The Life Functioning Questionnaire (LFQ): a brief, gender-neutral scale assessing functional outcome

Abstract

The Life Functioning Questionnaire (LFQ) is a 5-min, 14-item, gender-neutral self-report questionnaire designed to assess role function over the preceding month in four domains: workplace, duties at home, leisure time with family and leisure time with friends. To validate the LFQ for use as an instrument assessing functional outcome in patients with a mood disorder, the LFQ was administered to three different samples of patients (N=87). Fifty-nine concurrently completed the self-report version of the Social Adjustment Scale (SAS-SR) and 32 concurrently had a Clinical Global Impression Scale for Bipolar Disorder (CGI-BP) assessment. The LFQ proved to have high internal consistency reliability, high test–retest reliability, excellent concurrent validity with the SAS-SR, and high validity as a measurement of severity of illness when compared with the CGI-BP. The LFQ provides a reliable, consistent and valid assessment of function at work and home in both male and female patients with a mood disorder.

Introduction

In the last decade, there has been an increase in awareness regarding the impact of psychiatric illness on role function and quality of life. This may be in part due to the fact that while criteria for evaluating symptomatic remission in psychiatric disorders are easily defined, functional recovery criteria are less clear (Andrews et al., 1994, Dickerson, 1997).

Studies evaluating ‘functional outcome’ have defined it in different ways (psychosocial impairment, work impairment, work adjustment) and have employed a variety of means to assess it. (See Table 1, which summarizes a number of instruments in this domain.)

Among the multidimensional scales assessing outcome, the Social Adjustment Scale (SAS) is the instrument most commonly used in the area of depression treatment (Weissman and Bothwell, 1976, Mintz et al., 1999). The SAS-SR (Self-Report) has high internal consistency and test-retest reliability (Edwards et al., 1978); further, a high rate of agreement between depressed patients and their relatives has been demonstrated on this instrument (Weissman and Bothwell, 1976). However, there are some limitations of the SAS. Because it is a comprehensive assessment of multiple domains of social functioning, its length is a barrier to use in screening or routine assessment. On the other hand, the work section is very short, and lacks qualitative information. In the ‘Work Outside the Home’ section, respondents must choose only one principal role (worker for pay, housewife, student, retired, unemployed), and the ‘Work At Home’ section is designated rather clearly only for ‘housewives.’ This scale was designed in the 1970s when most people had one main role. This design is less suitable today, when many women (and men) have multiple roles, and both genders have responsibilities at home. A final issue with the SAS is that it does not make any explicit connections between psychiatric symptoms and problems with work or social functioning. Typically, severity of symptoms and level of functioning are assessed with separate instruments, so the ways that the former influence the latter must be inferred.

The Life Functioning Questionnaire (LFQ) (Appendix A) was developed to address some of these issues. The purpose of the scale is to assess work and role functioning in patients with psychiatric illness. The LFQ covers the same basic role functions previously covered in the well-known SAS-SR and other work scales such as the Endicott Work Productivity Scale (Endicott and Nee, 1997) and the Longitudinal Interval Follow-up Evaluation—Range of Impaired Functioning Tool (LIFE–RIFT, Leon et al., 2000), etc. (For an overview see Mintz et al., 1999.)

Part I of the LFQ, the focus of this article, provides a quick, multidimensional, non-gender-biased assessment of functional capacity in psychiatric patients. It is a 5-min, self-report scale with 14 items that measure role function over the preceding month in the following four areas: leisure time with friends (Section A, 3 items), leisure time with family (Section B, 3 items), duties at home (Section C, 4 items), and duties at work (Section D, 4 items). For each domain, there are questions about the amount of time spent in activities; interpersonal conflict or friction; and level of enjoyment. For the duties at home and work sections, there is an additional self-assessment question about performance. Items are rated using a 4-point scale, 1=no problems, 2=mild problems, 3=moderate problems, and 4=severe problems. A score of 1 on each item indicates no role impairment, and a score of ≥2 on any item demonstrates some impairment in that domain. At the end of each role function section, respondents may write in the reason they believe they are having difficulty.

In the ‘Duties At Home’ section, the LFQ lists a variety of tasks (e.g. housework, car repairs, child care) with the deliberate intent of communicating to respondents that the section applies to both genders. In the ‘Duties At Work’ section, additional information can be gathered, approximately (1) the number of days of work missed in the past month and (2) some specific causal relationships patients may perceive between the functional impairments they experience and their psychiatric illness/symptoms by means of a checklist of possible causes and space for comments.

Part II of the LFQ assesses work role in the last 30 days. Respondents define their work situation (in which they can check more than one option). Additional information regarding work, financial and living status in the past 6 months, as well as information on the last time they worked full time and why they are no longer working full time, can be obtained in this section.

The purpose of this study was to validate Part I of the LFQ for use as an instrument to assess role functioning in subjects with a mood disorder.