Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30, Göteborg, Sweden.
Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden.
BMC Psychiatry. 2021 Mar 10;21(1):147. doi: 10.1186/s12888-021-03101-9.
The World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0) is a self-administered instrument to assess functional impairment. It is used in the general population as well as different patient groups. However, its application to patients with psychotic disorders may be hampered by disease-specific difficulties of self-estimation. This study aimed to examine the psychometric properties of the short (12-item) WHODAS-2.0 in a naturalistic sample of outpatients attending a psychosis clinic in Gothenburg, Sweden.
Annual data from two outpatient clinics registered 2016-2019 were analyzed retrospectively. The assessment of the short WHODAS-2.0 was based on the first questionnaire completed by 881 patients. Confirmatory factor analysis evaluated previously validated models. Item convergent and discriminant validity as well as internal reliability were computed. Construct validity was assessed by comparing mean differences in accord with previous research regarding patients' characteristics associated with functioning such as advanced age, diagnosed comorbidities, antipsychotic treatment status, and symptom severity measured with PANSS-8 remission items.
A heterogeneous sample was obtained in terms of age (range: 20-92), various living situations, and different geographic areas of birth. Most patients (75%) had been diagnosed with psychotic disorders more than 10 years ago and the majority (89%) were on antipsychotic medication. We confirmed an adjusted two-level factor model with a single second-order disability factor and six first-order factors representing the six IFC dimensions. The WHODAS-2.0 sum score measuring general disability showed good reliability (Cronbach's alpha = 0.89). Construct validity was confirmed as older patients, patients with comorbidities, and patients in assisted living had higher WHODAS-2.0 scores. Patients with no or mild psychotic symptoms had significantly lower WHODAS-2.0 sum scores than patients with more severe symptoms.
The findings further validate the 12-item WHODAS-2.0 in a naturalistic sample of outpatients with psychotic disorders. This study corroborates the clinical significance of the short, 12-item WHODAS-2.0 by demonstrating consistent associations between patients' age, medical comorbidities, living situation, antipsychotic treatment status, and psychotic symptom severity.
世界卫生组织残疾评估表 2.0（WHODAS-2.0）是一种自我管理的工具，用于评估功能障碍。它在普通人群以及不同的患者群体中都有使用。然而，由于自我评估方面的疾病特异性困难，其在精神障碍患者中的应用可能会受到阻碍。本研究旨在检验简短（12 项）WHODAS-2.0 在瑞典哥德堡一家精神病诊所的门诊患者自然样本中的心理测量特性。
回顾性分析了 2016-2019 年两个门诊部的年度数据。对 881 名患者首次完成的简短 WHODAS-2.0 进行评估。验证性因素分析评估了先前验证的模型。计算了项目收敛和区分效度以及内部信度。通过比较与先前研究中与功能相关的患者特征的平均差异（如年龄较大、诊断合并症、抗精神病药物治疗状态和用 PANSS-8 缓解项目测量的症状严重程度）来评估结构效度。
在年龄（范围：20-92 岁）、各种生活状况和不同出生地地理区域方面，获得了一个异质的样本。大多数患者（75%）的精神障碍诊断超过 10 年，大多数患者（89%）接受抗精神病药物治疗。我们证实了一个调整后的二级因素模型，具有一个单一的二级残疾因素和六个代表六个 IFC 维度的一级因素。测量一般残疾的 WHODAS-2.0 总分显示出良好的信度（Cronbach's alpha=0.89）。结构效度得到了确认，即年龄较大的患者、有合并症的患者和在辅助生活中的患者的 WHODAS-2.0 评分较高。无或轻度精神症状的患者的 WHODAS-2.0 总分明显低于症状更严重的患者。
这些发现进一步验证了 12 项 WHODAS-2.0 在精神病门诊患者的自然样本中的有效性。本研究通过证明患者年龄、合并症、生活状况、抗精神病药物治疗状态和精神症状严重程度之间存在一致的关联，证实了简短的 12 项 WHODAS-2.0 的临床意义。
