• John Brazier, Janice Connell, Diana Papaioannou, Clara Mukuria, Brendan Mulhern, Tessa Peasgood, Myfawnwy Lloyd Jones, Suzy Paisley, Alicia O'Cathain, Michael Barkham, Martin Knapp, Sarah Byford, Simon Gilbody, and Glenys Parry.
• Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
• Health Technol Assess. 2014 May 1; 18 (34): vii-viii, xiii-xxv, 1-188.

BackgroundGeneric preference-based measures of health like the EQ-5D and SF-6D(®) are increasingly being used in economic evaluation and outcome assessment. However, there are concerns as to whether or not these generic measures are appropriate for use in people with mental health problems.ObjectivesThe EQ-5D and SF-36(®) (including its derivatives the SF-12(®) and SF-6D) were assessed using the psychometric criteria of validity and responsiveness using quantitative and qualitative methods. Another aim was to estimate mapping functions between the EQ-5D and SF-6D and condition-specific measures, where appropriate.DesignFour studies were undertaken to examine the appropriateness of the measures: (1) a systematic review of quantitative evidence on validity and responsiveness; (2) a further quantitative assessment of these criteria using existing data sets; (3) a review of qualitative research on the quality of life of people with mental health problems; and (4) qualitative semistructured interviews of people with a full range of problems. A fifth study estimated mapping functions between mental health-specific measures and the EQ-5D and SF-6D.SettingA choice of venue was offered for the interviews including the participant's own home, a room at the university or a centre frequently used by mental health services.ParticipantsThe interviews were undertaken with 19 people with a broad range of mental health problems at varying levels of severity.Main Outcome MeasuresThe reviews included the EQ-5D and SF-36 (and the SF-12 and SF-6D). The psychometric analysis included the Hospital Anxiety and Depression Scale (HADS), Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), Generalised Anxiety Disorder Assessment (GAD-7), General Health Questionnaire (GHQ-12) and Patient Health Questionnaire (PHQ-9).Results(1) and (2) The EQ-5D and SF-36 achieved an adequate level of performance in depression, and to some extent in anxiety and personality disorder. Results from the psychometric analyses in schizophrenia and bipolar disorder have been more mixed. (3) A framework analysis of 13 studies identified six major themes. (4) The interview data fitted the themes from the review well and resulted in minor modifications to the themes. The final set of themes comprised: well-being and ill-being; control, autonomy and choice; self-perception; belonging; activity; hope and hopelessness; and physical health.ConclusionsThe EQ-5D and SF-36 achieved mixed results in the quantitative testing against psychometric criteria. The qualitative analysis suggests this is because they provide a very limited coverage of themes identified by people with mental health problems. Recommendations for future work include the development of new preference-based measures in mental health that are based on, or substantially revise, an existing measure.FundingThe Medical Research Council.

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