A Systematic Review of Quality of Life Assessments of Offenders

• Author: Ashley Elizabeth Muller
• Published date: 01 October 2020
• Date: 01 October 2020
• DOI: 10.1177/0306624X19881929
• Subject Matter: Articles

https://doi.org/10.1177/0306624X19881929

International Journal of

Offender Therapy and

Comparative Criminology

2020, Vol. 64(13-14) 1364 –1397

© The Author(s) 2020

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DOI: 10.1177/0306624X19881929

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Article

A Systematic Review of

Quality of Life Assessments

of Offenders

Ashley Elizabeth Muller1,2

Abstract

Strength-based theories of rehabilitation emphasize the importance of opportunities

for offenders to achieve “good lives” to not re-offend. The extent to which these

groups feel enabled to achieve a good life may be measured through subjective, overall

quality of life (QoL). The aim is to systematically review the QoL instruments used

among detained offenders and synthesize the factors related to their QoL. A systematic

literature review was conducted to retrieve articles that assessed the overall QoL of a

sample of detained offenders using a validated instrument. The instruments’ specificity,

dimensionality, and respondent and administrator burden were assessed, and factors

reported as significantly related to QoL were summarized. In total, 41 articles were

included in the review: 20 reported on forensic samples and 20 on prisoners, with

one study randomly assigning offenders to either forensic treatment or prison. Among

the included articles, 12 validated instruments were utilized. Only one instrument,

the Forensic Inpatient Quality of Life Questionnaire, was specifically developed for

and validated in forensic patients. Detained offending populations reported lower

QoL than the general population, and those with untreated mental illness reported

the lowest. The most consistent predictors of QoL longitudinally were social factors,

while substance use and detention-specific variables were not consistently related.

In general, the relationships between poor mental health, loneliness, and poor QoL

seen in offenders are also seen among other marginalized populations. To improve

the evidence base for QoL assessment in this vulnerable group, current gold standard

QoL instruments should be validated in detained populations.

Keywords

quality of life, psychometrics, Forensic Inpatient Quality of Life Scale, WHOQOL-

BREF

1Norwegian Institute of Public Health, Oslo, Norway

2Norwegian Centre for Addiction Research, Oslo, Norway

Corresponding Author:

Ashley Elizabeth Muller, Norwegian Centre for Public Health, Pb 222 Skøyen, 0123 Oslo, Norway.

Email: aemu@fhi.no

881929IJOXXX10.1177/0306624X19881929International Journal of Offender Therapy and Comparative CriminologyMuller

research-article2020

Muller 1365

Background

The Good Lives Model (GLM) and Quality of Life (QoL)

Offending groups have a higher prevalence of mental health problems, substance use,

sexual abuse histories, trauma experience, and risk factors for preventable chronic

diseases than the general population (Durand et al., 2017; Fazel & Baillargeon, 2010;

Fazel, Hayes, Bartellas, Clerici, & Trestman, 2016; Fazel, Yoon, & Hayes, 2017;

Massoglia & Pridemore, 2015; Wolff & Shi, 2012). In addition, they often represent

socially and economically marginalized groups (DeFina & Hannon, 2009; Foster &

Hagan, 2007; Wildeman & Wang, 2017). Strength-based theories of offender rehabili-

tation such as the GLM acknowledge these disadvantages in their conceptualizations

of both offending and rehabilitation. In the GLM, all humans are understood as

attempting to achieve primary human goods; Ward, Mann, and Gannon (2007) and

Ward and Stewart (2003) suggest these include a healthy life and functioning, knowl-

edge, a sense of ability and mastery, autonomy, freedom from distress, meaningful

relationships, community, purpose, happiness, and creativity. If a person lacks proso-

cial—that is, socially acceptable, safe, and functional—ways of achieving these goods,

then antisocial (criminal) attempts to achieve these goods is the recourse (Ward et al.,

2007; Ward & Stewart, 2003).

In other words, detention can be a result of lacking the means to attain primary

goods. To reduce the risk of re-offending, detention should therefore aim to equip

people with the capabilities to achieve self-determined “good lives.” The extent to

which this occurs is questionable in light of high rates of recidivism across the globe

(Fazel & Wolf, 2015). One way to measure the extent to which offending groups feel

they have achieved a “good life” may be to measure overall QoL, a construct defined

by the World Health Organization (WHO) as “an individuals’ perception of their posi-

tion in life in the context of the culture and value systems in which they live and in

relation to their goals, expectations, standards and concerns” (World Health

Organization Quality of Life Assessment [WHOQOL] Group, 1996, p. 453). The

objectively measurable indicators of poverty, deprivation, and ill health, which are

overrepresented among incarcerated populations, inarguably have negative impacts on

an individual’s material security, social status, and even longevity. QoL is a subjective

evaluation by an individual of these indicators and of her or his situation as a whole.

As such, it provides information on the effect of a situation such as detention that can-

not be measured through traditional, objective indicators. QoL has been found useful

in predicting post-treatment outcomes and survival in people with substance use dis-

orders, cancer, and other chronic diseases, even controlling for mortality-related vari-

ables (Laudet & Stanick, 2010; Thompson et al., 2014; Tsai et al., 2010).

Improved QoL of detained offending groups is not the goal of all detention systems.

In systems influenced by punitive approaches, it is particularly unlikely that QoL

would be an outcome of interest: Detention is a sanction and a deterrent for their and

others’ future crimes. Liebling’s seminal research has argued that in British prisons, in

which a punitive approach has also been progressively adopted in the past three

1366 International Journal of Offender Therapy and Comparative Criminology 64(13-14)

decades, prison environments are characterized by a decided disinterest in offending

groups’ QoL and welfare, operationalized through little or no opportunities for their

personal development (Liebling, 2006, 2011, 2017).

On the contrary, a rehabilitative approach, the context for the development of the

GLM, differs most centrally from a punitive approach in its intention to “motivat[e],

guid[e], and support[] constructive change in whatever characteristics or circum-

stances engender their criminal behavior or subvert their prosocial behavior” (Lipsey

& Cullen, 2007, p. 302). One example of an incarceration system with a rehabilitative

approach is that of Norway, and national guidelines clearly state that separation from

society is considered sufficient punishment—the only deprived right shall be the loss

of liberty. The QoL of detained offenders should improve over detention so that they

are situated as best as possible to successfully reintegrate into society, which includes

not re-offending (Norwegian Correctional Services, 2017).

Factors Related to QoL Among Offending Groups

Compared with the literature on the QoL of the general population and chronic dis-

ease groups, literature on the QoL of detained offending groups is modest, albeit

increasing (van Nieuwenhuizen, Schene, & Koeter, 2009). In a large cross-sectional

study of prisoners, psychological distress was the strongest correlate of poor QoL

(Muller & Bukten, 2019), and this relationship is consistently reported among both

the general population (Caron, Cargo, Daniel, & Liu, 2019; Solis & Lotufo-Neto,

2019) and people with chronic diseases (Akhtari-Zavare et al., 2018; Björkman &

Hansson, 2002; Fleury et al., 2013; Hansson & Björkman, 2007; Lehto, Ojanen, &

Kellokumpu-Lehtinen, 2005; Rabin, Heldt, Hirakata, & Fleck, 2008). Poor QoL has

also been reported among populations with similar risk patterns as detained offend-

ers, such as people with histories of childhood maltreatment (Greger, Myhre,

Lydersen, & Jozefiak, 2016), personality disorders (Cramer, Torgersen, & Kringlen,

2006; Lindstedt, Soderlund, Stalenheim, & Sjoden, 2005), and substance use disor-

ders (De Maeyer, Vanderplasschen, & Broekaert, 2010; Muller, Skurtveit, & Clausen,

2016; Strada et al., 2017).

Issues in QoL Assessment

Minimum standards for QoL instruments have been recommended by the International

Society for Quality of Life Research, after surveying 120 experts in patient-reported

outcome measurement (Reeve et al., 2013). In addition to reliability and validity – two

common indicators of methodological quality – the conceptual and measurement

model should be documented, and the instrument developed with input from the target

population. The burden to respondents should be as low as possible, as should the

burden to administrators (relating to calculating scores and potentially to administer-

ing an interview). Scores should also be interpretable and with a clearly defined mini-

mum important difference. As a subjective construct, QoL should be self-reported, not

reported by a proxy such as a carer or a partner (Coen, 2011). By virtue of being