Quality of life in patients treated with methadone: The WHOQOL-BREF, psychometric study and application results

Keywords: quality of life, whoqol-bref, methadone treatment, psychometrics, structural analysis, addiction


The most commonly instrument used to measure quality of life in patients with addictive behaviors is the WHOQOL-BREF, developed by the World Health Organization. No studies have been found to explore the psychometric properties in Spanish clinical samples. This paper aims to study their reliability as well as the construct validity in a representative sample of patients and comparing the results to the data available for the general population in Spain. A sample was recruited comprised of 523 subjects who were undergoing treatment with methadone in Madrid and Extremadura. A confirmatory factor analysis was completed to test the theoretically proposed structure and then an optimized-parallel analysis was done to establish the most adequate number of components. The result offers solid values for internal consistency both as concerns the items and the scales. The theoretical tetra-dimensional structure is confirmed in the sample although serious arguments are also found for considering its one-dimensionality. The structural relationship between the four domains was studied. The WHOQOL-BREF proves to be a reliable and valid test for use on patients treated with methadone, providing a multi-dimensional measure of perceived quality of life that includes social and environmental factors of great importance in treating addiction problems.


Download data is not yet available.

Author Biographies

Eduardo J. Pedrero-Pérez, Instituto de Adicciones. Madrid Salud.
Research Manager. Formation and Research unit. Evaluation and Quality Department.
MethaQoL Group, Junta de Extremadura

MethaQoL Group: Madrid: Barreda-Marina, M.A., Bartolomé-Gil, C., Bosque-Coro, S., Callejo-Escobar, J., Ema-López, I., Dominguez-Aranda, M.A., Ferrero-Herreros, Y.E., Galera-García, Ó., Garrido-Ureña, B., Gil de Bernabe-Lopez, M.J., González-Galnares, I.R., Gutiérrez-Cáceres, S., Heras-Dolader, S., Hernández-Tejada, C., López-Jiménez, M.C., López-Zurita, C., Martin-Carmona, G., Notario-Poves, P., Olmos-Espinosa, R., Pacheco-Otoya, G., Pérez-Carrasco, E., Pérez-López, G., Puerta-García, C., Rojo-Mota, G., Sáez-Maldonado, A., Salgado-Marcos, N., San Juan-Sanz, P., Sújar-Plaza, M.I.

Extremadura: Borrallo-Berjón, M.J., Boticario-Villarroel, M.V., Bueno-Pozo, R., Iglesias-Jiménez, M.F., Mateos-Ayucar, M.P.


Amato, L., Davoli, M., Perucci, C. A., Ferri, M., Faggiano, F., & Mattick, R. P. (2005). An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. Journal of Substance Abuse Treatment, 28, 321-329. doi: 10.1016/j.jsat.2005.02.007

Barros da Silva Lima, A. B., Fleck, M., Pechansky, F., De Boni, R., & Sukop, P. (2005). Psychometric properties of the World Health Organization quality of life instrument (WHOQoL-BREF) in alcoholic males: a pilot study. Quality of Life Research, 14, 473-478. doi: 10.1007/s11136-004-5327-1

Benitez-Borrego, S., Guàrdia-Olmos, J., & Urzúa-Morales, A. (2014). Factorial structural analysis of the Spanish version of WHOQOL-BREF: an exploratory structural equation model study. Quality of Life Research, 23, 2205-2212. doi: 10.1007/s11136-014-0663-2

Bizzarri, J., Rucci, P., Vallotta, A., Girelli, M., Scandolari, A., Zerbetto, E., … Dellantonio, E. (2005). Dual diagnosis and quality of life in patients in treatment for opioid dependence. Substance Use & Misuse, 40, 1765-1776. doi: 10.1080/10826080500260800

Chang, K. C., Wang, J. D., Tang, H. P., Cheng, C. M., & Lin, C. Y. (2014). Psychometric evaluation, using Rasch analysis, of the WHOQOL-BREF in heroin-dependent people undergoing methadone maintenance treatment: further item validation. Health and Quality of Life Outcomes, 12, 1. doi: 10.1186/s12955-014-0148-6

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.

De Maeyer, J., Vanderplasschen, W., & Broekaert, E. (2010). Quality of life among opiate-dependent individuals: a review of the literature. International Journal of Drug Policy, 21, 364–380. doi: 10.1016/j.drugpo.2010.01.010

De Maeyer, J., Vanderplasschen, W., Lammertyn, J., van Nieuwenhuizen, C., Sabbe, B., & Broekaert, E. (2011). Current quality of life and its determinants among opiate-dependent individuals five years after starting methadone treatment. Quality of Life Research, 20, 139-150. doi: 10.1007/s11136-010-9732-3

Den Oudsten, B. L., Lucas-Carrasco, R., Green, A. M., & The WHOQOL-Dis Group. (2011). Perceptions of persons with Parkinson's disease, family and professionals on quality of life: an international focus group study. Disability and Rehabilitation, 33, 2490-2508. doi: 10.3109/09638288.2011.575527

DeSalvo, K. B., Bloser, N., Reynolds, K., He, J., & Muntner, P. (2006). Mortality prediction with a single general self-rated health question. A meta-analysis. Journal of General Internal Medicine, 21, 267–275. doi: 10.1111/j.1525-1497.2005.00291.x

Dunn, T. J., Baguley, T., & Brunsden, V. (2014). From alpha to omega: A practical solution to the pervasive problem of internal consistency estimation. British Journal of Psychology, 105, 399-412. doi: 10.1111/bjop.12046

Espinoza, I., Osorio, P., Torrejón, M. J., Lucas-Carrasco, R., & Bunout, D. (2011). Validación del cuestionario de calidad de vida (WHOQOL-BREF) en adultos mayores chilenos [Validation of the WHOQOL-BREF quality of life questionnaire among Chilean older people]. Revista Médica de Chile, 139, 579-586. doi: 10.4067/S0034-98872011000500003

Fayers, P. M. & Machin, D. (2007). Principles of measurement scales (p. 31-47). En Fayers, P. M. & Machin, D., Quality of Life (2ª ed.). Chichester: John Wiley & Sons Ltd.

Feelemyer, J. P., Des Jarlais, D. C., Arasteh, K., Phillips, B. W., & Hagan, H. (2014). Changes in quality of life (WHOQOL-BREF) and addiction severity index (ASI) among participants in opioid substitution treatment (OST) in low and middle income countries: An international systematic review. Drug and Alcohol Dependence, 134, 251-258. doi: 10.1016/j.drugalcdep.2013.10.011

Fu, T. S., Tuan, Y. C., Yen, M. Y., Wu, W. H., Huang, C. W., Chen, W. T., Lee. T. S. H. (2013). Psychometric properties of the World Health Organization quality of life assessment–brief in methadone patients: a validation study in northern Taiwan. Harm Reduction Journal, 10, 37. doi: 10.1186/1477-7517-10-37

Hedrich, D., Alves, P., Farrell, M., Stover, H., Moller, L., & Mayet, S. (2012). The effectiveness of opioid maintenance treatment in prison settings: a systematic review. Addiction, 107, 501-517. doi: 10.1111/j.1360-0443.2011.03676.x

Laudet, A. B. (2011). The case for considering quality of life in addiction research and clinical practice. Addiction Science & Clinical Practice, 6, 44-55.

Lorenzo-Seva, U. & Ferrando, P.J. (2013). FACTOR 9.2. A comprehensive program for fitting exploratory and semiconfirmatory factor analysis and IRT models. Applied Psychological Measurement, 37, 497-498.

Lucas-Carrasco, R. (1998). Versión española del WHOQOL. Madrid: Editorial Ergón.

Lucas-Carrasco, R. (2012). The WHO quality of life (WHOQOL) questionnaire: Spanish development and validation studies. Quality of Life Research, 21, 161-165. doi: 10.1007/s11136-011-9926-3

Lucas-Carrasco, R., Skevington, S. M., Gómez-Benito, J., Rejas, J., & March, J. (2011). Using the WHOQOL-BREF in persons with dementia: a validation study. Alzheimer Disease & Associated Disorders, 25, 345-351. doi: 10.1097/WAD.0b013e31820bc98b

Padaiga, Z., Subata, E., & Vanagas, G. (2007). Outpatient methadone maintenance treatment program. Quality of life and health of opioid-dependent persons in Lithuania. Medicina (Kaunas), 43, 235-241.

Pedrero-Pérez, E. J. & Díaz-Olalla, J. M. (2016). COOP/WONCA: Reliability and validity of the test administered by telephone. Atención Primaria, 48, 25-32. doi: 10.1016/j.aprim.2014.12.010

Pedrero-Pérez, E. J. & MethaQoL Group. (2017). Methadone dosage and its relationship to quality of life, satisfaction, psychopathology, cognitive performance and additional consumption of non-prescribed drugs. Adicciones, 29, 37-54. doi: 10.20882/adicciones.831

Power, M., Bullinger, M., & Harper, A. (1999). The World Health Organization WHOQOL-100: Tests of the universality of quality of life in 15 different cultural groups worldwide. Health Psychology, 18, 495-505. doi: 10.1037/0278-6133.18.5.495

Rojas, A. J., Lozano, O., Foresti, K., Zolfaghari, E., & Zubaran, C. (2015). Comparison and concordance of health-related quality of life tests among substance users. Health and Quality of Life Outcomes, 13, 1. doi: 10.1186/s12955-015-0364-8

Sánchez-Hervás, E., Tomás-Gradolí, V., Molina Bou, N., del Olmo Gurrea, R., & Morales Gallús, E. M. (2002). Calidad de vida, psicopatología, procesos de cambio e historial adictivo en la dependencia a sustancias psicoactivas [Quality of live, psychophatology, process of change and addictive history in dependent to psychoactive drugs]. Trastornos Adictivos, 4, 62-68. doi: 10.1016/S1575-0973(02)70056-1

Servicio Andaluz de Salud (2010). Desarrollo de Programas de Tratamiento Asertivo Comunitario en Andalucía. Documento marco. Anexo 3.1. Granada: Área de Dirección de Organizaciones Sanitarias de la Escuela Andaluza de Salud Pública.

Skevington, S. M., Lotfy, M., & O'Connell, K. A. (2004). The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Quality of life Research, 13, 299-310. doi: 10.1023/B:QURE.0000018486.91360.00

Skevington, S. M. & McCrate, F. M. (2012). Expecting a good quality of life in health: assessing people with diverse diseases and conditions using the WHOQOL‐BREF. Health Expectations, 15, 49-62. doi: 10.1111/j.1369-7625.2010.00650.x

Skevington, S. M., Sartorius, N., Amir, M., and THE WHOQOL Group. (2004). Developing methods for assessing quality of life in different cultural settings. Social Psychiatry and Psychiatric Epidemiology, 39, 1-8. doi: 10.1007/s00127-004-0700-5

The WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment. Psychological Medicine, 28, 551-558.

Trompenaars, F. J., Masthoff, E. D., van Heck, G. L., Hodiamont, P. P. G., & de Vries, J. (2005). Content validity, construct validity, and reliability of the WHOQOL-Bref in a population of Dutch adult psychiatric outpatients. Quality of Life Research, 14, 151-160. doi: 10.1007/s11136-004-0787-x

Urzúa, A. & Caqueo-Urízar, A. (2013). Estructura factorial y valores de referencia del WHOQoL-Bref en población adulta chilena [Factorial structure of WHOQoL-Bref quality of life questionnaire]. Revista Médica de Chile, 141, 1547-1554. doi: 10.4067/S0034-98872013001200008

Vanderplasschen, W., Naert, J., Vander Laenen, F., & De Maeyer, J. (2015). Treatment satisfaction and quality of support in outpatient substitution treatment: opiate users’ experiences and perspectives. Drugs: Education, Prevention, and Policy, 22, 272-280. doi: 10.3109/09687637.2014.981508

How to Cite
Pedrero-Pérez, E. J., & Group, M. (2018). Quality of life in patients treated with methadone: The WHOQOL-BREF, psychometric study and application results. Anales De Psicología / Annals of Psychology, 34(2), 251-257. https://doi.org/10.6018/analesps.34.2.282971
Clinical and Health Psychology