Questionnaire Measuring Quality of Work Life Validated for People with Borderline Personality Disorder

A 40-item questionnaire designed to capture how people experience their working lives has now been shown to hold together statistically among workers with borderline personality disorder, a group whose relationship with employment is often fragile and complicated. In a study published in the Scandinavian Journal of Occupational Therapy, researchers report that the Quality of Work Life questionnaire, originally developed with people living with severe mental illness, displays good construct validity and strong internal consistency when completed by adults with BPD who are employed or in the process of returning to work.

Borderline personality disorder is characterized by difficulties in interpersonal functioning, emotional regulation and self-perception, and these very features shape how affected individuals experience the workplace. Employment can bring documented benefits to people with severe mental illness, including identification with a socially valued role, enhanced self-esteem, a sense of competence gained from learning new skills, and opportunities to expand social networks. Previous research has even associated working with cognitive improvement and symptom reduction. Yet the workplace can also reactivate symptoms such as emotional dysregulation and impulsive behavior, and stigmatization or discrimination by employers and colleagues adds further strain. People with BPD frequently navigate unstable work trajectories marked by frequent job changes, performance challenges and heightened work-related stress, partly attributable to that stigmatization.

The concept of quality of work life sits at the center of this tension. It is commonly defined as a worker’s overall relationship with the work environment, encompassing organizational, personal and social factors, and it extends beyond job satisfaction, which refers to the affective state arising from the match between job-related expectations and the rewards a job provides. The stakes are broad: Statistics Canada has reported that roughly 20 percent of employed Canadians describe their job as a source of high stress, while the European Agency for Safety and Health at Work has found that 27 percent of workers in Europe experience stress, anxiety or depression caused or worsened by work. Consequences of work-related stress include reduced productivity, presenteeism and absenteeism, early retirement, workplace accidents and employee turnover, all of which can drive up health-related costs.

The questionnaire itself grew out of qualitative research in which people with severe mental disorders, mainly psychotic disorders, described what quality of work life meant to them. Those accounts revealed two overarching macrodimensions: structural and physical elements of the job, and interpersonal and intrapersonal aspects. The resulting instrument distributes 40 items across eight subscales: work tasks, working conditions, work environment, organizational management, perception of being a good worker, relationships with colleagues, relationship with one’s manager, and sense of belonging to the organization. Each item is rated on a four-point scale from completely disagree to completely agree, and the questionnaire is administered in French. Earlier psychometric work among people with psychiatric disabilities working in social enterprises had demonstrated good to excellent internal consistency, with Cronbach’s alphas ranging from 0.70 to 0.93, and very good test-retest reliability of r = 0.91. In a prospective study of 67 employed individuals with psychiatric disabilities, a Cox regression analysis showed that quality of work life measured by the questionnaire was the only significant predictor of job tenure in social enterprises at a six-month follow-up.

What remained untested was the questionnaire’s construct validity, and whether it performed specifically for workers with BPD. To address this, the research team recruited participants through four specialized personality disorders services offering evidence-based psychotherapies such as Dialectical Behavior Therapy or Mentalization-Based Treatment, alongside interdisciplinary interventions including occupational therapy, and through one community-based organization serving people with BPD across multiple regions of the province of Quebec, Canada. Eligible participants were between 18 and 65 years old, had a diagnosis of BPD established by a qualified healthcare professional, were either currently employed or engaged in a return-to-work process following sick leave, and could understand French. No exclusion criteria were applied, and all participants were receiving treatment at the time of recruitment.

Data were collected between November 2021 and March 2024 through an online survey that participants completed after providing electronic consent. Although 150 people finished the survey, in line with recommended minimum sample sizes for factor analyses, 20 participants, mainly self-employed workers and peer support workers, were excluded because many items did not apply to their work context, such as questions about colleagues or an immediate supervisor when working alone. The final confirmatory factor analyses therefore rested on 130 individuals with BPD. Most identified as women, the mean age was 35 years with a range of 18 to 63, more than half had completed college or university education, 39 percent were single, and 33 percent were parents. Slightly more than half reported at least one additional mental health condition, most often an anxiety disorder, and about 20 percent reported a physical health condition affecting their functioning, most frequently related to chronic pain.

The sample was substantially attached to the labor market: nearly 75 percent worked full-time, roughly 45 percent held more than one job, and the most common tenure in the current primary job ranged from one to three years. For slightly more than half of participants, the current main job was compatible with their training; for 65 percent it corresponded to a personal interest, and for 83 percent it related to their competencies. The total mean score on the questionnaire was high, at 2.99 out of 4 with a standard deviation of 0.46, indicating an overall positive perception of quality of work life. The highest mean score concerned the dimension reflecting a positive self-perception as a worker, while the lowest pertained to organizational actions supporting quality of work life.

The statistical core of the study came from confirmatory factor analyses performed separately for the two macrodimensions. For the structural and physical dimension, a model including correlations among subscales showed an excellent fit, with all fit indices meeting recommended thresholds, which included a chi-square to degrees-of-freedom ratio of 2 or below, an RMSEA below 0.08, and NNFI and CFI values of 0.90 or higher as acceptable and around 0.95 or higher as good. For the intra- and interpersonal dimension, the initial model yielded fit indices at the lower limit of the acceptable threshold, so a revised model was specified that allowed correlated measurement error between the item about being proud to work for one’s organization and the item about being satisfied with the organization, which correlated at r = 0.57. That revised model proved satisfactory across all criteria. Reliability was strong for both macrodimensions, with Cronbach’s alpha of 0.84 for the structural and physical dimension and 0.94 for the intra- and interpersonal dimension. Subscale alphas ranged from 0.57 to 0.90 in the structural dimension and from 0.79 to 0.94 in the interpersonal one, with only the work environment subscale falling below a satisfactory level. Pearson’s correlations among subscales were generally moderate, between 0.27 and 0.79, suggesting each subscale captures distinct yet related aspects, and the sense-of-belonging subscale correlated highly with all others, appearing to act as a cross-cutting dimension.

An exploratory, a posteriori comparison of subgroups added a suggestive secondary finding. Participants whose current job corresponded to an interest differed significantly from those for whom it did not on both macrodimensions, at p ≤ 0.01, while no significant mean differences emerged between subgroups divided by psychological comorbidity or by alignment between job and training. The authors interpret the generally higher scores on relational components of the questionnaire in light of core BPD features, noting that people with BPD consistently describe cultivating gratifying relationships as essential to their recovery, and that intrapersonal factors such as self-knowledge and self-esteem, along with interpersonal support, have been reported as important for work participation. They also suggest that well-established psychotherapies targeting intra- and interpersonal processes, including Dialectical Behavior Therapy, Mentalization-Based Treatment and Transference-Focused Psychotherapy, may support interpersonal functioning at work, while emphasizing that comprehensive work-centred interventions must still address the full range of work-related factors.

The study’s limitations are clearly stated. The questionnaire may require adjustments for self-employed workers and peer support workers, the work environment subscale’s low alpha coefficient warrants closer examination and possible item revision, and the sample size was limited despite added recruitment sites and reminders, since recruiting employed people with a confirmed BPD diagnosis proved challenging. Construct validity and internal consistency have now been established, but further psychometric testing is needed, including cut-off norms, convergent validity with other instruments, and longitudinal assessment of predictive validity for job tenure. The authors also note the questionnaire was tested across multiple sites within a single Canadian province, so studies with culturally and geographically diverse samples, in other languages, could add nuance. Within those bounds, the conclusion stands: the Quality of Work Life questionnaire is a valid self-report measure for employed individuals with BPD, one that can complement tools already used by occupational therapists and help identify the factors that shape whether work becomes a source of recovery or of renewed difficulty.

Subject of Research: Psychometric validation of the Quality of Work Life questionnaire among employed adults with borderline personality disorder

Article Title: Validation of the Quality of Work Life Questionnaire in Individuals with Borderline Personality Disorder

Article References: Larivière, N., & Corbière, M. (2026). Validation of the Quality of Work Life Questionnaire in Individuals with Borderline Personality Disorder. Scandinavian Journal of Occupational Therapy, 33(1), 10. https://doi.org/10.1007/s44474-026-00012-4

Image Credits: AI Generated

DOI: 10.1007/s44474-026-00012-4

Keywords: borderline personality disorder, quality of work life, psychometric validation, confirmatory factor analysis, occupational therapy, mental health, employment, job tenure, reliability, Quebec, return to work, self-report questionnaire