Adaptation, response-shift and quality of life ratings in mentally well and unwell groups

In this paper, a novel decomposition of adaptation, focusing on aspirations and resignation, is presented. Adaptation, response-shift and quality of life were assessed over 2 years, using the same methodology in three different health-status groups: severe mental illness (n = 149); common mental disorder (n = 354); and no disorder (n = 583). Adaptation effects occurred in all life domains including health, but in only one third of each sample. As hypothesised, aspirations tended to be associated with lower quality of life (QOL) ratings and resignation was associated with higher QOL scores (although not significantly higher, necessarily). These two effects tended to cancel each other out, so that the overall impact of adaptation was minimal. Health-status, changes in objective situation (e.g. financial circumstances) and changes in depression were all associated with QOL at follow-up, but resignation and aspiration also made independent contributions. Resignation was more closely related to changes in global ratings than to domain-specific ratings, whereas aspirations appeared consistently and made a greater contribution. The results are consistent with other measurement approaches that indicate that adaptation effects in relation to QOL, are not large.