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Psychometric properties of the WHOQOL-BREF amongst wounded, injured, and ill members of the United States military

Keston Lindsay (Beth-El College of Nursing and Health Sciences, University of Colorado at Colorado Springs, Colorado Springs, Colorado, USA)
Michelle Ferrer (Department of Kinesiology and Physical Education, Eastern Connecticut State University, Willimantic, Connecticut, USA)
Ronald Davis (Department of Kinesiology, Texas Woman’s University, Denton, Texas, USA)
David Nichols (Department of Kinesiology, Texas Woman’s University, Denton, Texas, USA)

Mental Health Review Journal

ISSN: 1361-9322

Article publication date: 12 June 2017




Advances in military medical care have facilitated a reduction of fatalities in the global war on terror, relative to previous conflicts. The physical and psychological trauma of returning personnel remain a challenge, and poor physical and psychological health have been shown to affect quality of life (QOL). The purpose of this paper is to validate the WHOQOL-BREF questionnaire amongst wounded, injured and ill military personnel, and to determine the characteristics of distinct groups found in this sample.


In total, 52 male and female military personnel (34.69+7.63 years, n=51) completed 24 items of the WHOQOL-BREF. Principal component analysis using the direct oblimin rotation was used to determine the factor structure of the WHOQOL-BREF and k-means cluster analysis was used to determine QOL characteristics of the separate groups.


The WHOQOL-BREF is a reliable tool for measuring QOL for American military personnel. However, the psychometric structure of the WHOQOL-BREF in this sample differed from the original domains. The first cluster analysis based on the original domains produced two clusters: a group of 12 that had poor QOL, and a group of 40 that had relatively good QOL except for the physical domain. The second cluster analysis differed in independence and access/social support only.

Research limitations/implications

Although the sample was small for principal component analysis, the investigators chose to proceed with this procedure, because objective indicators such as measures of sampling adequacy and communalities met or exceeded acceptable thresholds.


Rehabilitation programs for military ill, injured and wounded should contain components that promote independence and self-actualization.



The authors would like to thank the participants for their time in participating in this study. All authors declare that they had no competing interests. All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


Lindsay, K., Ferrer, M., Davis, R. and Nichols, D. (2017), "Psychometric properties of the WHOQOL-BREF amongst wounded, injured, and ill members of the United States military", Mental Health Review Journal, Vol. 22 No. 2, pp. 124-135.



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