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采用世界卫生组织残疾评定量表 2.0 评估创伤后应激障碍退伍军人的残疾程度。

Using the World Health Organization Disability Assessment Schedule 2.0 to assess disability in veterans with posttraumatic stress disorder.

机构信息

National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, United States of America.

Boston University School of Medicine, Boston, Massachusetts, United States of America.

出版信息

PLoS One. 2019 Aug 7;14(8):e0220806. doi: 10.1371/journal.pone.0220806. eCollection 2019.

Abstract

The introduction of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was accompanied by the elimination of the Global Assessment of Functioning (GAF) scale, which was previously used to assess functioning. Although the World Health Organization Disability Assessment Schedule, Version 2.0 (WHODAS 2.0) was offered as a measure for further study, widespread adoption of the WHODAS 2.0 has yet to occur. The lack of a standardized instrument for assessing posttraumatic stress disorder (PTSD)-related disability has important implications for disability compensation. Accordingly, this study was designed to determine and codify the utility of the WHODAS 2.0 for assessing PTSD-related disability. Veterans from several VA medical centers (N = 1109) were included. We examined PTSD using several definitions and modalities and considered results by gender and age. Across definitions and modalities, veterans with PTSD reported significantly greater WHODAS 2.0 total (large effects; all ts > 6.00; all ps < .01; all Cohen's ds > 1.03) and subscale (medium-to-large effects; all ts > 2.29; all ps < .05; all Cohen's ds > .39) scores than those without PTSD. WHODAS 2.0 scores did not vary by gender; however, younger veterans reported less disability than older veterans (small effects; all Fs > 4.30; all ps < .05; all η2s < .05). We identified 32 as the optimally efficient cutoff score for discriminating veterans with and without PTSD-related disability, although this varied somewhat by age and gender. Findings support the utility of the WHODAS 2.0 in assessing PTSD-related disability.

摘要

《精神障碍诊断与统计手册》(DSM-5)的引入伴随着全球功能评估量表(GAF)的淘汰,该量表以前用于评估功能。尽管世界卫生组织残疾评估表 2.0(WHODAS 2.0)被作为进一步研究的手段提供,但 WHODAS 2.0 的广泛采用尚未发生。缺乏评估创伤后应激障碍(PTSD)相关残疾的标准化工具对残疾补偿具有重要意义。因此,本研究旨在确定和编纂 WHODAS 2.0 在评估 PTSD 相关残疾方面的效用。研究纳入了来自几个退伍军人事务部医疗中心的退伍军人(N=1109)。我们使用了几种定义和模式来检查 PTSD,并考虑了性别和年龄的结果。在各种定义和模式下,患有 PTSD 的退伍军人报告的 WHODAS 2.0 总分(大效应;所有 t 值>6.00;所有 p 值<.01;所有 Cohen's d 值>1.03)和子量表(中到大效应;所有 t 值>2.29;所有 p 值<.05;所有 Cohen's d 值>.39)得分明显高于没有 PTSD 的退伍军人。WHODAS 2.0 得分不受性别影响;然而,年轻的退伍军人报告的残疾程度低于年长的退伍军人(小效应;所有 F 值>4.30;所有 p 值<.05;所有 η2 值<.05)。我们确定 32 为区分 PTSD 相关残疾和无 PTSD 相关残疾的退伍军人的最佳效率截止分数,尽管这在一定程度上因年龄和性别而异。研究结果支持 WHODAS 2.0 在评估 PTSD 相关残疾方面的效用。

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