7-APPLICATION AND RESULTS OF THE MANCHESTER SHORTASSESSMENT OF QUALITY OF LIFE (MANSA)

S. PRIEBE,P.HUXLEY,S.KNIGHT &S. EVANSSUMMARY
BasedBackgroundexperiences 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 havebeen tested in a sample of community care patients.
Method Fifty-five randomly selected patients on the Care Programme Approachwere interviewed using the LQLP, the MANSA and the Brief Psychiatric Rating
Scale.
Results Correlations between subjective quality of life scores on MANSA andLQLP 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 wasin 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 psychometricproperties appear satisfactory.
onINTRODUCTION
In the last 10 years, quality of life in people with mental illness has become a popularconstruct 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 andwith life domains plays a central role and is assessed on Likert type self rating scales (Orleyet al. 1998).
Based on Lehman’s original work in the US, Oliver et al. (1991/92) established theLancashire Quality of Life Profile (LQLP) which has been widely used in Europe (Priebeet 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 andtreatment settings eft al. 1997; Kaiser et al. 1997; Priebe al. 1998a,b), and to besensitive 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 approximately 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 byDownloaded from http://isp.sagepub.com at BASILDON HOSPITAL on March 24, 2010

8specific scales; most importantly, there are many items in the LQLP that have not been foundto be relevant for discriminating between samples or for demonstrating change. Regarding
the objective variables, there are various items with insufficient variance. In addition, there isno 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 inthe 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 byquestion 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 theresults 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 totake into account all of the above mentioned shortcomings (see Appendix and Priebe et al. inpress 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’
more than one

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 andworking hours per week; monthly income; state benefits; living situation including number ofchildren, 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 thesequestions are termed objective and to be answered with yes or no. Twelve questions arestrictly subjective. The objective items assess the existence of a &dquo;close friend&dquo;, number ofcontacts 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 employment, or training/education, or unemployment/retirement), financial situation, number andquality of friendships, leisure activities, accommodation, personal safety, people that thepatient lives with (or living alone), sex life, relationship with family, physical health, andmental health. A manual outlines explanation of questions and their operationalisation (alsosee 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 managementby the School of Psychiatry at the University of Manchester. Local authorities were asked toselect at random approximately 20 patients aged between 18 and 65 who are on the Care

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9Programme Approach and receiving services under the Community and Mental Healthlegislation. For the purpose of this study, quality of life was assessed in all patients who wereinterviewed in three localities, i.e. two inner city and one metropolitan borough using theLQLP as well as the MANSA. Psychopathology was assessed on the 24 item version ofthe Brief Psychiatric Rating Scale (BPRS; Ventura et al. 1993). All interviews were doneby 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 visitedor been visited by a friend within the last week. Two patients each reported having beenaccused 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) and5.18 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 wasr-0.49 (p < 0.001) and with the BPRS sub score anxiety/depression r-0.42
in<Cronbach’sforthesatisfaction
MANSA
was0.74.
(p 0.01).
alpharatings==

Table 1
Correlations between satisfaction ratings onLQLP 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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10DISCUSSION
The high correlations of MANSA and LQLP scores suggest a concurrent validity for theMANSA 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, theMANSA appears a viable and valid instrument to obtain condensed and accurate quality oflife 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 andmethodological 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 symptomrelated. 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 tobe assessed.
In evaluative studies, psychopathology should be assessed and controlled for as aninfluential 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 apriori stated hypotheses, and for generating such hypotheses if mean scores reveal significant
differences.

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12

PRIEBE, S., HUXLEY, P., KNIGHT, S. & EVANS, S. (in press b) The Manchester Short Assessment of Qualityof Life (MANSA). In Priebe, S., Oliver, J. & Kaiser, W. Quality of Life and Mental Health Care. Wrightson
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Professor Stefan Priebe, Department of Psychiatry, St. Bartholomew’s and the Royal London School of Medicine andDentistry, Queen Mary & Westfield College, University of London, UK
Professor Peter Huxley, The Department of Psychiatric Social Work, School of Psychiatry and Behavioural Sciences,
University of Manchester, UK
Susan Knight, The Department of Psychiatric Social Work, School of Psychiatry and Behavioural Sciences,
University of Manchester, UK
Sherrill Evans, The Department of Psychiatric Social Work, School of Psychiatry and Behavioural Sciences,
University of Manchester, UK
Correspondence to Professor Priebe, Academic Unit for Social & Community Psychiatry, East Ham Memorial
Hospital, London, E7 8QR, UK

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