Abstract
PurposePrevious studies of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) interview version suggested a second-order model, with a general disability factor and six factors on a lower level. The goal of this study is to investigate if we can find support for a similar higher-order factor structure of the 36-item self-report version of the WHODAS 2.0 in a Dutch psychiatric outpatient sample. We aim to give special attention to the differences between the non-working group sample and the working group sample. Additionally, we intend to provide preliminary norms for clinical interpretation of the WHODAS 2.0 scores in psychiatric settings.MethodsPatients seeking specialized ambulatory treatment, primarily for depressive or anxiety symptoms, completed the WHODAS 2.0 as part of the initial interview. The total sample consisted of 770 patients with a mean age of 37.5 years (SD = 13.3) of whom 280 were males and 490 were females. Several factorial compositions (i.e., one unidimensional model and two second-order models) were modeled using confirmatory factor analysis (CFA). Descriptive statistics, model-fit statistics, reliability of the (sub)scales, and preliminary norms for interpreting test scores are reported.ResultsFor the non-working group, the second-order model with a general disability factor and six factors on a lower level, provided an adequate fit. Whereas, for the working group, the second-order model with a general disability factor and seven factors on a lower level seemed more appropriate. The WHODAS 2.0 36-item self-report form showed adequate levels of reliability. Percentile ranks and normalized T-scores are provided to aid clinical evaluations.ConclusionOur results lend support for a factorial structure of the WHODAS 2.0 36-item self-report version that is comparable to the interview version. While we conjecture that a seven-factor solution might give a better reflection of item content and item variance, further research is needed to assess the clinical relevance of such a model. At this point, we recommend using the second-order structure with six factors that matches past findings of the interview form.
Highlights
Adequate levels of functioning play a key role in successful aging in regard to deriving meaning and purpose in life, and have various favorable effects on mental and physical health [1, 2] According to the definition of the World Health Organization (WHO), health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” In line with this definition, it is safe to assume that merely using a medical classification and an inventory of symptoms, yield insufficient information on the level of care that is needed and the expected outcomes of healthcare
The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) [5], which is directly connected to the ICF concepts, is recommended by the WHO and the International Consortium for Health Outcomes Measurement (ICHOM) as a standard measure for the level of functioning [6]
The fit indices for the multidimensional models were acceptable. We interpreted this as support for the contention that a multidimensional model should be preferred, and that the subscales of the WHODAS 2.0 patient self-report have added value when measuring the level of functioning
Summary
Adequate levels of functioning play a key role in successful aging in regard to deriving meaning and purpose in life, and have various favorable effects on mental and physical health [1, 2] According to the definition of the World Health Organization (WHO), health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” In line with this definition, it is safe to assume that merely using a medical classification and an inventory of symptoms, yield insufficient information on the level of care that is needed and the expected outcomes of healthcare. An international systematic review on the use and psychometric properties of the WHODAS 2.0 [10] identified 810 studies from 94 countries published between 1999 and 2015, using the WHODAS (i.e., the 36-item version, 12-item version or the combined 12 + 24 item version in various formats: interview-administered, self-administered, and/or proxy-administered) From this review it is not clear how many studies used the 36-item patient self-report (i.e., self-administered) version ; but only fifteen of these studies were conducted in the field of psychiatry in The Netherlands using a 36-item format. These Dutch studies did not examine the psychometric properties of the WHODAS, but mostly used the WHODAS as an independent measure of functional impairment. It should be evaluated whether the factor structure of the WHODAS 2.0 interview version is adequate for the self-report version
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