Quality of Life as Medicine: Interventions that Induce Salutogenesis. A Review of the Literature

This paper reviews the medical (salutogenic) effect of interventions that aim to improve quality of life. Review of studies where the global quality of life in chronically ill patients was improved independently of subjective and objective factors (like physical and mental health, yearly income, education, social network, self-esteem, sexual ability and problems or work). The methods used were subtypes of integrative medicine (non-drug CAM) like mind body medicine, body psychotherapy, clinical holistic medicine, consciousness-based medicine and sexology. In about 20 papers on QOL as medicine, in cancer, coronary heart disease, chronic pain, mental illness, sexual dysfunction, low self-esteem, low working ability and poor QOL, the most successful intervention strategy seems to be to create a maternal, infantile bonding induced by a combination of conversation therapy and bodywork. The papers examined the treatments of over 2,000 chronically ill or dysfunctional patients and more than 20 different types of health problems. Global QOL measured by SEQOL, QOL5, QOL1, self-rated physical health, self-rated mental health, self-rated sexual functioning, anorgasmia, genital pain, self-rated working ability, self-rated relation to self, well-being, life-satisfaction, happiness, fulfillment of needs, experience of temporal and spatial domains, expression of life’s potentials, and objective functioning. We found “QOL as medicine” able in the treatment of physical disorders and illnesses including chronic pain (Number Needed to Treat (NNT) = 1–3, Number Needed to Harm (NNH) > 500), in mental illness (NNT = 1–3, NNH > 500), in sexual dysfunctions (NNT = 1–2, NNH > 1,000), self-rated low working ability (NNT = 2, NNH > 500), and self-rated low QOL (NNT = 2, NNH > 2,000). We found that QOL improving interventions helped or cured 30–90% of the patients, typically within one year, independent of the type of health problem. “QOL as medicine” seems to be able in improving chronic mental, somatic and sexual health issues without side effects.     

Construct and Criterion Validity of a Norwegian Instrument for Health Related Quality of Life Among Elderly Women Living at Home

Purpose of the study: The aim of the current study is to validate an instrument consisting of five items and first used in the Nord-Trondelag Health Survey (HUNT-5), as a measure of health related quality of life (QOL) in a population of elderly women living at home. Design and methods: A random sample of 307 women aged 75 years and over (mean 80.8 years, response rate 74.5%) and living at home were interviewed using the HUNT-5 instrument, the 20-question version of the General Health Questionnaire (GHQ-20) and the respondents’ records of their health status and functional ability. Results: No significant relationships were found between age and the sumscores of GHQ-20 and HUNT-5. Factor analysis indicated that HUNT-5 is primarily unidimensional. The Cronbach α for HUNT-5 was 0.79 and that for GHQ-20 was 0.87. The correlation between the HUNT-5 and the GHQ-20 sumscores was 0.75 (p < 0.001). There were significant correlations between some of the health and function items and the two QOL instruments (ranging from 0.14 to 0.68). Implications: This evaluation supports the psychometric validity of HUNT-5 for elderly women living at home. It is important to take into consideration the women’s own experience of their health and functional ability in planning therapy and in obtaining the best possible QOL for them.     

Correlates of wellbeing among African American lesbians

Although there is a growing body of knowledge about health among African American women in general, there is a dearth of information on African American lesbians. The primary purpose of this study was to investigate the correlates of health-related quality of life among African American lesbians using a cross-sectional anonymous survey with topics and measures developed by members of the African American lesbian community. Surveys were completed by 123 English speaking adult women who identified as African American lesbians and were attending the Zuna Institute's National Black Lesbian Conference. Overall, we found a very high health-related quality of life, in spite of a high frequency of health impairments. The average body mass index (BMI) for this sample was 32.2 (SD?=?8.0); 13% were morbidly obese, having a BMI of 40 or more and only 15% of the women were in a healthy weight range; advancing age was associated with poorer physical functioning, decreased physical role functioning, and more pain. Health-related quality of life was associated with depression and spirituality, but not religion. This study highlights the need for subjective measures of health-related quality of life as well as checklists of diseases and disorders.     

Examining the appropriateness of importance weighting on satisfaction score from range-of-affect hypothesis: hierarchical linear modeling for within-subject data

This study examines the range-of-affect hypothesis in a within-subject context using the weighting situation faced in quality of life (QOL) measurement. Data collected in Wu and Yao’s (2006b) study were used (332 undergraduates at National Taiwan University). The mean age was 19.80 years (std = 1.98). They completed a QOL questionnaire and indicated satisfaction, importance, and perceived have–want discrepancy on 12 life domains. Hierarchical linear modeling with a random-coefficients regression model was applied. At the first level (within-individual level), the satisfaction scores for each item were regressed on the have-want discrepancy, importance, and the interaction between have-want discrepancy and importance (have-want discrepancy ×  importance) of the same item. At the second level (between-individual level), the intercept, coefficients of have-want discrepancy, importance and the interaction between have-want discrepancy and importance at the first level were regarded as varying randomly over all participants. Results of this study supported the range-of-affect hypothesis, showing that the relationship between item have-want discrepancy and item satisfaction is stronger for high importance items than low importance items for a given individual. Implications for important weighting on item satisfaction scores were discussed.     

Quality of Life in Macau,China

We report the initial findings of an ongoing, long-term investigation into subjective quality of life in Macau, a Special Administrative Region of China. Data were collected via quarterly public surveys (2007 to 2009; n = 8,230), as part of the Macau Quality of Life Report. The main aims of the study were to: (a) ascertain the public’s satisfaction with life and with the regional situation in Macau; (b) confirm the utility of the International Wellbeing Index (IWI) as a measure of subjective life quality; and (c) contribute to ongoing discussion in the literature on quality of life in China. The data indicated moderate levels of personal (PWI = 64.4; range 63–66.7) and national (NWI = 59.7; 57.4–63.7) wellbeing across the study period, which implies that residents in Macau are generally satisfied with life. The lowest scores were reported in the first quarter of 2009, a period of great economic uncertainty in Macau and the world, but were positioned within the normative range. The IWI demonstrated good psychometric performance, consistent with previous studies in China and the West, which confirmed its utility. These findings are discussed in relation to the IWI’s theoretical underpinnings and the literature.     

Quality of Life Measurement in the Field of Intellectual Disabilities: Eight Principles for Assessing Quality of Life-Related Personal Outcomes

As the concept of quality of life (QOL) has evolved from a theoretical concept to both a measurable construct and an action-oriented change agent in the field of intellectual disabilities, there has emerged a corresponding need to develop, implement, and use a systematic approach to the assessment of domain-referenced quality of life outcomes. The purpose of this article is to suggest eight principles based on published literature and the authors’ experiences that should underlie the assessment of QOL-related personal outcomes in the field of intellectual disabilities. Data from the development of the personal outcomes scale are used to exemplify each principle. The article’s premise is that model development and test construction should work in tandem, and that a ‘quality of life assessment instrument’ should be based on an empirically derived QOL conceptual and measurement framework/model.     

Subjective Quality of Life in Zhuhai City,South China: A Public Survey Using the International Wellbeing Index

The study of subjective quality of life and its connotations in the People’s Republic of China is at a preliminary stage. Although there is an emerging body of literature on this topic, there are few datasets representative of the general public, particularly in Mainland China. This paper reports the findings of a public survey (N = 449) conducted in Zhuhai City, South China using the International Wellbeing Index (IWI). There were four main aims: (1) to judge whether residents were satisfied with their lives; (2) to compare the data with recent findings from Hong Kong and Macau; (3) to investigate the equivalence of the IWI in terms of its psychometric properties; and (4) to determine the applicability of the ‘Theory of Homeostasis Wellbeing’. The data indicated a moderate level of personal (PWI score = 64.4.) and national (NWI score = 57.4) wellbeing, consistent with recent findings from Hong Kong and Macau. The PWI score was within the normative range for non-Western countries, which indicates that the residents were, on the whole, satisfied with their lives. Although previously reported objective measures of quality of life in Zhuhai are lower than in Hong Kong and Macau, this is not reflected in this study’s subjective measures. This finding was interpreted in terms of the ‘Theory of Subjective Wellbeing Homeostasis’, and the specific situation in Zhuhai, as there seems to be an absence of factors (i.e., no harsh economic or social situation) which could drive subjective wellbeing below normal. Last, that the IWI demonstrated good psychometric performance in terms of its reliability, validity, and sensitivity, and concurred with previous published reports, it seems that the scale’s robustness generalises to Chinese samples.     

Health-Related Quality of Life Among Abused Women One Year After Leaving a Violent Partner

This is the first follow up study measuring quality of life among abused women who have left their abusive partner. The women (n = 22) answered a questionnaire while staying at women’s shelter and one year later. The aim was to examine long-term effects of intimate partner violence against women on health-related quality of life. Health-related quality of life was measured using the SF-36 Health Survey and the WHOQOL-BREF. The meantime for living in a violent partnership was 11 years, most of the women had children under 10 years living with them, low income and were on sickness absence or disability pension. About half of the women had experienced threats of violence and 6 had experienced violent acts after leaving their partner. SF-36 scores after one year were significantly better in vitality (t-test, P < 0.001), mental health (t-test P < 0.001) and social domains (t-test, P < 0.04). WHOQOL-BREF scores did not change significantly from baseline, showing that the SF-36 showed more responsiveness in this population. Regression analysis showed that serious physical violence reported at baseline predicted significantly less improvement in physical and mental health and role-emotional in the SF-36 and in social relationships and environmental health in the WHOQOL-BREF. High psychological violence at baseline predicted significantly less improvement in mental health in the SF-36 and in social relationships and environmental health in the WHOQOL-BREF.     

An Exploratory Analysis of Societal Preferences for Research-Driven Quality of Life Improvements in Canada

Research in the humanities, arts, and social sciences (HASS) tends to have impacts that enhance quality of life (QOL) but that are not amenable to pricing in established markets. If the economic value of ‘non-market’ research impacts is ignored when making the business case for HASS research, society will under-invest in it. My goal in this research was to quantify priorities and tradeoffs Canadians were willing to make between broad QOL attributes. A national sample (N = 1,612; 14,571 observations) cleaved into five distinct latent classes, each of which varied according to their preferences and willingness to pay for QOL impacts. One class, comprising 21% of the sample, placed a strong priority on QOL indicators relating to people, community, and culture, and was willing to pay, on average, 892 per household per year for improvements across a full range of QOL attributes. While willing to pay892 per household per year for improvements across a full range of QOL attributes. While willing to pay 1,393 per household per year in total, a second segment, comprising 20% of the sample, focused heavily on benefits more likely to be derived from science and technology research. Willingness to pay for specific and aggregate improvements amongst the balance of the sample was lower. Diverse preferences regarding potential QOL impacts suggest that researchers will need to consider both the source and magnitude of public benefits arising from HASS research in the future.     

A Translation and Validation Study of the Life Orientation Test Revised in the Greek Speaking Population of Nurses among Three Hospitals in Athens and Ioannina

The life orientation test-revised (LOT-R) (Scheier et al. in Journal of Personality and Social Psychology 67:1063–1078, 1994) is a brief measure for assessing dispositional optimism. The aim of this study was to develop a Greek language version of the LOT-R and to assess the instrument’s psychometric properties. The LOT-R was translated and culturally adopted in Greek language, and the final version was administered, along with a questionnaire consisting socioeconomic characteristics and a single item measuring optimism, to 276 Greek speaking, hospital nurses (222 female, 54 male), aged 22–65 years (mean 37.8, SD 8.3). Results showed that the LOT-R has good internal consistency (Cronbach’s α = .71 and item total correlation coefficients from .27 to .73, a unitary structure, and stability over a 3-months period (r = .66). Moreover, the Greek version of the scale exhibited good convergent validity with single-item optimism scale (r = .73). Principal components analysis revealed a two-factor structure representing the constructs of optimism and pessimism. The Greek life orientation test revised appears to be a valid tool in assessing dispositional optimism in Greek speaking people and is expected to facilitate the examination of optimism in Greek speaking populations.     

Importance has been Considered in Satisfaction Evaluation: an Experimental Examination of Locke’s Range-of-affect Hypothesis

Importance weighting is a common practice in quality of life (QOL) measurement research. Based on the widespread idea that important domains should make a greater contribution to individuals’ QOL total score, the weighting procedure of multiplying item satisfaction by an item’s importance has been adopted in many QOL instruments. Locke’s [1969, Organizational Behavior and Human Performance 4, 309–336; 1976, Handbook of Industrial and Organizational Psychology. Rand McNally, Chicago, pp. 1297–1343] range-of-affect hypothesis indicated that a satisfaction evaluation is determined by the have-want discrepancy, importance, and the interaction of the have-want discrepancy and importance, implying that a satisfaction evaluation incorporates the judgment of importance and weighting the satisfaction score with the importance score is unnecessary. The purpose of the current study was to address the issue of importance weighting by examining Locke’s range-of-affect hypothesis in the context of QOL research. A within-subject experiment was conducted to see if, given a varying amount of discrepancy, participants would reveal whether or not satisfaction/dissatisfaction is related to the dimension of importance placed on the object. Forty undergraduate students at National Taiwan University participated in the current study. Results revealed that the association between have-want discrepancy and object satisfaction is stronger on the high important dimension than the less important dimension. Generally, the results were consistent with Locke’s range-of-affect hypothesis, revealing that a satisfaction evaluation has incorporated the judgment of item importance, suggesting that the procedure of importance weighting is unnecessary. This paper was a part of the first author’s Master’s Thesis.     

Validation of the WeDQoL-Goals-Thailand Measure: Culture-Specific Individualised Quality of Life

The aim of this study was to validate an individualised measure of quality of life (WeDQoL-Goals-Thailand). Three hundred and sixty-nine Thai people completed the WeDQoL by interview. Respondents rated (0–2) the perceived necessity for wellbeing of 51 goals (goal necessity), then rated (0–3) their satisfaction with the same goals (goal satisfaction). Weighted goal attainment (possible range 0–6) was computed (necessity x satisfaction). Psychometric validation used frequency distributions, Principal Components Analysis (PCA), and Cronbach’s alpha. Analysis of variance, t-tests, Kruskal–Wallis, Mann–Whitney U, Spearman’s correlation and multiple regression explored socio-demographic, geographic and economic differences. Respondents were aged 15–89 (mean 45.7, SD 18.0); 169 men, 200 women. For weighted goal attainment scores, PCA found a 44-item scale (α = 0.91) and three subscales (community/social/health, α = 0.90; house and home, α = 0.80; nuclear family, α = 0.81). Thai Individualised Goal Attainment (TIGA) scale and the three subscales were computed as the mean of contributing weighted goal attainment scores, after excluding goals considered ‘not necessary’ to each individual. Unweighted and individualised scores differed significantly with socio-demographic, geographic and economic indicators. In multiple regression, both Thai Unweighted Goal Satisfaction (TUGS) and TIGA scale scores were predicted by being married, living in the South and in a non-urban location. TIGA scores were also predicted by being over 25 years old. WeDQoL-Goals-Thailand has excellent psychometric properties. Individualised scores reflect each person’s perspective on wellbeing and are sensitive to subgroup differences. However, unweighted satisfaction scores give a broadly similar picture and involve less complex computation.     

Effect of body image on gestational weight gain in overweight and obese women

Problem or backgroundThere is little information available describing how women who are overweight or obese in pregnancy perceive their bodies, and in particular the effect of body image dissatisfaction on gestational weight gain.QuestionTo describe how women who are overweight or obese in pregnancy perceive their body, and the effect of body image on gestational weight gain.MethodsThis prospective nested cohort study evaluated self estimation of body weight, preferred body shape, dieting behavior, satisfaction with body weight and shape, and gestational weight gain in pregnant women who were overweight or obese, through self-completed questionnaire in early pregnancy in South Australia from October 2010 to February 2012.FindingsOf the 442 women who completed the questionnaire, 25.8% correctly identified their BMI, with 70.1% under-estimating and 4.1% over-estimating their BMI. Women who were obese were significantly less likely to correctly identify their BMI, as were younger women. Women who incorrectly identified their BMI were significantly more likely to have higher gestational weight gain (P < 0.001). Approximately 45% of women indicated dissatisfaction with their weight or body shape, with this being more common in women of higher parity and higher BMI. Dissatisfaction was significantly related to gestational weight gain.ConclusionWomen who report increasing dissatisfaction with their body size and shape are more likely to gain excessive weight during pregnancy. Further research should explore insights about maternal body image and diet related behaviors.     

The Well-Being of 12 - to 16-Year-Old Adolescents and their Parents: Results from 1999 to 2003 Spanish Samples

This study adopts satisfaction with life as a whole and satisfaction with specific life domains as indicators to analyse the relationships between the well-being of 12 to 16-year-old adolescents and some related constructs such as self-esteem, perceived control and perceived social support. Well-being indicators from a 2003 Spanish sample using an 11-point scale (N = 1,634) are compared with an equivalent 1999 Spanish sample using a 5-point scale (N = 1,618). The different results obtained from the 2003 sample with a Principal Component Analysis (PCA) using a shorter and a longer list of life domains are also discussed. A sub-sample of the adolescents’ results from the 2003 sample are compared with their parents’ answers, using the same well-being indicators. Using a list of 8 life domains, and despite the change of scale used, overall results show no relevant changes in adolescents’ satisfaction with life domains between 1999 and 2003 in Spain and are in agreement with normative data expected from western societies [Cummins: 1998, Social Indicators Research 43, pp. 307–334; Cummins et al.: 2001, Australian Unity Well-being Index (Australian Centre on Quality of Life, Deakin University, Melbourne)]. Adolescents’ overall life satisfaction has been shown to correlate consistently with the other well-being related constructs. However, it clearly decreases with age over the period studied. The results also show that increasing the list of life domains has a major impact on the structure of the results obtained. When we compare results from parents with those from their own child, outstanding differences in well-being appear between generations: few domain satisfaction dimensions show significant correlation between parents and children and more than 20% of the population studied shows high discrepancies in the answers in four domains.     

Safe drinking water and satisfaction with environmental quality of life in some oil and gas industry impacted cities of Nigeria

The availability and safety of drinking water and the environmental quality of life was investigated in five cities located in an oil-producing area of Nigeria using questionnaire-based scales, discussion and laboratory tests. Polythene-packaged sachet water and commercial and non-commercial private boreholes largely met the drinking water requirement of the cities. Consumption of sachet water was high (14.0–20.0 points vs. 25.0 points) but regression analysis indicated strong negative relationships with income group (β = −0.75, P < 0.005) and educational level (β = −0.77, P < 0.005) of respondents (658). Private borehole water was prevalent (18.7–19.9 vs. 20.0) while public water supplies were almost non-existent (4.8–5.6 vs. 20.0) in the cities. Vulnerability to contamination in all water sources was indicated following unacceptable counts of total and faecal coliform bacteria in 10–62.5 and 3–25% of samples, respectfully. Respondents were not satisfied with environmental quality of life indicated by the quality of housing, school, health services, refuse disposal, recreation, streetlight, transport and police (3.43–4.01 vs. 10). It is concluded that modernization and industrialization due to the oil and gas industries, tended to increase individualization to the negligence of common services as evidenced by the preponderance of private boreholes and sachet water.     

Do We Need to Weight Satisfaction Scores with Importance Ratings in Measuring Quality of Life?

Trauer and Mackinnon (2001; Quality of life research 10, pp. 579–585) recently proposed that weighting satisfaction scores by importance ratings in measuring quality of life is undesirable and unnecessary. However, they didn’t use empirical data to support their claim. In this study, different weighting algorithms developed by Cummins (1997; Comprehensive Quality of Life Scale – Adult: Manual [Deakin, University Australia]), Raphael et al. (1996; Journal of Adolescent Health 19, pp. 366–375), Ferrans and Powers (1985; Advances in Nursing Science 8, pp. 15–24) and Frisch (1992; Comprehensive Casebook of Cognitive Therapy [Plenum Press, New York]) for measuring quality of life (QOL) were applied. Weighted scores computed from these weighting algorithms were compared with unweighted scores in predicting a global life satisfaction measure by correlation and moderated regression analyses. One hundred and thirty undergraduate students at National Taiwan University participated in the study voluntarily. They completed a 15-item questionnaire on quality of campus life developed by the authors. They also completed the Satisfaction with Life Scale (SWLS), a global life satisfaction measure developed by Diener et al. (1985; Journal of Personality Assessment 49, pp. 71–75). The correlation results revealed that the weighted scores computed from different algorithms didn’t have higher correlations to the SWLS than the unweighted scores. The moderated regression results also revealed that item importance did not moderate the relationship between item satisfaction and the overall life satisfaction. All these findings revealed that weighting satisfaction with importance is unnecessary. This paper was a part of the first author’s Master Thesis     

Investigating the Structural Validity of Ryff’s Psychological Well-Being Scales Across Two Samples

Ryff’s (1989b) Psychological Well-Being (PWB) scales measure six related constructs of human functioning. The present paper examined the validity of Ryff’s 6-factor PWB model, using data from a life events study (N = 401) and an organisational climate study (N = 679). Previous validation studies, using Confirmatory Factor Analysis (CFA), have identified alternative PWB models, but limitations include the use of shorter scale versions with items relating to a number of life domains within the same PWB factor, and failure to examine the influence of participants’ socio-demographic characteristics on PWB. In this study, Exploratory Factor Analysis (EFA) mostly found consistency in the PWB items and structure between the two studies whereby a 3-factor model delineated between items relating to Autonomy, Positive Relations and a super-ordinate factor comprising the other PWB factors. Using CFA, Goodness of Fit indices reached acceptable levels for the adjusted PWB model identified by the EFA, whilst differences between adjusted models of PWB previously identified in the literature were hardly evident. Post-hoc analysis by gender demonstrated socio-demographic effects on the structure and items that comprise PWB. Further development of PWB measures is needed to reflect its hierarchical and multi-dimensional nature. In the scales’ current form, the construct validation of the PWB factors will continue to be problematic and will fail to adequately evaluate the nature and impact of PWB.     

Exploratory Study on Drug Users’ Perspectives on Quality of Life: More than Health-Related Quality of Life?

In drug treatment outcome literature, a focus on objective and socially desirable indicators of change (e.g. no drug use) has predominated, while outcome indicators that are important for drug users themselves (e.g. quality of life, satisfaction with treatment) have largely been neglected. Nonetheless, Quality of Life (QoL) has become an important concept to evaluate effectiveness of treatment in mental health care research and disability studies. Given the almost exclusive focus on Health-related Quality of Life (HRQOL) in substance abuse research and the neglect of clients’ perspectives in this field, we explore in this study the concept of QoL as perceived by drug users. Focus group discussions (n = 9) were organised in various treatment settings and community services for drug users in the region of Ghent, Belgium to identify important dimensions of QoL and their interpretation by drug users. Data were clustered and analysed based on the theoretical framework of Robert Schalock (Quality of life. Volume 1: Conceptualization and measurement, 1996). The domains ‘personal relationships’, ‘social inclusion’ and ‘self-determination’ were discussed most frequently by the participants. They stressed the importance of a supportive social network in particular. It can be concluded that QoL is not primarily associated by drug users with health and it involves much more than the aspects typically represented in measures of HRQOL.     

Can We Weight Satisfaction Score with Importance Ranks Across Life Domains?

The main purpose of this study was to investigate the utility of importance weighting when importance ranks were considered as the weighting values by (1) examining the range-of-affect hypothesis in the within-subject context and (2) comparing performances of weighted and unweighted satisfaction scores in predicting overall judgment of subjective well-being. Participants were 167 undergraduates at National Taiwan University. The mean age was 19.80 years (SD = 1.98). They were first asked to complete the measurements for global life satisfaction and overall QOL and then completed a QOL questionnaire for rating satisfaction, perceived have–want discrepancy on 12 life domains and ranking importance on these domains. Hierarchical linear modeling with a random-coefficients regression model was applied to examine the range-of-affect hypothesis in the within-subject context. Correlation analysis was applied to evaluate performances of weighted and unweighted satisfaction scores in predicting overall judgment of subjective well-being. Results of this study supported the range-of-affect hypothesis, showing that the relationship between item have–want discrepancy and item satisfaction is stronger for high importance items than low importance items for a given individual. Correlation analysis found that the four weighted satisfaction scores computed from the algorithms proposed by Hsieh (Social Indicators Research 61:227–240, 2003) were not superior to unweighted satisfaction score in predicting overall QOL and global life satisfaction. All these findings suggested that weighting satisfaction scores with importance ranks may not have theoretical basis and empirical contribution.     

A Comparison of Alternative Models of Individual Quality of Life for Social Service Recipients

There is considerable debate in the area of individual quality of life research regarding the factor structure of the QOL construct that is focused on the number and composition of QOL factors and domains, and its hierarchical nature. The main goal of this study involve testing by means of confirmatory factor analyses five models that have been pointed out by recent scientific literature: firstly, an unidimensional model; secondly, a QOL model that consisted of eight inter-correlated domains proposed by Schalock and Verdugo (2002); thirdly, a model composed of these eight 1st-order factors and one 2nd- order factor; the forth and five are model with the eight 1st-order factors and three 2nd-order factor that has been denominated in other studies ‘Salamanca model’ and ‘Schalock model’. Data were collected from 3.029 social service recipients from Catalonia (Spain) who completed the GENCAT Scale, an objective QOL questionnaire. The best fit of the eight inter-correlated and 1st order domains was empirically demonstrated. Implications for future research are also discussed.