Toward standardised documentation in psychiatric evaluations: identifying functioning aspects and contextual factors in psychiatric reports of Swiss disability claimants with chronic widespread pain.

U Schwegler,J Anner,B Trezzini,C Peter

doi:10.4414/smw.2014.14008

Abstract

In Switzerland, psychiatric evaluations are crucial for deciding on eligibility of disability benefits for claimants with chronic widespread pain (CWP). However, the poor standardisation and low transparency of such evaluations have been criticised. Standardisation and transparency may be enhanced by comprehensive functioning documentation using the International Classification of Functioning, Disability and Health (ICF). We applied the ICF as a reference frame to determine a list of functioning aspects and contextual factors commonly reported in psychiatric work capacity evaluations of Swiss disability claimants with CWP. We conducted a retrospective qualitative and quantitative content analysis of 24 psychiatric reports of claimants with CWP by using the ICF taxonomy and a personal factor categorisation for data coding. Coded categories were considered candidate items for standardised documentation in psychiatric evaluations involving CWP if they passed a predetermined threshold based on their relative frequency across reports. A total of 71 second level ICF and personal factor categories passed the threshold. In total, 21 categories referred to the ICF component personal factors, 19 to body functions, 18 to activities and participation, and 13 to environmental factors. The list of ICF and personal factor categories we determined in this study addresses concepts commonly reported in psychiatric evaluations of medical work capacity involving CWP. It can serve as a starting point in developing a standard for comprehensive functioning documentation in the present context.

Highlights

Chronic pain disorders account for a large number of disability claims and cause high costs for disability insurance providers [1]
The list of ICF and personal factor categories we determined in this study addresses concepts commonly reported in psychiatric evaluations of medical
Four (16.7%) reports involved the diagnosis “M54.8 Panvertebral syndrome”, 3 (12.5%) involved “F45.1 Undifferentiated somatoform disorder”, and 2 (8.3%) involved “F33 Recurrent depressive disorder, with somatic symptoms” and “M79.7 Fibromyalgia”

Summary

Introduction

Chronic pain disorders account for a large number of disability claims and cause high costs for disability insurance providers [1]. Medical work capacity evaluations for chronic pain disorders are challenging because of complex biopsychosocial interactions that determine functioning [2]. CWP is often accompanied by psychiatric co-morbidities like depression [5] or anxiety disorders [6], and mental problems such as post-traumatic stress [7] or attention deficits [8]. Such co-morbidities, and their effect on work function, are assessed in psychiatric evaluations of medical work capacity (PEMWC). Psychiatric evaluations are, crucial for determining medical work capacity of claimants with CWP [9]

Methods

Results

Conclusion