáíÞ óýãêñéóç. Ùóôüóï,
ìðïñåß ãåíéêÜ íá óõìðåñÜíåé êáíåßò üôé:
– Ç ðïéüôçôá æùÞò ôùí áóèåíþí ìå ó÷éæïöñÝíåéá åßíáé
÷åéñüôåñç áðü ôçí ðïéüôçôá æùÞò ôïõ ãåíéêïý ðëç-
èõóìïý, êáèþò êáé áðü áõôÞ Üëëùí áóèåíþí ÷ùñßò
øõ÷éáôñéêÞ íüóï
– Ôá íÝá Üôïìá, ïé ãõíáßêåò, ïé Ýããáìïé êáé üóïé Ý÷ïõí
÷áìçëü ìïñöùôéêü åðßðåäï áíáöÝñïõí êáëýôåñç ðïé-
üôçôá æùÞò
– ¼óï ðéï ÷ñïíßá åßíáé ìéá áóèÝíåéá, ôüóï ÷åéñüôåñç
åßíáé ç ðïéüôçôá æùÞò
– Ç øõ÷ïðáèïëïãßá êáé åéäéêÜ ôá áñíçôéêÜ óýíäñïìá
óõíäÝïíôáé ìå ÷áìçëÞ ðïéüôçôá æùÞò
– ¼óï ðéï ëßãåò åßíáé ïé öáñìáêåõôéêÝò áíåðéèýìçôåò
åíÝñãåéåò êáé ï óõíäõáóìüò öáñìáêåõôéêÞò áãùãÞò
êáé øõ÷ïèåñáðåßáò, ôüóï êáëýôåñç åßíáé ç ðïéüôçôá
æùÞò
– Ïé áóèåíåßò ðïõ åíóùìáôþíïíôáé óå õðïóôçñéêôéêÜ
ðñïãñÜììáôá ôçò êïéíüôçôáò ðáñïõóéÜæïõí êáëýôå-
ñç ðïéüôçôá æùÞò áðü ôïõò áóèåíåßò ðïõ âñßóêïíôáé
óôá éäñýìáôá.
3.3. Ðïéüôçôá æùÞò êáé ïéêïãÝíåéá ôùí áóèåíþí
Áí êáé ôï èÝìá ôçò ðïéüôçôáò æùÞò ôùí áóèåíþí á-
ðÝóðáóå áñêåôü åíäéáöÝñïí ôá ôåëåõôáßá ÷ñüíéá, ëßãåò
Þôáí ïé ìåëÝôåò ðïõ Ýãéíáí ãéá ôçí ðïéüôçôá æùÞò ôùí
óõããåíþí êáé ôùí ïéêïãåíåéþí êáé ãåíéêÜ üëùí åêåß-
íùí ðïõ Ý÷ïõí åðùìéóôåß ôç öñïíôßäá ôùí øõ÷éêÜ á-
óèåíþí. Ïé ëßãåò óõóôçìáôéêÝò ìåëÝôåò ðÜíù óå áõôü
ôï èÝìá åðéêåíôñþíïíôáé êõñßùò óå üóïõò öñüíôéæáí
ôïõò çëéêéùìÝíïõò êáé ôïõò áíèñþðïõò ìå ÷ñüíéåò á-
íáðçñßåò êáé ëéãüôåñåò óå üóïõò åß÷áí øõ÷éêÝò äéáôá-
ñá÷Ýò.44 Óôï ÷þñï ôçò ÷ñïíßáò êáé óïâáñÞò øõ÷éêÞò äéá-
ôáñá÷Þò, ïé ðåñéóóüôåñåò ìåëÝôåò áíáöÝñïíôáé óôçí ïé-
êïãåíåéáêÞ åðéâÜñõíóç êáé Ý÷ïõí äéåîá÷èåß ôüóï áðü
åðáããåëìáôßåò øõ÷éêÞò õãåßáò, åéäéêïýò óôá èÝìáôá ïé-
êïãÝíåéáò, üóï êáé áðü óõëëüãïõò ãïíÝùí êáé ïéêïãå-
Ì. ÏÉÊÏÍÏÌÏÕ êáé óõí
íåéþí.45–48 Áðü áõôÝò ôéò Ýñåõíåò Ý÷åé öáíåß üôé ïé óõã-
ãåíåßò êáé üóïé Ý÷ïõí ãåíéêþò åðùìéóôåß ôç öñïíôßäá
ôùí áóèåíþí âéþíïõí óçìáíôéêÞ øõ÷ïëïãéêÞ åðéâÜ-
ñõíóç êáé åßíáé åêôåèåéìÝíïé óå êáôáóôÜóåéò ðïõ ðñï-
êáëïýí Üã÷ïò êáé ùò åê ôïýôïõ ðáñïõóéÜæïõí õðïâáè-
ìéóìÝíç ðïéüôçôá æùÞò. Èåùñåßôáé üôé üóïé Ý÷ïõí áíá-
ëÜâåé ôç öñïíôßäá ôùí øõ÷éêÜ áóèåíþí äåí Ý÷ïõí óõ-
íÞèùò õëéêÞ êáé óõíáéóèçìáôéêÞ õðïóôÞñéîç, êõñßùò ü-
ìùò äåí áíáãíùñßæåôáé ï óçìáíôéêüò ôïõò ñüëïò êáé ç
óõììåôï÷Þ ôïõò óôïí ôïìÝá ôçò øõ÷éêÞò õãåßáò, ìå á-
ðïôÝëåóìá ï ñüëïò ôïõò íá ìçí áðïôåëåß ðçãÞ éêáíï-
ðïßçóçò ãéá ôç æùÞ ôïõò.
4. Ç ÐÏÉÏÔÇÔÁ ÆÙÇÓ
ÓÔÉÓ ËÏÉÐÅÓ ØÕ×ÉÊÅÓ ÄÉÁÔÁÑÁ×ÅÓ
¸íá óçìáíôéêü åñþôçìá, ðïõ Ý÷åé áðáó÷ïëÞóåé ôïõò
åñåõíçôÝò óôïí ôïìÝá ôçò øõ÷éêÞò õãåßáò, ðñáãìáôåýå-
ôáé ôï áí ïé áóèåíåßò ðïõ ðÜó÷ïõí áðü äéÜöïñåò øõ-
÷éêÝò äéáôáñá÷Ýò ðáñïõóéÜæïõí äéáöïñåôéêÜ ó÷Þìáôá
ðïéüôçôáò æùÞò êáé ðñïößë áíáðçñßáò óôïõò ôïìåßò å-
êåßíïõò ôçò æùÞò ðïõ åðçñåÜæïíôáé áðü ôçí øõ÷éêÞ íü-
óï. Áí ç áðÜíôçóç óå áõôü ôï åñþôçìá åßíáé èåôéêÞ, ôü-
ôå èá ðñÝðåé íá êáèïñéóôïýí ïé óõãêåêñéìÝíåò ðåñéï-
÷Ýò Þ ïé ôïìåßò óôïõò ïðïßïõò ðáñïõóéÜæåôáé ç áíéêá-
íüôçôá óå óõíÜñôçóç ìå ôçí øõ÷éêÞ íüóï, êáèþò åðß-
óçò êáé ïé ôïìåßò óôïõò ïðïßïõò ÷ñåéÜæåôáé êáíåßò íá å-
ðéêåíôñùèåß üôáí áîéïëïãåß ôçí åðßäñáóç ìéáò èåñá-
ðåõôéêÞò ðáñÝìâáóçò. ÅðéðëÝïí, åðåéäÞ ïé ðåñéóóüôå-
ñïé áóèåíåßò ìå øõ÷éêÜ íïóÞìáôá, óôï åðßðåäï ôçò ðñù-
ôïâÜèìéáò ðåñßèáëøçò, ðáñïõóéÜæïõí ðåñéóóüôåñá á-
ðü Ýíá øõ÷éáôñéêÜ óõìðôþìáôá, ìéá óçìáíôéêÞ åñþôç-
óç áöïñÜ óôï âáèìü óôïí ïðïßï ç óõíïëéêÞ áíáðçñßá
óå ó÷Ýóç ìå ìéá óõãêåêñéìÝíç øõ÷éáôñéêÞ íüóï (ð.÷.
êáôÜèëéøç) ìðïñåß íá åîçãçèåß áðü ôç óõíýðáñîç êáé
Üëëùí øõ÷éêþí äéáôáñá÷þí, äçëáäÞ ôç óõííïóçñüôç-
ôá, ãåãïíüò áñêåôÜ êïéíü ãéá ôïõò ðåñéóóüôåñïõò á-
óèåíåßò. Ãéá ðáñÜäåéãìá, óå ðïéï âáèìü Ýíá Üôïìï ðïõ
ðÜó÷åé áðü ìéá áã÷þäç äéáôáñá÷Þ ðáñïõóéÜæåé Ýíá
ðñïößë áíéêáíüôçôáò óå äéÜöïñïõò ôïìåßò ôçò æùÞò, ðïõ
åßíáé áðüññïéá ôçò êáôáèëéðôéêÞò óõìðôùìáôïëïãßáò, ç
ïðïßá óõ÷íÜ óõíõðÜñ÷åé óå áõôÞ ôç íïóïëïãéêÞ êáôç-
ãïñßá ôùí áóèåíþí.49
Ìéá Üëëç åñþôçóç, ðïõ Ý÷åé áðáó÷ïëÞóåé ôçí Ýñåõ-
íá óå áõôüí ôïí ôïìÝá, áöïñÜ óôç äéáöïñÜ ìåôáîý ôçò
áíáðçñßáò ðïõ áðïññÝåé áðü ôéò øõ÷éêÝò äéáôáñá÷Ýò
êáé ôïõ ó÷Þìáôïò áíáðçñßáò ðïõ ðñïêýðôåé áðü ôá óù-
ìáôéêÜ íïóÞìáôá. Ç ÌåëÝôç Éáôñéêþí ÁðïôåëåóìÜôùí
(MOS) Ýäåéîå üôé óôçí ðñùôïâÜèìéá ðåñßèáëøç ïé á-
óèåíåßò ìå êáôáèëéðôéêÜ óõìðôþìáôá, óõãêñéíüìåíïé ìå
÷ñüíéïõò óùìáôéêïýò áóèåíåßò, ðáñïõóßáóáí óå ìåãá-
ÐÏÉÏÔÇÔÁ ÆÙÇÓ ÊÁÉ ØÕ×ÉÊÇ ÕÃÅÉÁ
ëýôåñï âáèìü äõóëåéôïõñãßá óå äéÜöïñïõò ôïìåßò ôçò
æùÞò, ðïõ åðçñåÜæïíôáé áðü ôçí øõ÷éêÞ õãåßá. Íá óç-
ìåéùèåß üìùò üôé ç ìåëÝôç áõôÞ åðéêåíôñþèçêå óôç äéá-
ãíùóôéêÞ êáôçãïñßá ôçò êáôÜèëéøçò êáé äåí áîéïëüãç-
óå ôéò åðéðôþóåéò áðü Üëëåò øõ÷éêÝò äéáôáñá÷Ýò ðïõ åì-
öáíßæïíôáé óôéò õðçñåóßåò ðñùôïâÜèìéáò ðåñßèáëøçò,
üðùò ïé áã÷þäåéò íåõñþóåéò, ïé óùìáôüìïñöåò äéáôá-
ñá÷Ýò, ï áëêïïëéóìüò ê.ëð.50 Ìéá ó÷åôéêÜ ðñüóöáôç Ý-
ñåõíá áðü ôïí Ðáãêüóìéï Ïñãáíéóìü Õãåßáò óå 15 ÷þ-
ñåò, Ýäåéîå üôé äéÜöïñåò øõ÷éêÝò äéáôáñá÷Ýò åß÷áí ùò
áðïôÝëåóìá ôçí ðñüêëçóç óïâáñÞò áíáðçñßáò óôç ëåé-
ôïõñãéêüôçôá ôïõ áôüìïõ, ìå ìéêñÝò üìùò äéáöïñÝò ìå-
ôáîý ôïõò üôáí óôçí áíÜëõóç åëÞöèç õðüøç ï ðáñÜ-
ãïíôáò ôçò óõííïóçñüôçôáò.51 Óýìöùíá üìùò ìå ôá á-
ðïôåëÝóìáôá ìéáò Üëëçò ìåëÝôçò, ôçò PRIME-MD 1000
(Primary Care Evaluation of Mental Disorders), ïé äéá-
öïñåôéêÝò ïìÜäåò ôùí øõ÷éáôñéêþí áóèåíþí ðáñïõ-
óßáóáí, áíôßóôïé÷á, äéáöïñåôéêÜ ó÷Þìáôá Þ ðñïößë á-
íáðçñßáò.49 ¸ôóé, ïé äéáôáñá÷Ýò ôïõ óõíáéóèÞìáôïò åì-
öÜíéóáí ìåãÜëåò óõó÷åôßóåéò ìå üëåò ôéò êëßìáêåò êáé
ôéò äéáóôÜóåéò ôçò ðïéüôçôáò æùÞò, ìå ÷áìçëüôåñåò ôé-
ìÝò óôçí êëßìáêá ôçò óùìáôéêÞò ëåéôïõñãéêüôçôáò. Óõ-
ãêñéíüìåíåò äå ìå Üëëåò óõíÞèåéò øõ÷éêÝò äéáôáñá÷Ýò,
åß÷áí ôç ìéêñüôåñç ìåôáâïëÞ ùò ðñïò ôç óõíïëéêÞ áíé-
êáíüôçôá üôáí åëÞöèåé õðüøç ï ðáñÜãïíôáò ôçò óõí-
íïóçñüôçôáò. Áõôü äçëþíåé üôé ï ôýðïò ôçò áíáðçñßáò
ôùí áóèåíþí ìå óõíáéóèçìáôéêÞ äéáôáñá÷Þ ìðïñåß íá
èåùñçèåß üôé ïöåßëåôáé óôç óõííïóçñüôçôá óå ðïëý ìé-
êñüôåñï âáèìü áðü ü,ôé óôçí ðåñßðôùóç Üëëùí øõ÷é-
êþí äéáôáñá÷þí. Ôá áíùôÝñù åõñÞìáôá õðïóôçñßæïõí
ôç óýã÷ñïíç ôÜóç íá äßíåôáé Ýãêáéñá ç áðáñáßôçôç ðñï-
óï÷Þ êáé èåñáðåßá óôéò óõíáéóèçìáôéêÝò äéáôáñá÷Ýò óôï
ðëáßóéï ôçò ðñùôïâÜèìéáò ðåñßèáëøçò.52,53
¸íá æÞôçìá ðïõ ôßèåôáé óôéò óõíáéóèçìáôéêÝò äéáôá-
ñá÷Ýò åßíáé ïé äéáöïñÝò ðïõ ðáñáôçñïýíôáé áíÜìåóá
óôçí õðïêåéìåíéêÞ áîéïëüãçóç ôçò ðïéüôçôáò æùÞò áðü
ôïí ßäéï ôïí ðÜó÷ïíôá êáé óôçí áíôéêåéìåíéêÞ áîéïëü-
ãçóÞ ôçò. Åýêïëá ãßíåôáé óáöÝò üôé Ýíáò êáôáèëéðôéêüò
áóèåíÞò èá áîéïëïãÞóåé ôçí êáôÜóôáóÞ ôïõ, ôïí êïé-
íùíéêü ôïõ ñüëï, êáèþò êáé ôéò óõíèÞêåò äéáâßùóçò ùò
÷åéñüôåñá áð’ ü,ôé Ýíáò áíåîÜñôçôïò ðáñáôçñçôÞò. Ôï
áíôßèåôï óõìâáßíåé óå Ýíáí áóèåíÞ ðïõ âñßóêåôáé óôç
öÜóç ôçò ìáíßáò.41
ÁíáöïñéêÜ ìå ôéò áã÷þäåéò äéáôáñá÷Ýò, ðáñÜ ôïí áõ-
îáíüìåíï áñéèìü ìåëåôþí ðïõ ëáìâÜíåé ÷þñá ôá ôå-
ëåõôáßá 15 ÷ñüíéá, ç Ýñåõíá áíáöïñéêÜ ìå ôçí åðßäñáóÞ
ôïõò óôçí ðïéüôçôá æùÞò âñßóêåôáé áêüìç óôá áñ÷éêÜ
óôÜäéá. Ðáñüëá áõôÜ, ïé ìåëÝôåò ðïõ Ý÷ïõí äéåîá÷èåß
Ýùò ôþñá, ó÷åäüí êáèïëéêÜ ðáñïõóéÜæïõí ôéò áã÷þäåéò
äéáôáñá÷Ýò ùò áóèÝíåéåò ðïõ õðïâáèìßæïõí óçìáíôéêÜ
ôçí ðïéüôçôá æùÞò êáé ôçí øõ÷ïêïéíùíéêÞ ëåéôïõñãéêü-
247
ôçôá óå ðïëëïýò ôïìåßò ôçò ëåéôïõñãéêüôçôáò.54 ¸÷åé
âñåèåß üôé ïé åðéðôþóåéò ãéá ôéò áã÷þäåéò äéáôáñá÷Ýò åì-
öáíßæïíôáé êõñßùò óå ôñåéò ôïìåßò: óôïí êïéíùíéêü ôï-
ìÝá, óôç ëåéôïõñãéêüôçôá ôùí ñüëùí êáé ôçí øõ÷éêÞ õ-
ãåßá, êáèþò êáé óôçí áýîçóç ôùí çìåñþí áíéêáíüôç-
ôáò. Ùóôüóï, ç öýóç ôçò áíåðÜñêåéáò óôçí ðïéüôçôá æù-
Þò, áíÜëïãá ìå ôçí êÜèå äéáôáñá÷Þ, ðáñïõóéÜæåé ó÷å-
ôéêÞ ðïéêéëßá. Ãéá ðáñÜäåéãìá, ïé Kessler êáé Frack
(1997)55 âñÞêáí üôé, áíÜìåóá óôá Üôïìá ìå áã÷þäåéò
äéáôáñá÷Ýò, åêåßíá ìå äéáôáñá÷Þ ðáíéêïý åß÷áí ôéò ðå-
ñéóóüôåñåò çìÝñåò êáôÜ ôéò ïðïßåò ç ðáñáãùãéêüôçôÜ
ôïõò Þôáí ìåéùìÝíç, åíþ ôá Üôïìá ìå êïéíùíéêÞ öïâßá
åß÷áí ôéò ëéãüôåñåò. Ôá äåäïìÝíá ãéá ôá Üôïìá ìå ãåíé-
êåõìÝíç áã÷þäç äéáôáñá÷Þ êáé ìåôáôñáõìáôéêÞ áã÷þ-
äç äéáôáñá÷Þ âñÝèçêáí íá êõìáßíïíôáé êÜðïõ åíäéÜ-
ìåóá. Ãåíéêþò, üìùò, ðáñáôçñÞèçêå üôé ôá Üôïìá ðïõ
ðÜó÷ïõí áðü áã÷þäåéò äéáôáñá÷Ýò, óõãêñéíüìåíá ìå
ìç ðÜó÷ïíôåò, Ýäåéîáí óôáôéóôéêþò óçìáíôéêÜ õøçëüôå-
ñá åðßðåäá åñãáóéáêÞò áíåðÜñêåéáò. ¢ëëá åñåõíçôéêÜ
äåäïìÝíá õðïäåéêíýïõí üôé ç äéáôáñá÷Þ ðáíéêïý êá-
èþò êáé ç ìåôáôñáõìáôéêÞ áã÷þäçò äéáôáñá÷Þ ìðïñåß
íá Ý÷ïõí ðåñéóóüôåñï áñíçôéêÞ åðßäñáóç óôçí ðïéüôç-
ôá æùÞò áðü ôéò õðüëïéðåò áã÷þäåéò äéáôáñá÷Ýò. Õ-
ðÜñ÷ïõí åíäåßîåéò üôé ïé äñáóôéêÝò öáñìáêïëïãéêÝò Þ
øõ÷ïèåñáðåõôéêÝò èåñáðåßåò âåëôéþíïõí ôçí ðïéüôçôá
æùÞò óå áóèåíåßò ìå äéáôáñá÷Þ ðáíéêïý êáé êïéíùíéêÞ
öïâßá, ãåãïíüò ùóôüóï ðïõ äåí Ý÷åé áêüìç äéáöáíåß
ãéá ôéò õðüëïéðåò áã÷þäåéò äéáôáñá÷Ýò.56,57
Óå Üëëåò Ýñåõíåò âñÝèçêå üôé óçìáíôéêü âáèìü áíá-
ðçñßáò ðáñïõóßáæáí áóèåíåßò ìå ãåíéêåõìÝíç áã÷þäç
äéáôáñá÷Þ êáé ìç ðñïóäéïñéæüìåíç áã÷þäç äéáôáñá÷Þ,
åíþ ïé óùìáôüìïñöåò äéáôáñá÷Ýò åìöÜíéæáí áíáðçñßá
óôç ëåéôïõñãéêüôçôá ôùí ñüëùí, ôï óùìáôéêü ðüíï êáé ôç
ãåíéêÞ åêôßìçóç ôçò êáôÜóôáóçò ôçò õãåßáò.54 ÅíäéáöÝ-
ñïí ðáñïõóéÜæåé ç ðåñßðôùóç ôçò éäåïøõ÷áíáãêáóôéêÞò
äéáôáñá÷Þò, êõñßùò ëüãù ôïõ üôé, ðáñÜ ôçí áíáãíùñé-
óìÝíç óïâáñüôçôÜ ôçò, åëÜ÷éóôåò ìåëÝôåò Ý÷ïõí ðñï-
óðáèÞóåé íá ìåôñÞóïõí ôçí åðßäñáóÞ ôçò óôçí ðïéüôçôá
æùÞò. Óôç ìåëÝôç ôùí Koran et al,58 ç éäåïøõ÷áíáãêá-
óôéêÞ äéáôáñá÷Þ ðåñéãñÜöåôáé íá Ý÷åé áîéïóçìåßùôç áñ-
íçôéêÞ åðßäñáóç óôçí ðïéüôçôá æùÞò, åéäéêÜ óôïí ôïìÝá
ôçò êïéíùíéêÞò ëåéôïõñãéêüôçôáò, ìå óçìáíôéêü ðåñéïñé-
óìü óôïõò ñüëïõò åîáéôßáò óõíáéóèçìáôéêÞò äõóêáìøßáò.
Ïé áóèåíåßò ìå äéáôáñá÷Ýò óôçí ðñüóëçøç ôñïöÞò
ðáñïõóßáæáí óçìáíôéêÞ áíáðçñßá óôçí êïéíùíéêÞ ëåé-
ôïõñãéêüôçôá, ôçí øõ÷éêÞ õãåßá êáé ôï óùìáôéêü ðüíï.
Ç áíéêáíüôçôá óôïí êïéíùíéêü ôïìÝá èåùñåßôáé áíáìå-
íüìåíç êáé áíôéêáôïðôñßæåé ôçí åõáéóèçóßá ðïõ ÷áñá-
êôçñßæåé áõôïýò ôïõò áóèåíåßò ùò ðñïò ôç óùìáôéêÞ ôïõò
åìöÜíéóç êáé ôï âÜñïò.49
ÔÝëïò, áðïôåëåß ðáñÜäïîï åýñçìá üôé ôá Üôïìá ìå å-
îÜñôçóç áðü ïõóßåò êáé ÷ñÞóç áëêïüë, ðïõ áîéïëïãÞ-
248
èçêáí óå õðçñåóßåò ðñùôïâÜèìéáò öñïíôßäáò, äåí ðá-
ñïõóßáóáí óçìáíôéêÞ õðïâÜèìéóç óôçí ðïéüôçôá ôçò æù-
Þò ôïõò. Áõôü ðéèáíüí íá ïöåßëåôáé óôï ãåãïíüò üôé ïé
áóèåíåßò åêåßíïé ðïõ ðñïóÝñ÷ïíôáé óôéò õðçñåóßåò ðñù-
ôïâÜèìéáò ðåñßèáëøçò ãéá ÷ñÞóç ïõóéþí äåí ðáñïõ-
óéÜæïõí óïâáñÜ ðñïâëÞìáôá ùò ðñïò ôç ÷ñÞóç Þ üôé
÷ñçóéìïðïéïýí éó÷õñïýò ìç÷áíéóìïýò Üìõíáò, üðùò ç
Üñíçóç ôùí ðñïâëçìÜôùí ôïõò.49
Óå áíôßèåóç, ðÜíôùò, ìå üëá ôá áíùôÝñù åõñÞìáôá,
ðïõ êáôáäåéêíýïõí ôïí ôýðï ôçò áíáðçñßáò áíÜëïãá ìå
ôç äéáãíùóôéêÞ êáôçãïñßá, ôá áðïôåëÝóìáôá áðü ôç ìå-
ëÝôç ôïõ Ðáãêüóìéïõ Ïñãáíéóìïý Õãåßáò äåí ðáñïõ-
óéÜæïõí óçìáíôéêÝò äéáöïñÝò áíÜìåóá óôéò äéÜöïñåò øõ-
÷éêÝò äéáôáñá÷Ýò, ãåãïíüò ðïõ ðéèáíüí ïöåßëåôáé óôç
ìåèïäïëïãßá ðïõ ÷ñçóéìïðïéÞèçêå ãéá ôïí Ýëåã÷ï ôçò
åðßäñáóçò ôçò óõííïóçñüôçôáò óôçí ðïéüôçôá æùÞò.51
5. ÆÇÔÇÌÁÔÁ ÁÎÉÏËÏÃÇÓÇÓ
5.1. Øõ÷ïìåôñéêÞ áîéïëüãçóç
Ç áîéïëüãçóç ôçò ðïéüôçôáò æùÞò ðñáãìáôïðïéåßôáé ìå
ôç ÷ñÞóç øõ÷ïìåôñéêþí åñãáëåßùí, êáôÜ êýñéï ëüãï å-
ñùôçìáôïëïãßùí, áõôïóõìðëçñïýìåíùí Þ óõìðëçñïý-
ìåíùí óå äïìçìÝíåò êáé çìéäïìçìÝíåò óõíåíôåýîåéò.
Ç ðëåéïíüôçôá ôùí áîéïëïãçôéêþí åñãáëåßùí, ðïõ ðá-
ñïõóéÜæïíôáé óå áõôÞ ôçí áíáóêüðçóç, äçìéïõñãÞèçêå
ãéá íá ÷ñçóéìïðïéçèïýí óå ìåëÝôåò ðïõ áöïñïýóáí äéÜ-
öïñåò äéáãíùóôéêÝò êáôçãïñßåò øõ÷éáôñéêÜ ðáó÷üíôùí
áðü ÷ñüíéåò êáé óïâáñÝò äéáôáñá÷Ýò, üðùò ð.÷. ç ó÷é-
æïöñÝíåéá, Þ Üëëåò êáôçãïñßåò, üðùò ïé óõíáéóèçìáôé-
êÝò äéáôáñá÷Ýò, ðïõ åðßóçò åðéöÝñïõí óïâáñÝò åðé-
ðôþóåéò óôç ëåéôïõñãéêüôçôá. Ó÷åôéêÜ ðñüóöáôá, áíá-
ðôý÷èçêáí åñãáëåßá ìÝôñçóçò ôçò ðïéüôçôáò æùÞò ðïõ
áðåõèýíïíôáé óå áóèåíåßò ìå ëéãüôåñï óïâáñÝò øõ÷éá-
ôñéêÝò äéáôáñá÷Ýò, ð.÷. óå Üôïìá ðïõ åíäÝ÷åôáé íá á-
íôéìåôùðßóïõí ìéá óýíôïìç, ïîåßá öÜóç êáôÜèëéøçò Þ
óå áóèåíåßò ìå íåõñùóéêïý ôýðïõ äéáôáñá÷Ýò. Ôá üñ-
ãáíá áõôÜ åìðßðôïõí óå 3 êáôçãïñßåò:
á. óå áõôÜ ðïõ áðåõèýíïíôáé ãåíéêÜ óå ÷ñüíéïõò á-
óèåíåßò
â. óå áõôÜ ðïõ ÷ñçóéìïðïéïýíôáé åéäéêÜ óå áóèåíåßò ìå
ó÷éæïöñÝíåéá êáé
ã. óå åêåßíá ðïõ áðåõèýíïíôáé óå áóèåíåßò ðïõ ðÜó÷ïõí
áðü êáôÜèëéøç Þ áã÷þäåéò äéáôáñá÷Ýò.
Ôá ðåñéóóüôåñá åñãáëåßá åîåôÜæïõí ôçí ðïéüôçôá æù-
Þò ãåíéêÜ êáé óöáéñéêÜ, åíþ ôá ôåëåõôáßá ÷ñüíéá áíá-
ðôý÷èçêáí åñãáëåßá ðïõ åßíáé åîåéäéêåõìÝíá êáé áðåõ-
èýíïíôáé óå áóèåíåßò ðïõ ðÜó÷ïõí áðü ìéá óõãêåêñé-
ìÝíç íüóï, åîåôÜæïíôáò ôçí ðïéüôçôá æùÞò óå óõíÜñôç-
óç ìå ôçí õãåßá êáé ôéò ðïëëáðëÝò åðéðôþóåéò ôçò íü-
óïõ Þ ôçò èåñáðåßáò.
Ì. ÏÉÊÏÍÏÌÏÕ êáé óõí
ÁíáöïñéêÜ ìå ôçí ðñþôç êáôçãïñßá, ç áîéïëüãçóç ôçò
ðïéüôçôáò æùÞò ôùí áôüìùí ðïõ ðÜó÷ïõí áðü ÷ñüíéåò
øõ÷éêÝò äéáôáñá÷Ýò óôïé÷åéïèåôåßôáé ìå âÜóç Ýíá ãåíé-
êü ðëáßóéï èåìÜôùí, ðïõ èåùñïýíôáé üôé åðçñåÜæïõí
êáé êáèïñßæïõí ôçí ðïéüôçôá æùÞò. Óýìöùíá ìå áõôü,
åîåôÜæïíôáé äéÜöïñåò ðëåõñÝò Þ äéáóôÜóåéò ôïõ áôüìïõ,
üðùò ç ëåéôïõñãéêüôçôá óôïí êïéíùíéêü, ïéêïãåíåéáêü,
óåîïõáëéêü, åñãáóéáêü ôïìÝá, ç øõ÷ïëïãéêÞ åõåîßá, êá-
èþò êáé ÷áñáêôçñéóôéêÜ ôïõ ðåñéâÜëëïíôïò ðïõ èåù-
ñïýíôáé üôé êáèïñßæïõí ùò Ýíá âáèìü ôçí ðïéüôçôá æù-
Þò, üðùò ïé ïéêïíïìéêïß ðüñïé êáé ïé åõêáéñßåò ãéá á-
ðáó÷üëçóç, øõ÷áãùãßá êáé åêðáßäåõóç.3,59,60
5.2. Áíáóêüðçóç øõ÷ïìåôñéêþí åñãáëåßùí
ôçò ðïéüôçôáò æùÞò
Ç áíáóêüðçóç áõôÞ Ý÷åé óôü÷ï íá ðáñïõóéÜóåé ôá
âáóéêÜ óôïé÷åßá ôùí ðåñéóóüôåñùí ïñãÜíùí ðïõ ÷ñç-
óéìïðïéïýíôáé ãéá ôçí åêôßìçóç ôçò ðïéüôçôáò æùÞò óôï
÷þñï ôçò Øõ÷éêÞò Õãåßáò.3,61,62 Ôá åñãáëåßá áõôÜ åßíáé:
5.2.1. ¸íôõðï ÐñïóáñìïãÞò óôçí Êïéíüôçôá (Com-
munity Adjustment Form, CAF, Stein & Test 1980, Hoult
& Reynolds 1984). Åßíáé ìéá çìéäïìçìÝíç óõíÝíôåõ-
îç,63,64 ç ïðïßá êáôáóêåõÜóôçêå ãéá ôçí áîéïëüãçóç ôçò
éêáíïðïßçóçò æùÞò êáé ôçí åêôßìçóç ïñéóìÝíùí äéá-
óôÜóåùí ôçò ðïéüôçôáò æùÞò, óôá ðëáßóéá ìéáò ôõ÷áéï-
ðïéçìÝíçò ìåëÝôçò áóèåíþí ìå óïâáñÝò øõ÷éêÝò äéá-
ôáñá÷Ýò. Ïé ôïìåßò ðïõ åîåôÜæïíôáé ðåñéëáìâÜíïõí øõ-
÷áãùãßá, ðïéüôçôá ôïõ ÷þñïõ äéáâßùóçò, éóôïñéêü å-
ðáããåëìáôéêÞò áðáó÷üëçóçò êáé åðáããåëìáôéêÞ êáôÜ-
óôáóç, ðüñïõò êáé ìÝãåèïò åéóïäÞìáôïò, ðáñï÷Ýò öá-
ãçôïý êáé óôÝãçò, åðáöÞ ìå ößëïõò, åðáöÞ ìå ôçí ïé-
êïãÝíåéá, ðñïâëÞìáôá ìå ôï íüìï, éêáíïðïßçóç æùÞò,
áõôïåêôßìçóç, éáôñéêÞ áóöÜëåéá, ÷ñÞóç ôùí õðçñåóéþí
õãåßáò.
5.2.2. ÊáôÜëïãïò Ðïéüôçôáò ÆùÞò (Quality of Life
Checklist, QLC, Malm et al 1981). Ï êáôÜëïãïò áõ-
ôüò65 äçìéïõñãÞèçêå ãéá íá åîåôÜóåé ðïéá óôïé÷åßá ôçò
ðïéüôçôáò æùÞò åßíáé óçìáíôéêÜ ãéá ôïõò øõ÷éêÜ á-
óèåíåßò, Ýôóé þóôå íá ÷ñçóéìïðïéçèïýí óôç óõíÝ÷åéá
óôï èåñáðåõôéêü ó÷åäéáóìü. Ïé ôïìåßò ðïõ áîéïëï-
ãïýíôáé ðåñéëáìâÜíïõí øõ÷áãùãßá, åñãáóßá, åðáã-
ãåëìáôéêÞ áðïêáôÜóôáóç, ïéêïíïìéêÞ åîÜñôçóç, êïé-
íùíéêÝò ó÷Ýóåéò, ãíþóç êáé åêðáßäåõóç, øõ÷ïëïãéêÞ
åîÜñôçóç, åóùôåñéêÝò åìðåéñßåò, éáôñéêÞ öñïíôßäá (øõ-
÷éáôñéêÞ êáé ãåíéêÞ), ðïéïôéêÜ äåäïìÝíá êáôïéêßáò,
èñçóêåßá.
5.2.3. Êëßìáêá Iêáíïðïßçóçò ìå Tïìåßò ôçò ZùÞò (Sat-
isfaction with Life Domains Scale, SLDS, Baker & In-
tagliata 1982, Johnson 1991). Ôï åñãáëåßï áõôü66,67 á-
íáðôý÷èçêå ãéá íá ìåôñÞóåé ôçí åðßäñáóç ôçò øõ÷éêÞò
ÐÏÉÏÔÇÔÁ ÆÙÇÓ ÊÁÉ ØÕ×ÉÊÇ ÕÃÅÉÁ
íüóïõ óôçí ðïéüôçôá æùÞò ÷ñüíéùí øõ÷éáôñéêþí áóèå-
íþí óôá ðëáßóéá åíüò ðñïãñÜììáôïò êïéíïôéêÞò óôÞñé-
îçò, óôçí Ðïëéôåßá ôçò ÍÝáò Õüñêçò. Ôï ðåñéå÷üìåíï
ôùí åñùôÞóåùí áíáöÝñåôáé óôçí éêáíïðïßçóç ôïõ á-
óèåíïýò ìå ôéò óõíèÞêåò óôÝãáóçò, ôïõò óõãêáôïßêïõò
êáé ôïõò ãåßôïíåò, ôçí ôñïöÞ, ôï ñïõ÷éóìü, ôçí õãåßá,
ôïõò ößëïõò, ôçí ïéêïãÝíåéá, ôéò ó÷Ýóåéò ãåíéêÜ ìå Üë-
ëïõò áíèñþðïõò, ôçí åñãáóßá, ôï çìåñÞóéï ðñüãñáì-
ìá, ôïí åëåýèåñï ÷ñüíï, ôçí øõ÷áãùãßá, ôéò ôïðéêÝò õ-
ðçñåóßåò êáé ôçí ðáñï÷Þ õðçñåóéþí, ôçí ïéêïíïìéêÞ êá-
ôÜóôáóç, êáèþò êáé ôçí ôñÝ÷ïõóá óôåãáóôéêÞ ñýèìéóç
óå óýãêñéóç ìå ôç äéáìïíÞ êáé íïóçëåßá óå íïóïêï-
ìåßï.
5.2.4. Åñùôçìáôïëüãéï ¼ñåãêïí ãéá ôçí Ðïéüôçôá
ÆùÞò (Oregon Quality of Life Questionnaire, OQLQ,
Bigelow et al 1982, 1991, Bigelow & Young 1991). Ôï
ðåñéå÷üìåíï ôïõ åñãáëåßïõ19,25,68 åëÝã÷åé 14 ôïìåßò: øõ-
÷éêÞ äõóöïñßá, øõ÷ïëïãéêÞ åõåîßá, áíôï÷Þ óôç ìáôáß-
ùóç, óõíïëéêÞ éêáíïðïßçóç ìå ôéò âáóéêÝò áíÜãêåò, á-
íåîáñôçóßá, äéáðñïóùðéêÝò óõíáëëáãÝò, ïéêïãåíåéá-
êïýò ñüëïõò, êïéíùíéêÞ óôÞñéîç, ïéêéáêÝò åñãáóßåò, äõ-
íáôüôçôá ãéá åñãáóßá, áðüäïóç óôçí åñãáóßá, äéá÷åßñé-
óç åëåýèåñïõ ÷ñüíïõ, áñíçôéêÝò åðéðôþóåéò áðü ôç
÷ñÞóç áëêïüë Þ åîáñôçóéïãüíùí ïõóéþí.
5.2.5. ÓõíÝíôåõîç ËÝìáí ãéá ôçí Ðïéüôçôá ÆùÞò (Leh-
man Quality of Life Interview, QOLI, Lehman et al 1982,
1988, 1993, Sullivan et al 1992, Mechanic et al 1994,
Lehman et al 1995). Ôï åñãáëåßï áõôü13,15,31,39,69,70 áîéï-
ëïãåß ôéò óõíèÞêåò æùÞò áôüìùí ðïõ ðÜó÷ïõí áðü øõ-
÷éêÝò äéáôáñá÷Ýò áðü äýï ïðôéêÝò ãùíßåò: ôçí «áíôéêåé-
ìåíéêÞ», äçëáäÞ åîåôÜæåé ðïéá åßíáé ç åìðåéñßá ôïõ á-
óèåíïýò, êáé ôçí «õðïêåéìåíéêÞ», äçëáäÞ åîåôÜæåé ðþò
áéóèÜíåôáé ï áóèåíÞò ãéá ôçí åìðåéñßá áõôÞ. ÏñéóìÝíïé
ôïìåßò ðïõ åëÝã÷ïíôáé áöïñïýí ôéò óõíèÞêåò äéáâßù-
óçò, ôéò êáèçìåñéíÝò äñáóôçñéüôçôåò êáé ôç ëåéôïõñãé-
êüôçôá, ôéò ïéêïãåíåéáêÝò ó÷Ýóåéò, ôéò êïéíùíéêÝò ó÷Ý-
óåéò, ôá ïéêïíïìéêÜ èÝìáôá êáé ôçí áóöÜëåéá, ê.Ü.
5.2.6. ÓõíÝíôåõîç ãéá ôçí Ðïéüôçôá ÆùÞò ôïõ ÐåëÜ-
ôç (Client Quality of Life Interview, CQLI, Coldstrom &
Manderscheid 1986). Ôï åñãáëåßï áõôü71 Þôáí Ýíá áðü
ìéá óåéñÜ øõ÷ïìåôñéêþí åñãáëåßùí ðïõ äçìéïõñãÞèç-
êáí ãéá ôçí åêôßìçóç ôùí èåñáðåõôéêþí áðïôåëåóìÜôùí
óå Üôïìá ìå óïâáñÝò øõ÷éêÝò äéáôáñá÷Ýò óôá ðëáßóéá
ðáñï÷Þò ðñïãñáììÜôùí êïéíïôéêÞò óôÞñéîçò. Ïé ôïìåßò
ðïõ åîåôÜæïíôáé ðåñéëáìâÜíïõí êÜëõøç âáóéêþí áíá-
ãêþí (ôñïöÞ, ñïõ÷éóìü, óôÝãç, õãåßá, áóöÜëåéá, õãéåé-
íÞ, ïéêïíïìéêïß ðüñïé), åðáããåëìáôéêÞ êáôÜñôéóç, ôï-
ðïèÝôçóç óå åñãáóßá, êáèçìåñéíÝò äñáóôçñéüôçôåò, øõ-
÷áãùãßá, êïéíùíéêÞ ðñüíïéá, éäéùôéêü ðåñéâÜëëïí, å-
ìðéóôïóýíç óôïí åáõôü, øõ÷éêÞ çñåìßá, åëåýèåñï ÷ñü-
íï ãéá êïéíùíéêÝò åðáöÝò.
249
5.2.7. ÌåëÝôç ãéá ôï «Åõ Æçí»-ÓõíÝíôåõîç ãéá ôïí Ðå-
ëÜôç (California Well-Being Project Client Interview,
CWBPCI, Campbell et al 1989). Ôï åñãáëåßï áõôü72 á-
íáðôý÷èçêå óôá ðëáßóéá ìåëÝôçò ìå óôü÷ï ôçí êáëýôå-
ñç êáé ðéï ïëïêëçñùìÝíç êáôáíüçóç ôùí áôüìùí ðïõ
åßíáé øõ÷éêÜ ðÜó÷ïíôåò êáé äÝ÷ïíôáé êÜðïéá ìïñöÞ èå-
ñáðåßáò.
Ôï åñãáëåßï ðåñéëáìâÜíåé ôïìåßò, üðùò ç åðÜñêåéá
ôùí ïéêïíïìéêþí ðüñùí, ôï åéóüäçìá, ç óôÝãç, ïé ðñï-
óùðéêÝò ðñïóäïêßåò êáé ïé óôü÷ïé, ïé ïéêïãåíåéáêÝò
ó÷Ýóåéò, ïé ó÷Ýóåéò ìå ôá ðáéäéÜ, ç ïéêåéüôçôá, ôá äé-
êáéþìáôá ôùí áóèåíþí, ï óôéãìáôéóìüò.
5.2.8. ÄéÜãñáììá Ðïéüôçôáò ÆùÞò-(Lancashire) (Lan-
cashire Quality of Life Profile, LQOLP, Oliver 1991, O-
liver et al 1996). Ôï åñãáëåßï73,74 áðïôåëåß ìéá ôñïðï-
ðïéçìÝíç ìïñöÞ óõíÝíôåõîçò ôïõ Lehman ãéá ôçí ðïé-
üôçôá æùÞò. Áíáðôý÷èçêå óôç Ì. Âñåôáíßá ãéá ôçí á-
îéïëüãçóç ôçò áðïôåëåóìáôéêüôçôáò ôùí õðçñåóéþí øõ-
÷éêÞò õãåßáò, ìå óôü÷ï ôçí áíáâÜèìéóç ôçò ðïéüôçôáò
æùÞò ôùí áóèåíþí.
Áîéïëïãåß ôçí ðïéüôçôá æùÞò êáé ôçí éêáíïðïßçóç óå 9
ôïìåßò: åñãáóßá/åêðáßäåõóç, øõ÷áãùãßá/óõììåôï÷Þ, èñç-
óêåõôéêÝò ðåðïéèÞóåéò, ïéêïíïìéêÜ, óõíèÞêåò äéáâßùóçò,
áóöÜëåéá êáé íïìéêÜ èÝìáôá, ïéêïãåíåéáêÝò ó÷Ýóåéò, êïé-
íùíéêÝò ó÷Ýóåéò, õãåßá.
5.2.9. Áõôïóõìðëçñïýìåíï Eñùôçìáôïëüãéï ãéá ôçí
Ðïéüôçôá ÆùÞò (Quality of Self Assessment Inventory,
QLSAI, Skantze 1993). To åñãáëåßï áõôü75 ðñïóöÝñåé
ðëçñïöüñçóç óå ôïìåßò ôçò ðïéüôçôáò æùÞò ðïõ åßíáé
óçìáíôéêïß ãéá ôïõò áóèåíåßò, Ýôóé þóôå ôá áðïôåëÝóìáôá
óôç óõíÝ÷åéá íá ÷ñçóéìïðïéçèïýí óôïí áôïìéêü èåñá-
ðåõôéêü ó÷åäéáóìü ôïõ áóèåíïýò. Ïé ôïìåßò ðïõ áîéï-
ëïãïýíôáé åßíáé ïé åîÞò: óùìáôéêÞ õãåßá, óôÝãç, ðåñé-
âÜëëïí êáôïéêßáò, ïéêïíïìéêÜ èÝìáôá, áõôïåîõðçñÝôç-
óç êáé íïéêïêõñéü, åîÜñôçóç, åðáöÝò, åñãáóßá, øõ÷á-
ãùãßá, ãíþóç êáé åêðáßäåõóç, õðïêåéìåíéêÝò åìðåéñßåò,
øõ÷éêÞ õãåßá, êïéíùíéêÝò õðçñåóßåò, èñçóêåõôéêÝò ðå-
ðïéèÞóåéò.
5.2.10. Äåßêôçò ãéá ôçí Ðïéüôçôá ÆùÞò óôçí Øõ÷éêÞ
Õãåßá (Quality of Life Éndex for Mental Health, QLI-MH,
Becker et al 1993). Ôï åñãáëåßï áõôü76 Ý÷åé ó÷åäéáóôåß
Ýôóé, þóôå íá ëáìâÜíïíôáé õðüøç ü÷é ìüíï ïé áðüøåéò
ôùí áóèåíþí, áëëÜ êáé ôùí ïéêïãåíåéþí êáé ôùí èåñá-
ðåõôþí ôïõò. Ïé ôïìåßò ðïõ áîéïëïãïýíôáé ðåñéëáìâÜ-
íïõí äñáóôçñéüôçôåò áðáó÷üëçóçò, øõ÷ïëïãéêÞ åõåîßá,
óùìáôéêÞ õãåßá, êáèçìåñéíÝò äñáóôçñéüôçôåò, êïéíùíé-
êÝò ó÷Ýóåéò, ïéêïíïìéêÜ, óõìðôùìáôïëïãßá.
5.2.11. Êëßìáêá ÓõíÝíôåõîçò ãéá ôçí Ðïéüôçôá ÆùÞò
(Quality of Life Interview Scale, QOLIS, Holcomb et al
250
1993). Ôï åñãáëåßï áõôü77 åßíáé Ýíá áîéïëïãéêü ìÝóï
ãéá ôçí ðïéüôçôá æùÞò áóèåíþí ìå óïâáñÝò øõ÷éáôñé-
êÝò äéáôáñá÷Ýò. Ïé ôïìåßò ðïõ áîéïëïãïýíôáé ðåñéëáì-
âÜíïõí ôï åðßðåäï áõôïíïìßáò, ôçí áõôïåêôßìçóç, ôçí
êïéíùíéêÞ óôÞñéîç, ôç óùìáôéêÞ õãåßá, ôá óõíáéóèÞìá-
ôá èõìïý, ôçí åðéèåôéêüôçôá, ôç óõíáéóèçìáôéêÞ áíå-
îáñôçóßá êáé ôçí åêðëÞñùóç ôùí ðñïóùðéêþí óôü÷ùí.
5.3. Åñãáëåßá ãéá ôç ó÷éæïöñÝíåéá
Åíþ üëá ôá ðñïáíáöåñèÝíôá øõ÷ïìåôñéêÜ åñãáëåßá
ãéá ôçí ðïéüôçôá æùÞò ÷ñçóéìïðïéÞèçêáí êõñßùò ãéá ôçí
áîéïëüãçóç áóèåíþí ìå ó÷éæïöñÝíåéá, êáíÝíá áðü áõ-
ôÜ äåí Ý÷åé ó÷åäéáóôåß åéäéêÜ ãéá ôçí åêôßìçóç óõãêå-
êñéìÝíùí óôïé÷åßùí ðïõ ðñïêýðôïõí áðü áõôÞ ôçí á-
óèÝíåéá. ÕðÜñ÷åé ìüíï Ýíá åñãáëåßï,78 ðïõ èåùñåßôáé
üôé åêôéìÜ óõãêåêñéìÝíá ôçí ðïéüôçôá æùÞò óôç ó÷éæï-
öñÝíåéá, ç Êëßìáêá Ðïéüôçôáò ÆùÞò (Heinrichs et al
1984). Ç êëßìáêá áõôÞ áíáðôý÷èçêå ãéá ôçí áîéïëüãç-
óç ôçò åëëåéììáôéêüôçôáò óå áóèåíåßò ìå äéÜãíùóç ó÷é-
æïöñÝíåéáò. Ïé ôïìåßò ðïõ åîåôÜæïíôáé åßíáé ðïëëïß êáé
÷ùñßæïíôáé óå 3 ìåãÜëåò åíüôçôåò: åíäï-øõ÷éêÞ åìðåé-
ñßá, äéáðñïóùðéêÝò ó÷Ýóåéò êáé ëåéôïõñãéêüôçôá ñüëùí.
5.4. Åñãáëåßá ãéá ôéò óõíáéóèçìáôéêÝò
êáé áã÷þäåéò äéáôáñá÷Ýò
Ï ôïìÝáò ôçò áîéïëüãçóçò ôçò ðïéüôçôáò æùÞò áôü-
ìùí ðïõ ðÜó÷ïõí áðü øõ÷éêÝò äéáôáñá÷Ýò êáé äåí å-
ìðßðôïõí óôçí êáôçãïñßá ôùí ÷ñïíßùí êáé óïâáñþí äéá-
ôáñá÷þí, åßíáé ó÷åôéêÜ ðñüóöáôïò. Ôï åñÝèéóìá ãéá ôç
äéåýñõíóç ôçò áîéïëüãçóçò áõôÞò ðñïÝñ÷åôáé áðü ôçí
áíÜãêç íá äéåñåõíçèåß ç åðßäñáóç ôçò öáñìáêåõôéêÞò
áãùãÞò, ü÷é ìüíï óôç ó÷éæïöñÝíåéá, áëëÜ êáé óå Üëëåò
êáôçãïñßåò äéáôáñá÷þí êáé íá ðñïêýøïõí óáöÝóôåñá
óôïé÷åßá ãéá ôçí èåñáðåõôéêÞ áðïôåëåóìáôéêüôçôá. Ôá íå-
üôåñá áõôÜ åñãáëåßá Ý÷ïõí åðéêåíôñùìÝíï óôü÷ï êáé á-
ðåõèýíïíôáé óå øõ÷éêÝò äéáôáñá÷Ýò ðïõ äåí åðéöÝñïõí
óïâáñÞ áíáðçñßá.
5.4.1. Åñùôçìáôïëüãéï ãéá ôçí Áðüëáõóç êáé ôçí
Éêáíïðïßçóç ÆùÞò (Quality of life Enjoyment and Sat-
isfaction Questionnaire, Q-LES-Q, Endicott et al 1993).
Ôï åñãáëåßï79 áðïóêïðåß íá ðñïóöÝñåé ìéá áîéïëüãç-
óç ðïõ íá åßíáé áðëÞ êáé åýêïëç óôç ÷ñÞóç, ó÷åôéêÜ
ìå ôç äõíáôüôçôá ôïõ áóèåíïýò íá áðïëáìâÜíåé ôç æùÞ
êáé íá íïéþèåé éêáíïðïßçóç. ÐáñÝ÷åé 8 óõíïëéêÝò âáè-
ìïëïãßåò, ðïõ áíôéóôïé÷ïýí óôïõò êÜôùèé ôïìåßò: óù-
ìáôéêÞ õãåßá, óõíáéóèçìáôéêÞ äéÜèåóç, åëåýèåñïò ÷ñü-
íïò êáé øõ÷áãùãßá, êïéíùíéêÝò ó÷Ýóåéò êáé ãåíéêüôåñåò
äñáóôçñéüôçôåò.
5.4.2. Êëßìáêá Ðïéüôçôáò ÆùÞò Smithkline Beecham
(Smithkline Beecham Quality of Life Scale, SBQOL, Sto-
Ì. ÏÉÊÏÍÏÌÏÕ êáé óõí
ker et al 1992). Ôï åñãáëåßï80 Ý÷åé äçìéïõñãçèåß áðï-
êëåéóôéêÜ ãéá ôçí áîéïëüãçóç áóèåíþí ìå óõíáéóèçìáôé-
êÝò äéáôáñá÷Ýò. Ïé ôïìåßò ðïõ åëÝã÷ïíôáé ðåñéëáìâÜíïõí
øõ÷éêÞ åõåîßá, óùìáôéêÞ åõåîßá, êïéíùíéêÝò ó÷Ýóåéò, äñá-
óôçñéüôçôåò, åíäéáöÝñïíôá, äéÜèåóç, áõôïÝëåã÷ï, ëåé-
ôïõñãéêüôçôá óôï óåîïõáëéêü ôïìÝá, åñãáóßá, áðáó÷ü-
ëçóç, èñçóêåõôéêÝò ðåðïéèÞóåéò, ïéêïíïìéêÜ èÝìáôá. Ï
áóèåíÞò Ý÷åé ôç äõíáôüôçôá íá áðáíôÞóåé ìå âÜóç (á)
ðþò áíôéëáìâÜíåôáé ôïí åáõôü ôïõ óôïí ðáñüíôá ÷ñüíï,
(â) ôïí éäáíéêü åáõôü ðïõ èá åðéèõìïýóå íá Ý÷åé êáé (ã)
ôïí «Üññùóôï» åáõôü.
5.4.3. Êëßìáêá Ðïéüôçôáò ÆùÞò ãéá ôçí ÊáôÜèëéøç
(Quality of Life in Depression Scale, QLDS, Hunt &
McKenna 1992). Ôï åñãáëåßï81 äçìéïõñãÞèçêå ãéá íá
áîéïëïãÞóåé ôçí åðßðôùóç ôçò êáôÜèëéøçò óôçí ðïéüôç-
ôá æùÞò ôùí áóèåíþí. ÅëÝã÷ïíôáé 6 ôïìåßò: ïéêéáêÝò äñá-
óôçñéüôçôåò, äéáðñïóùðéêÝò ó÷Ýóåéò, êïéíùíéêÞ æùÞ,
ãíùóôéêÞ ëåéôïõñãéêüôçôá, ðñïóùðéêÞ õãéåéíÞ, åëåýèå-
ñïò ÷ñüíïò êáé øõ÷áãùãßá.
Ãåíéêþò, ç ðëåéïíüôçôá ôùí áîéïëïãéêþí ïñãÜíùí ðïõ
Ý÷ïõí áíáðôõ÷èåß ãéá ôçí åêôßìçóç ôçò ðïéüôçôáò æùÞò
óôçí øõ÷éêÞ õãåßá ðåñéëáìâÜíïõí ëÞììáôá, ðïõ ôï ðå-
ñéå÷üìåíü ôïõò áíáöÝñåôáé óå ïñéóìÝíåò ðëåõñÝò ôçò óù-
ìáôéêÞò, óõíáéóèçìáôéêÞò êáé êïéíùíéêÞò ëåéôïõñãéêüôç-
ôáò. ÅðéðëÝïí, ùò äåßêôçò ôçò ëåéôïõñãéêÞò áíéêáíüôçôáò
ôïõ áôüìïõ ÷ñçóéìïðïéåßôáé óõ÷íÜ ï áñéèìüò ôùí çìå-
ñþí êáôÜ ôéò ïðïßåò ôï Üôïìï åßíáé áíßêáíï íá ëåéôïõñ-
ãÞóåé éêáíïðïéçôéêÜ óôçí êáèçìåñéíÞ ôïõ æùÞ.3,59,82–84
Åðßóçò, óõìðåñéëáìâÜíïíôáé óõíÞèùò Ýíá Þ äýï ëÞì-
ìáôá ìå ãåíéêü ðåñéå÷üìåíï, ðïõ áðïóêïðïýí óå ìéá
óöáéñéêÞ åêôßìçóç ôçò ðïéüôçôáò æùÞò êáé ôçò ãåíéêÞò
êáôÜóôáóçò ôçò õãåßáò ôïõ áóèåíïýò.3,59
ÐïëëÜ, ðÜíôùò, åßíáé ôá ìåèïäïëïãéêÜ æçôÞìáôá ðïõ
ðñÝðåé íá áðáó÷ïëÞóïõí ôïõò ìåëåôçôÝò ôçò ðïéüôçôáò
æùÞò, üðùò åðéóçìáßíåôáé áðü ôïí Santorius (1997).85
Áðü ôéò åðéóçìÜíóåéò áõôÝò, èåùñïýìå üôé ïé ðëÝïí óç-
ìáíôéêÝò åßíáé áõôÝò ðïõ êáôáäåéêíýïõí ôçí áíÜãêç:
– Áðëïðïßçóçò ôùí ïñãÜíùí, þóôå íá ìðïñïýí íá ÷ñç-
óéìïðïéçèïýí áðü ôïõò åðáããåëìáôßåò õãåßáò êáé ü÷é
ìüíï áðü åîåéäéêåõìÝíïõò åñåõíçôÝò
– ÁíÜðôõîçò êïéíÜ ðáñáäåêôþí åñãáëåßùí, äåäïìÝíïõ
üôé ç Ýñåõíá áêüìá ðÜó÷åé áðü äéáöùíßåò ùò ðñïò
ôéò ìåèüäïõò ðñïóÝããéóçò êáèþò êáé áðü ôçí Ýëëåé-
øç ïñéóìïý ôùí åííïéþí
– Äçìéïõñãßáò Ýãêõñùí äéáðïëéôéóìéêþí ïñãÜíùí
– Âåëôßùóçò ôùí ìåèüäùí ìÝôñçóçò ôçò ðïéüôçôáò æù-
Þò ôùí áôüìùí ðïõ äåí ìðïñïýí íá åðéêïéíùíÞóïõí
ìå ôï óõíïìéëçôÞ-åêôéìçôÞ
ÐÏÉÏÔÇÔÁ ÆÙÇÓ ÊÁÉ ØÕ×ÉÊÇ ÕÃÅÉÁ 251

– Åêôßìçóçò ôçò ðïéüôçôáò æùÞò üëùí üóùí åìðëÝêï-
íôáé óôç èåñáðåõôéêÞ äéáäéêáóßá, äçëáäÞ ôïõ áóèå-
íïýò, ôçò ïéêïãÝíåéáò êáé ôùí åðáããåëìáôéþí õãåßáò
– Åýñåóçò ôñüðùí åíóùìÜôùóçò ôçò åêôßìçóçò ôçò ðïé-
üôçôáò æùÞò óå Üëëá áîéïëïãéêÜ üñãáíá, ðïõ ÷ñçóé-
ìïðïéïýíôáé ãåíéêüôåñá óôï ÷þñï ôçò õãåßáò.
ÅîÜëëïõ, ç ðñüêëçóç ãéá ôïõò åðáããåëìáôßåò øõ÷é-
êÞò õãåßáò åßíáé íá èåùñçèåß ç Ýííïéá ôçò ðïéüôçôáò
æùÞò êåíôñéêü êñéôÞñéï ãéá ôçí åðéôõ÷ßá êÜèå ðáñÝìâá-
óçò ðïõ óôï÷åýåé óôç âåëôßùóç ôçò øõ÷éêÞò õãåßáò. ¸-
ôóé ìüíï èá óõìâÜëåé óôçí áíáâÜèìéóç ôçò ðïéüôçôáò
ôçò öñïíôßäáò ôùí øõ÷éêÜ áóèåíþí, áëëÜ êáé óôçí ðñï-
óðÜèåéá ãéá ìéá ðéï áíèñþðéíç êïéíùíßá ãåíéêüôåñá.

ABSTRACT

Quality of life and mental health. Conceptional approaches

and clinical and assessment issues
M. ECONOMOU, M. KOKKOSIS, E. TRÉANTAFILLOU, G. CHRISTODOULOU
Department of Psychiatry, University of Athens, School of Medicine,
Eginition Hospital, Athens, Greece
Archives of Hellenic Medicine 2001, 18(3):239–253
In the last two decades, there has been an increased interest in the field of quality of life (QïL) in medicine in general and
more recently in relation to mental disorders. The term quality of life refers to a loosely related body of work on psycho-
logical well-being, social and emotional functioning, health status, functional performance, life satisfaction, social support
and standard of living for which normative, objective and subjective indicators of physical, mental, social and emotional
functioning are all used. Although definitions vary, the “quality of life” concept encompasses three overarching dimen-
sions: (a) what a person is capable of doing (functional status), (b) access to resources and opportunities to use these a-
bilities to pursue interests, and (c) the sense of well-being. The first two dimensions are often referred to as objective QoL
and the latter as subjective QoL. Within these dimensions, certain life domains have been identified, such as health, fam-
ily, social relations, work, financial status and living situation, giving to the QoL concept a complex notion. Current re-
search interest has focused on the QoL of people with chronic mental illnesses and primarily schizophrenia, mainly be-
cause of the social and economic impacts which these disabling conditions have on patients, their families and the com-
munity. Most of the studies showed that patients with severe chronic mental illness have an impoverished QoL. In the case
of depression it seems that depression and reduced QoL are tautological concepts. In the case of anxiety disorders there
is growing evidence of substantial impairment in the subjective quality of life, objective functioning and environmental cir-
cumstances in this population. The nature of the impairment in QoL, however, shows some variation depending on the
particular disorder. Over the past decade, several measures have been developed to assess the QoL of persons with men-
tal illness, in particular severe and persistent psychoses but more recently also those with depression and anxiety disorders.
QoL assessments can prove useful in assessing needs, developing intervention strategies and evaluating outcomes of in-
terventions at both the system and individual patient levels.

Key words:: Ássessment, Mental health, Quality of life

Âéâëéïãñáößá
1. ÌÅÔÁÖÑÁÓÔÉÊÇ ÏÌÁÄÁ ÊÁÊÔÏÕ. ÁñéóôïôÝëçò ¢ðáíôá-ÇèéêÜ Íé-
êïìÜ÷åéá 1. ÊÜêôïò, ÁèÞíá, 1993, 7:31–39
2. ÌÅÔÁÖÑÁÓÔÉÊÇ ÏÌÁÄÁ ÊÁÊÔÏÕ. ÁñéóôïôÝëçò ¢ðáíôá-ÇèéêÜ Íé-
êïìÜ÷åéá 1. ÊÜêôïò, ÁèÞíá, 1993, 7:51
3. FAYERS PM, MACHIN D. Quality of Life-Assessment, Analysis and
Interpretation. John Wiley & Sons Ltd, West Sussex England,
2000:3–5
4. KATSCHNIG H. How useful is the concept of quality of life in
psychiatry? In: Katschnig H, Freeman H, Santorius N (eds) Qual-
ity of Life in Mental Disorders. John Wiley & Sons Ltd, West Sus-
sex England, 1997:3–7
5. McCALL S. Quality of life. Social Indicators Research 1975, 2:
229–248
6. BAKER F, INTAGLIATA J. Quality of life in the evaluation of com-
munity support systems. Evaluation and Program Planning 1982,
5:71–72
7. ZAUTRA A, GOODHART D. Quality of life indicators: A review of the
literature. Commun Mental Health Rev 1979, 4:1–10
8. LEHMAN AF. Instruments for measuring quality of life in mental ill-
ness. In: Katschnig H, Freeman H, Sartorius N (eds) Quality of
Life in Mental Disorders. John Wiley & Sons Ltd, West Sussex
England, 1997:79–80
9. JAHODA M. Current Concepts of Positive Mental Health. Basic
Books, New York, 1958
10. ELKINTON J. Medicine and the quality of life. Ann Intern Med 1966,
64:711–714
252
11. KATSCHNIG H, ANGERMEYER MC. Quality of life in depression. In:
Katschnig H, Freeman H, Sartorius N (eds) Quality of Life in Men-
tal Disorders. John Wiley & Sons Ltd, West Sussex England,
1997:137–148
12. LEHMAN AF. Instruments for measuring quality of life in mental ill-
ness. In: Katschnig H, Freeman H, Sartorius N (eds) Quality of
Life in Mental Disorders. John Wiley & Sons Ltd, West Sussex
England, 1997:84–85
13. LEHMAN AF. A quality of life interview for the chronically mental-
ly ill (QOLI). Eval Prog Planning 1988, 11:51–62
14. ÆÇÓÇ Á. Äåßêôåò áîéïëüãçóçò ôïõ áðïôåëÝóìáôïò ôùí øõ÷ï-
êïéíùíéêþí ðáñåìâÜóåùí óå ÷ñüíéïõò øõ÷éêÜ ðÜó÷ïíôåò.
Øõ÷éáôñéêÞ 1999, 10:197–202
15. LEHMAN AF, WARD NC, LINN LS. Chronic mental patients: The qual-
ity of life issue. Am J Psychiatry 1982, 139:1271–1276
16. CAMPBELL A, CONVERSE PE, RODGERS WL. The Quality of American
Life. Russell Sage, New York, 1976
17. ANDREWS FM, WÇITÍEY SB. Social Indicators of Well-being. America’s
Perception of Life Quality. Plenum Press, New York, 1976:1–24
18. ANGERMEYER MC, KILIAN R. Theoretical models of quality of life for
mental disorders. In: Katschnig H, Freeman H, Sartorius N (eds)
Quality of Life in Mental Disorders. John Wiley & Sons Ltd, West
Sussex England, 1997:20–29
19. BIGELOW DA, BRODSKY G, STEWART L, OLSON MM. The concept and
measurement of quality of life as a dependent variable in evalu-
ation of mental health services. In: Stahler GJ, Tash WR (eds)
Innovative Approaches to Mental Health Evaluation. Academic
Press Inc, New York, 1982:345–366
20. MASLOW AH. Motivation and Personality. Harper & Row, New
York, 1954
21. CAZENEUVE J, VICTOROFF D (ÅëëçíéêÞ ÌåôÜöñáóç: N. Øõñïý-
êçò). ÂáóéêÜ ÈÝìáôá ôçò Êïéíùíéïëïãßáò êáé Êïéíùíéïëïãéêü
Ëåîéêü. Åêäüóåéò Êáóôáíéþôç-Åðéêáéñüôçôá, ÁèÞíá, 1988:
143–147
22. WIERSMA D. Role functioning as a component of quality of life in
mental disorders. In: Katschnig H, Freeman H, Sartorius N (eds)
Quality of Life in Mental Disorders. John Wiley & Sons Ltd, West
Sussex England, 1997:46–49
23. PARSONS T. The Social System. Free Press, Glencoe, IL, 1951
24. ESTROFF SE. Making it Crazy. An Ethnography of Psychiatric Clien-
ts in an American Community. University of California Press,
Berkeley, CA, 1989
25. BIGELOW DA, McFARLAND BH, OLSON MM. Quality of life of com-
munity mental health program clients: Validating a measure.
Commun Ment Health J 1991, 27:43–55
26. ÆÇÓÇ Á. Äåßêôåò áîéïëüãçóçò ôïõ áðïôåëÝóìáôïò ôùí øõ÷ï-
êïéíùíéêþí ðáñåìâÜóåùí óå ÷ñüíéïõò øõ÷éêÜ ðÜó÷ïíôåò.
Øõ÷éáôñéêÞ 1999, 10:202–203
27. BARRY MM. Well-being and life satisfaction as components of
quality of life in mental disorders. In: Katschnig H, Freeman H,
Sartorius N (eds) Quality of Life in Mental Disorders. John Wiley
& Sons Ltd, West Sussex England, 1997:31–42
28. ZISSI A, BARRY MM, COCHRANE R. A mediational model of quality of
life for individuals with severe mental health problems. Psychol
Med 1998, 28:1221–1229
29. SKANTZE K, MALM U, DENCKER SJ, MAY PR. Quality of life in schizo-
phrenia. Nord Psykiatr Tidsskr 1990, 44:71–75
Ì. ÏÉÊÏÍÏÌÏÕ êáé óõí
30. SKANTZE K, MALM U. A new approach to facilitation of working
alliances based on patients’ quality of life goals. Nord Psykiatr
Tidsskr 1994, 48:37–55
31. LEHMAN AF, POSTRADO LT, RACHOBA LT. Convergent validation of
quality of life assessment for persons with severe mental illness.
Qual Life Res 1993, 2:327–333
32. BROWNE S, ROE M, LANE A, GERVIN M, MORRIS M, KINSELLA A ET AL.
Quality of life in schizophrenia: Relationship to sociodemo-
graphic factors, symptomatology and tardive dyskinesia. Acta
Psychiatr Scand 1996, 94:118–124
33. KEMMLER G, HOLZNER B, NEUDORFER CH, SCHWITZER J, MEISE U. What
constitutes overall life satisfaction of chronic schizophrenic out-
patients? Results of a pilot study using the Lancashire Quality of
Life Profile. Qual Life Res 1995, 4:445–446
34. SHEPHERD G, MUIZEN M, DEAN R, COONEY M. Residential care in hos-
pital and in the community-quality of care and quality of life. Br
J Psychiatry 1996, 168:448–456
35. AWAD AG, VORUGANTI LNP, HESLEGRAVE RJ. A conceptual model of
quality of life in schizophrenia: Description and preliminary clin-
ical validation. Qual Life Res 1997, 6:21–26
36. MELTZER HY. Dimensions of outcome with clozapine. Br J Psychi-
atry 1992, 160(Suppl 17):46–53
37. NABER D. Subjective effects of neuroleptic drugs. Relationships to
compliance and quality of life. In: Quality of Life and Disabilities
in Mental Disorders. Abstract Association of the European Psychi-
atrists, Vienna, 1994:104
38. BODES J, GONZALEZ MP, WALLACE DH, DOUSONO M, SAIZ PA. Quality
of life instruments in schizophrenia: a comparative study. Eur
Psychiatry 1996, 11(Suppl 4):228–232
39. SULLIVAN GS, WELLS KB, LEAKE B. Clinical factors associated with
better quality of life in a seriously mentaly ill population. Hosp
Comm Psychiatry 1992, 43:794–798
40. THORNICROFT G, GOOCH C, O’DRISCOLL C, REDA S. The TAPS Project:
The reliability of the Patient Attitude Questionnaire. In: Leff J (ed)
Evaluating community placement of long-stay psychiatric patien-
ts. Br J Psychiatry 1993, 162(Suppl 19):25–29
41. BARRY MM, CROSBY C. Quality of life as an evaluative measure in
assessing the impact of community care on people with long-
term psychiatric disorders. Br J Psychiatry 1996, 168:210–216
42. BAKER F, INTAGLIATA J. Quality of life in the evaluation of com-
munity support systems. Eval Prog Planning 1982, 5:69–70
43. SULLIVAN G, WELLS KB, LEAKE B. Quality of life of seriously mental-
ly ill persons in Mississippi. Hosp Comm Psychiatry 1991, 4:752–
755
44. HERMAN H, SCHOFIELD H, MURPHY B, SINGH B. The experiences and
quality of life of informal caregivers. In: Orley J (ed) Quality of
Life Assessment: International Perspectives. Springer, Berlin, 1994:
131–150
45. JOHNSON DL. The family’s experience of living with mental illness.
In: Lefley HP, Johnson DL (eds) Families as Allies in the Treatment
of the Mentally Ill. American Psychiatric Press, Washington DC,
1990:31–64
46. ATKINSON J. Survey Report. National Schizophrenia Society, Lon-
don, 1988
47. KATSCHNIG H, KRAMER B, SIMON MD. Austrian Questionnaire Survey
of Relatives of the Mentally iII. Ludwig-Boltzmann Institute for
Social Psychiatry, Vienna, Austria, 1993
ÐÏÉÏÔÇÔÁ ÆÙÇÓ ÊÁÉ ØÕ×ÉÊÇ ÕÃÅÉÁ
48. HOGMAN G. European Questionnaire Survey of Carers. European
Federation of Families of the Mentally iII (EUFAMI), Heverlee,
Belgium, 1994
49. HEALTH-RELATED QUALITY OF LIFE IN PRIMARY CARE PATIENTS WITH
MENTAL DISORDERS. Results from the PRIME-MED 1000 Study,
1995, 19:1511–1518
50. BRAZIER JE, HASPER R, JONES NMB, O’CATHAIN A, THOMAW KJ, VSHER-
WOOD T ET AL. Validating the SF-36 Health Survey Questionnaire:
new outcome measure for primary care. Br Med J 1992, 305:
160–164
51. ORMEL J, VON KORFF M, USTUN TB, PINI S, KOZTEN A, OLDHINKEL T.
Common mental disorders and disability across cultures results
from the WHO Collaborative Study on Psychological Problems
in General Health Care. JAMA 1994, 272:1741–1748
52. WELLS KB, STEWARD A, HAYS RD, BURNAM A, ROGERS W, DANIELS M ET
AL. The functioning and well-being of depressed patients: Results
from the Medical Outcomes Study. JAMA 1988, 262:914–919
53. WELLS KB, BURNAM MA, ROGERS W, HAYS R, CAMP P. The course of
depression in adult outpatients. Results from the Medical Out-
comes Study. Arch Gen Psychiatry 1992, 49:788–794
54. MAURO V, MENDLOWICZ MD, MURRAY B, STEIN MD. Quality of life in
individuals with anxiety disorders. Am J Psychiatry 2000, 157:
669–682
55. KESSLER RC, FRACK RG. The impact of psychiatric disorders on work
loss days. Psychol Med 1997, 27:861–873
56. SHERBOURNE CD, WELLS KB, JUDD LL. Functioning and well-being of
patients with panic disorder. Am J Psychiatry 1996, 153:213–218
57. HOLLIFIELD M, KATON W, SKIPPER B, CHAPMAN T, BALLENGER JC, MAN-
NUZZA S ET AL. Panic disorder and quality of life: variables pre-
dictive of functional impairment. Am J Psychiatry 1997, 154:766–
772
58. KORAN LM, THIENEMANN ML, DAVENPORT R. Quality of life for
patients with obsessive-compulsive disorder. Am J Psychiatry
1996, 153:783–788
59. ANDERSON RT, AARONSON NK, WILKIN D. Critical review of inter-
national assessments of health-related quality of life. Qual Life
Res 1993, 2:369–395
60. DONEBADIAN A. The quality of care. How can it be assessed? J Am
Med Assoc 1988, 260:1743–1748
61. SPILKER B, MOLINEK FR Jr, JOHNSON KA, SIMPSON RL Jr, TILSON HH.
Quality of life bibliography and indexes. Med Care 1990, 28
(Suppl 12):DS1–DS77
62. COX DR, FITZPATRICK R, FLETCHER AE, GORE SM, SPIEGELHALTER DJ,
JONES DR. Quality of life assessment: can we keep it simple? J Roy
Stat Soc Ser A 1992, 155:353–393
63. STEIN LI, TEST MA. Alternative to mental hospital treatment: I. Con-
ceptual model treatment program and clinical evaluation. Arch
Gen Psychiatry 1980, 37:392–397
64. HOULT J, REYNOLDS J. Schizophrenia; A comparative trial of com-
munity oriented and hospital oriented psychiatric care. Acta
Psychiatr Scand 1984, 69:350–372
65. MALM U, MAY PRA, DENCKER SJ. Evaluation of the quality of life of
the schizophrenic outpatient: A checklist. Schizophr Bull 1981,
7:477–487
66. BAKER F, INTAGLIATA J. Quality of life in the evaluation of com-
munity support systems. Eval Prog Planning 1982, 5:69–79
67. JOHNSON PJ. Emphasis on quality of life of people with severe
mental illness in community based care in Sweden. Psychosoc
Rehabil J 1991, 14:23–37
253
68. BIGELOW DA, YOUNG DJ. Effectiveness of a care management pro-
gram. Commun Ment Health J 1991, 27:115–123
69. MECHANIC D, McALPINE D, ROSENFIELD S, DAVIS D. Effects of illness
attribution and depression on the quality of life among persons
with serious mental illness. Soc Sci Med 1994, 39:155–164
70. LEHMAN AF, RACHUBA LT, POSTRADO LT. Demographic influences on
quality of life among persons with chronic mental illness. Eval
Prog Planning 1995, 18:155–164
71. COLDSTROM ID, MANDERSCHEID RW. The chronically mentally ill. A
descriptive analysis from the Uniform Client Data Instrument.
Comm Supp Serv J 1986, 2:4–9
72. CAMBELL J, SCHRAIBER R. The Well-Being Project. Mental Health
Clients Speak for Themselves. California Network of Mental
Health Clients, Sacramento, CA, 1989
73. OLIVER JPJ. The social care directive-development of quality of life
profile for use in community services for the mentally ill. Soc
Work Sc Rev 1991, 3:5–45
74. OLIVER J, HUXLEY P, BRIDGES K, MOHAMAD H. Quality of Life and
Mental Health Services. Routledge, London, 1996
75. SKANTZE K. Defining Subjective Quality of Life Self-Assessment
Inventory (QLS-100). A New Approach to Successful Alliance and
Service Development. Department of Psychiatry, Sahgrenska
Hospital, University of Gothenburg, Sweden, 1993
76. BECKER M, DIAMOND R, SAINFORT F. A new patient focused index for
measuring quality of life in persons with severe and persistent
illness. Qual Life Res 1993, 2:239–251
77. HOLCOMB WR, MORGAN P, ADAMS NA, PONDER H, FARREL M. Devel-
opment of a structural interview scale for measuring quality of
life of the severely mentally ill. J Clin Psychol 1993, 49:830–840
78. HEINRICHS DW, HANLON ET, CARPENTER WT Jr. The Quality of Life
Scale–an instrument for rating the schizophrenic deficit syn-
drome. Schizophr Bull 1984, 10:388–398
79. ENDICOTT J, NEE J, HARRISON W, BLUMENTHAL R. Quality of life enjoy-
ment and satisfaction questionnaire; A new measure. Psy-
chopharmacol Bull 1993, 29:321–326
80. STOKER MJ, DUNBAR GC, BEAUMONT G. The Smithkline Beecham
Quality of Life Scale: A validation and reliability study in patien-
ts with affective disorder. Qual Life Res 1992, 1:385–395
81. HUNT SM, McKENNA SP. A new measure of quality of life in depres-
sion: testing the reliability and construct validity of the QLDS.
Health Policy 1992, 22:321–330
82. GUYATT GH, FEENY DH, PATRICK DL. Measuring health-related qual-
ity of life. Ann Intern Med 1993, 118:622–629
83. FAYERS PM, HAND DJ, BJORDAL K, GROENVOLD M. Casual indicators
in quality of life research. Qual Life Res 1997, 6:393–406
84. STEWART AL, GREENFILED S, WARE JE Jr, HAYS RD. Functional status and
well-being of patients with chronic conditions: Results from the
Medical Outcomes Study. JAMA 1989, 262:907–913
85. SARTORIUS N. Quality of life and mental disorders: A global per-
spective. In: Katschnig H, Freeman H, Sartorius N (eds) Quality
of Life in Mental Disorders. John Wiley & Sons, West Sussex Eng-
land, 1997:319–328
Corresponding author:
M. Economou, Department of Psychiatry, University of Athens,
School of Medicine, Eginition Hospital, Athens, Greece