ABSTRACT
A number of prominent psychologists have articulated calls for a science of “positive psychology” to complement psychology’s traditional focus on psychopathological conditions (e.g., Seligman & Csikszentmihalyi, 2000). Rather than focusing exclusively on the origins, nature, and treatment of psychological symptoms, such a science would include attention to the study of psychological wellness. In this manner, psychological wellness is conceptualized to reflect more than the absence of symptoms. Comprehensive psychological evaluations must thus expand to incorporate individual and environmental strengths as well as psychological difficulties (Wright & Lopez, 2002). A variety of psychological strengths have been considered; however, the classification and measurement of many psychological strengths is in the early stages of development (Peterson & Seligman, 2004), precluding clinical applications of many constructs and measures at present.One positive psychology construct, perceived quality of life (PQOL) or life satisfaction, has received considerable research attention among adults and children and youth (Diener, Suh, Lucas, & Smith, 1999; Huebner, Suldo, & Gilman, 2006). PQOL has been defined as a cognitive evaluation by a person of the degree of positivity of his or her life (Diener, 1994). It has also been defined as “a person’s subjective evaluation of the degree to which his or her most important needs, goals, and wishes have been fulfilled” (Frisch, 1998, p. 24). PQOL reports have been differentiated with respect to evaluation of the quality of overall life and/or major, specific life domains, such as family, friendships, and school, and generally incorpo
rate the complete spectrum of psychological well-being, ranging from very low satisfaction (e.g., terrible) to neutral to very high life satisfaction (e.g., delighted). Such “life satisfaction” measures have been differentiated from measures of psychopathology, such as anxiety, depression, and externalizing problems. Subjective or PQOL reports have also been differentiated from objective quality-of-life measures (e.g., ranging from measures of socioeconomic status, health indexes, access to community resources, etc.). Studies of the relationship between objective and subjective measures have revealed modest relationships at best (Diener et al., 1999), along with evidence of cognitive mediation in many cases (Frisch, 1999).The incremental contribution of PQOL judgments to traditional symptom-focused psychological assessments of children and youth has been demonstrated in research by Greenspoon and Saklofske (2001). These researchers provided support for a dual-factor model of mental health in elementary school students through the identification of four distinct groups of children: high psychopathology (PTH)-low subjective well-being (SWB) (as measured by PQOL), high PTH-high SWB, low PTH-low SWB, and low PTH-high SWB. The identification of the low PTH-low SWB group particularly challenges traditional models of mental health in which psychological wellness is limited to the absence of psychopathological symptoms.High global PQOL, in particular, appears to operate as a psychological strength or asset in many children and youths. Significant correlations have been revealed between global PQOL reports and many intrapersonal and interpersonal measures of psychological problems, such as low self-esteem, hope, anxiety, depression, external locus of control, and malaptive attributional style. Significant relationships between PQOL reports and a variety of youth risk behaviors, such as suicide, alcohol and drug use, sexual risk taking, and dieting and exercise behavior have been shown (see Gilman & Huebner, 2003). Also, PQOL reports and physical illness indicators (Zullig, Vallois, Huebner, & Drane, 2005) as well as academic problems (Huebner, Suldo, & Gilman, 2006) have been found. Furthermore, PQOL reports have been shown to mediate the relationship between stressful life events and internalizing behavior problems in adolescence, as well as moderate the relationship between stressful life events and adolescent externalizing behaviors (McKnight, Huebner, & Suldo, 2002; Suldo & Huebner, 2004). That is, high life satisfaction has acted as a buffer against the effects of stressful life events. Among adults, a substantial body of research demonstrates that PQOL assessments show predictive utility with respect to psychological disorders, physical illness, health-related expenditures, and academic problems (see Frisch et al., 2003, for a review).Raphael, Brown, Ren wick, and Rootman (1997) discuss four benefits of quality-of-life research for health promotion programs that are applicable to the context of child clinical assessment as well. First, they suggest that quality-of-life information integrates psychosocial perspectives with medical and rehabilitation perspectives. For example, expanded definitions of health, such as that of the World Health Organization (1948), necessitate the consideration of optimal states of physical, mental, and social well-being and not merely the absence of disease. Thus, quality-of-life concerns, including PQOL, are increasingly evaluated along with symptomatic status in determining the effectiveness of health care interventions (see also Frisch, 1998). Second, Raphael et al. highlight the breadth of quality-of-life data, that is, the manner in which quality-of-life data emphasize environmental (e.g., family, school, community) as well as individual determinants of mental and physical health. Multidimensional PQOL reports, which yield indexes of children’s perceptions of crucial life contexts (e.g., family, friends, school, community, self) provide an estimate of the “goodness of fit” between a child and the objective conditions of her/his life (Schalock, Keith, Hoffman, & Karan, 1989). Third, quality-of-life data connect with health promotion and evaluation perspectives, given that such data (e.g., PQOL reports) reflect determinants and and/or moder-
ators (e.g., buffering strengths) of adaptive and maladaptive behavior. As noted earlier, low PQOL has been linked with a wide variety of difficulties in psychosocial, physical, and educational functioning (Huebner, Suldo, & Gilman, 2006). Furthermore, high PQOL may operate as a protective buffer promoting resilience in the face of adverse live circumstances. Fourth and finally, quality-of-life measures, including PQOL, can provide important information related to the effects of illness (e.g., psychopathology) or risk behavior and associated interventions. Ethical concerns (e.g., do no harm) could be interpreted so that mental health professionals and others (e.g., medical personnel, educators) should routinely assess PQOL to ensure that their interventions (e.g., psychosocial, medical, educational, etc.) do not negatively affect the PQOL of children and youth, particularly their longer-term PQOL. To date, however, few systematic efforts have been undertaken to monitor and safeguard children’s PQOL before, during, or after intervention services have been delivered. Indeed, Frisch (1998) asked whether it is ethical to introduce new treatments without first assessing their impact on clients’ quality of life.Positive psychology researchers have thus concluded that comprehensive psychological assessments should include attention to traditional psychological “symptom” data as well as positive psychological “strengths” data, which includes PQOL reports. For example, Wright and Lopez (2002) propose a four-front approach that includes assessment of (a) individual strengths (e.g., strong self-satisfaction), (b) individual weakness (e.g., symptoms), (c) environmental assets and resources (e.g., strong quality of family life), and (d) environmental stressors and deficits (e.g., poor peer relations). Applying the fourfold model to DSM, Wright and Lopez suggest intriguing modifications of Axes IV and V (along with the introduction of an Axis VI) to guide clinicians in identifying strengths-based data to include “what is working in the client’s life” (p. 40), in addition to data related to what is not working. Wright and Lopez argue that such a framework increases intervention possibilities by encouraging the discovery of personal and environmental resources that can enhance intervention efficacy and prevent future problems and/or relapses. Frisch (1998) also discusses the shortcomings of psychological assessments based exclusively on symptom-based measures, concluding that both symptom-based and PQOL measures are essential first-order components of comprehensive assessment plans that provide the strongest foundation for case conceptualization and treatment plans. He further speculates that “in the future, psychological and medical ‘checkups’ may routinely involve QOL assessments” (p. 36), given their potential cost-effectiveness and predictive validity.
