Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Centre for Psychiatric Research, Region Stockholm, Stockholm, Sweden.
Crim Behav Ment Health. 2024 Aug;34(4):347-359. doi: 10.1002/cbm.2344. Epub 2024 Jun 2.
Psychosocial rehabilitation in forensic psychiatric services requires sound measurement of patient and staff perceptions of psychosocial function. The recommended World Health Organisation Disability Assessment Schedule 2.0 (WHODAS), designed for this, has not been examined with offender patients.
To examine patient and staff WHODAS ratings of secure hospital inpatients with psychosis, any differences between them and explore associations with other clinical factors.
Seventy-three patients self-rated on the WHODAS after 3 months as inpatients. An occupational therapist interviewed the patient's primary nurse and care team at about the same time (staff ratings). Scores were calculated according to the WHODAS manual. WHODAS scores and interview-rated symptom severity, cognitive measures, daily antipsychotic dose and duration of care were compared.
Patient ratings indicated less disability than staff ratings for total score and for the domains of understanding and communicating, getting along and life activities. Self-care and participation ratings were similar. Patients were more likely to rate themselves as disabled in getting around (mobility). Only one-fifth of patient- and staff- ratings (16, 22%) were similar, while for nearly a third of the patients (23, 32%) self-ratings were higher than staff ratings. More severe positive symptoms were associated with higher self-rated WHODAS disability after accounting for treatment duration, negative symptoms, cognitive score and antipsychotic dose. No variable accounted for the staff/patient differences in ratings.
Our mean WHODAS score findings echoed those in other patient samples-of patient underestimation of disability, linked to severity of symptoms. In this study using the WHODAS for the first time in a forensic mental health secure inpatient service, however, we found that, by comparing individuals, half of the patients reported equivalent or greater disability than did staff. Future research should focus on elucidating from patients what contributes to their self-ratings. Understanding their thought processes in rating may enhance rehabilitation planning.
法医精神病服务中的心理社会康复需要对患者和工作人员对心理社会功能的感知进行可靠的测量。为此而设计的世界卫生组织残疾评定量表 2.0（WHODAS）尚未在罪犯患者中进行过检查。
检查精神病住院患者的 WHODAS 自评和工作人员评定，比较两者之间的差异，并探讨与其他临床因素的关联。
73 名住院患者在入院 3 个月后用 WHODAS 进行自评。职业治疗师同时对患者的主要护士和护理团队进行访谈（工作人员评定）。根据 WHODAS 手册计算分数。比较 WHODAS 评分以及访谈评估的症状严重程度、认知测量、每日抗精神病药物剂量和护理时间。
患者的总分和理解与沟通、人际交往和生活活动等领域的残疾程度均低于工作人员的评定。自我护理和参与评分相似。患者在行动（移动）方面更有可能自我评定为残疾。只有五分之一的患者和工作人员评定（16，22%）相似，而近三分之一的患者（23，32%）自我评定高于工作人员评定。在考虑治疗时间、阴性症状、认知评分和抗精神病药物剂量后，阳性症状越严重，自我评定的 WHODAS 残疾程度越高。没有任何变量可以解释工作人员和患者评定之间的差异。
我们的 WHODAS 平均得分结果与其他患者样本的结果一致，即患者低估了残疾程度，这与症状的严重程度有关。然而，在这项使用 WHODAS 首次在法医精神病学安全住院服务中进行的研究中，我们发现通过比较个体，一半的患者报告的残疾程度与工作人员相同或更大。未来的研究应重点关注从患者那里了解是什么导致了他们的自我评定。了解他们在评分过程中的思维过程可能会增强康复计划。
