Lars Hansson

Objective:  The objective of this article was to review some methodological issues in this field and give an overview of empirical research findings with a special focus on factors associated with or affecting subjective quality of life in people with a severe mental illness.Method:  A selective review of relevant scientific literature on quality of life in severe mental illness was conducted.Results:  Subjective quality of life in people with a severe mental illness is only to a lesser extent related to external life conditions. Major determinants are psychopathology, especially symptoms of depression and anxiety, and aspects of the social network. Personality related factors such as self‐esteem are also influential. Comparative studies have further shown that patients in community care settings have a better subjective quality of life than patients in hospital settings.Conclusion:  Efforts to improve subjective quality of life in people with severe mental illness should include a careful monitoring of depressive and anxiety symptoms, and pay particular attention to assessment of and interventions against unmet needs. Further, such interventions should stress a strengthening of the social support of the clients. It is also important to pay attention to mediators of changes in subjective quality of life such as self‐esteem, mastery, autonomy, and self‐efficacy.

Empowerment has become a widespread concept in various social policy contexts referring to different marginalized groups. Empowerment has also been focused within the mental health field although little empirical research exists. The aim of the present study was to investigate internal consistency and construct validity of the Swedish version of an empowerment scale developed for people with a mental illness, Making Decisions. Ninety‐two persons were subject to an interview also comprising assessments of quality of life, needs for care, psychiatric symptoms, psychosocial functioning, aspects of the social network, rejection experiences and attitudes of devaluation/discrimination towards people with mental illness. The results showed that the overall scale and the subscales had a good internal consistency, except for the subscale power–powerlessness. A factor analysis revealed two superordinate factors, self‐esteem and activism and community and power, with a satisfactory internal consistency. These two factors showed a good construct validity with expected associations to validation measures. Stigma was most markedly associated with self‐esteem and activism, and a higher level of education was most strongly associated with community and power. In conclusion, the Swedish version Making Decisions may well be used in further studies of empowerment among people with a mental illness.