The 12-item Self-Report World Health Organization Disability Assessment Schedule (WHODAS) 2.0 Administered Via the Internet to Individuals With Anxiety and Stress Disorders: A Psychometric Investigation Based on Data From Two Clinical Trials

Erland Axelsson, Elin Lindsäter, Brjánn Ljótsson, Erik Andersson, Erik Hedman-Lagerlöf, Erland Axelsson, Elin Lindsäter, Brjánn Ljótsson, Erik Andersson, Erik Hedman-Lagerlöf

Abstract

Background: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a widespread measure of disability and functional impairment, which is bundled with the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) for use in psychiatry. Administering psychometric scales via the Internet is an effective way to reach respondents and allow for convenient handling of data.

Objective: The aim was to study the psychometric properties of the 12-item self-report WHODAS 2.0 when administered online to individuals with anxiety and stress disorders. The WHODAS 2.0 was hypothesized to exhibit high internal consistency and be unidimensional. We also expected the WHODAS 2.0 to show high 2-week test-retest reliability, convergent validity (correlations approximately .50 to .90 with other self-report measures of functional impairment), that it would differentiate between patients with and without exhaustion disorder, and that it would respond to change in primary symptom domain.

Methods: We administered the 12-item self-report WHODAS 2.0 online to patients with anxiety and stress disorders (N=160) enrolled in clinical trials of cognitive behavior therapy, and analyzed psychometric properties within a classical test theory framework. Scores were compared with well-established symptom and disability measures, and sensitivity to change was studied from pretreatment to posttreatment assessment.

Results: The 12-item self-report WHODAS 2.0 showed high internal consistency (Cronbach alpha=.83-.92), high 2-week test-retest reliability (intraclass correlation coefficient=.83), adequate construct validity, and was sensitive to change. We found preliminary evidence for a three-factorial structure, but one strong factor accounted for a clear majority of the variance.

Conclusions: We conclude that the 12-item self-report WHODAS 2.0 is a psychometrically sound instrument when administered online to individuals with anxiety and stress disorders, but that it is probably fruitful to also report the three subfactors to facilitate comparisons between studies.

Trial registration: Clinicaltrials.gov NCT02540317; https://ichgcp.net/clinical-trials-registry/NCT02540317 (Archived by WebCite at http://www.webcitation.org/6vQEdYAem); Clinicaltrials.gov NCT02314065; https://ichgcp.net/clinical-trials-registry/NCT02314065 (Archived by WebCite at http://www.webcitation.org/6vQEjlUU8).

Keywords: Internet; WHODAS; disability; psychometrics; questionnaire; validity.

Conflict of interest statement

Conflicts of Interest: None declared.

©Erland Axelsson, Elin Lindsäter, Brjánn Ljótsson, Erik Andersson, Erik Hedman-Lagerlöf. Originally published in JMIR Mental Health (http://mental.jmir.org), 08.12.2017.

References

    1. Üstün TB, Kostanjsek N, Chatterji S, Rehm J, editors. Measuring Health and Disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0) Malta: World Health Organization; 2010.
    1. Üstün TB, Chatterji S, Kostanjsek N, Rehm J, Kennedy C, Epping-Jordan J, Saxena S, von Korff M, Pull C, World Health Organization. National Institutes of Health Developing the World Health Organization Disability Assessment Schedule 2.0. Bull World Health Organ. 2010 Nov 1;88(11):815–823. doi: 10.2471/BLT.09.067231.
    1. World Health Organization . International Classification of Functioning, Disability and Health: ICF. Geneva: World Health Organization; 2001.
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. Arlington, VA: American Psychiatric Association; 2013.
    1. Andrews G, Kemp A, Sunderland M, Von KM, Ustun TB. Normative data for the 12 item WHO Disability Assessment Schedule 2.0. PLoS One. 2009 Dec;4(12):e8343. doi: 10.1371/journal.pone.0008343.
    1. Weeks M, Garber BG, Zamorski MA. Disability and mental disorders in the Canadian Armed Forces. Can J Psychiatry. 2016 Apr;61(1 Suppl):56S–63S. doi: 10.1177/0706743716628853.
    1. McEvoy PM, Mahoney AE. Achieving certainty about the structure of intolerance of uncertainty in a treatment-seeking sample with anxiety and depression. J Anxiety Disord. 2011 Jan;25(1):112–122. doi: 10.1016/j.janxdis.2010.08.010.
    1. Luciano JV, Ayuso-Mateos JL, Fernández A, Serrano-Blanco A, Roca M, Haro JM. Psychometric properties of the twelve item World Health Organization Disability Assessment Schedule II (WHO-DAS II) in Spanish primary care patients with a first major depressive episode. J Affect Disord. 2010 Feb;121(1-2):52–58. doi: 10.1016/j.jad.2009.05.008.
    1. Buchanan T. Internet-based questionnaire assessment: appropriate use in clinical contexts. Cogn Behav Ther. 2003;32(3):100–109. doi: 10.1080/16506070310000957.
    1. Gosling SD, Vazire S, Srivastava S, John OP. Should we trust web-based studies? A comparative analysis of six preconceptions about internet questionnaires. Am Psychol. 2004 Mar;59(2):93–104. doi: 10.1037/0003-066X.59.2.93.
    1. Grossi G, Perski A, Osika W, Savic I. Stress-related exhaustion disorder - clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout. Scand J Psychol. 2015 Dec;56(6):626–636. doi: 10.1111/sjop.12251.
    1. Axelsson E, Andersson E, Ljótsson B, Wallhed Finn D, Hedman E. The health preoccupation diagnostic interview: inter-rater reliability of a structured interview for diagnostic assessment of DSM-5 somatic symptom disorder and illness anxiety disorder. Cogn Behav Ther. 2016 Jun;45(4):259–269. doi: 10.1080/16506073.2016.1161663.
    1. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59 Suppl 20:22–33;quiz 34.
    1. Sjonnesen K, Bulloch AG, Williams J, Lavorato D. Characterization of disability in Canadians with mental disorders using an abbreviated version of a DSM-5 emerging measure: the 12-Item WHO Disability Assessment Schedule (WHODAS) 2.0. Can J Psychiatry. 2016 Apr;61(4):227–235. doi: 10.1177/0706743716632514.
    1. Leon AC, Shear MK, Portera L, Klerman GL. Assessing impairment in patients with panic disorder: the Sheehan Disability Scale. Soc Psychiatry Psychiatr Epidemiol. 1992 Mar;27(2):78–82. doi: 10.1007/bf00788510.
    1. Leon AC, Olfson M, Portera L, Farber L, Sheehan DV. Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. Int J Psychiatry Med. 1997;27(2):93–105. doi: 10.2190/t8em-c8yh-373n-1uwd.
    1. De Zwart BC, Frings-Dresen MH, van Duivenbooden JC. Test-retest reliability of the Work Ability Index questionnaire. Occup Med (Lond) 2002 Jun;52(4):177–181. doi: 10.1093/occmed/52.4.177.
    1. Radkiewicz P, Widerszal-Bazyl M, NEXT-Study Group Psychometric properties of Work Ability Index in the light of comparative survey study. 2nd International Symposium on Work Ability; Oct 18-20, 2004; Verona, Italy. Elsevier; 2005.
    1. Ilmarinen J. The Work Ability Index (WAI) Occup Med. 2007 Mar 01;57(2):160. doi: 10.1093/occmed/kqm008.
    1. Salkovskis PM, Rimes KA, Warwick HMC, Clark DM. The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol Med. 2002 Jul;32(5):843–853. doi: 10.1017/S0033291702005822.
    1. Hedman E, Ljótsson B, Andersson E, Andersson G, Lindefors N, Rück C, Axelsson E, Lekander M. Psychometric properties of Internet-administered measures of health anxiety: an investigation of the Health Anxiety Inventory, the Illness Attitude Scales, and the Whiteley Index. J Anxiety Disord. 2015 Apr;31:32–37. doi: 10.1016/j.janxdis.2015.01.008.
    1. Hedman E, Lekander M, Ljótsson B, Lindefors N, Rück C, Andersson G, Andersson E. Optimal cut-off points on the health anxiety inventory, illness attitude scales and whiteley index to identify severe health anxiety. PLoS One. 2015;10(4):e0123412. doi: 10.1371/journal.pone.0123412.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983 Dec;24(4):385–396. doi: 10.2307/2136404.
    1. Svanborg P, Åsberg M. A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatr Scand. 1994 Jan;89(1):21–28. doi: 10.1111/j.1600-0447.1994.tb01480.x.
    1. Svanborg P, Åsberg M. A comparison between the Beck Depression Inventory (BDI) and the self-rating version of the Montgomery Asberg Depression Rating Scale (MADRS) J Affect Disord. 2001 May;64(2-3):203–216. doi: 10.1016/s0165-0327(00)00242-1.
    1. Carlbring P, Brunt S, Bohman S, Austin D, Richards J, Öst LG, Andersson G. Internet vs. paper and pencil administration of questionnaires commonly used in panic/agoraphobia research. Comput Hum Behav. 2007 May;23(3):1421–1434. doi: 10.1016/j.chb.2005.05.002.
    1. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092–1097. doi: 10.1001/archinte.166.10.1092.
    1. R Core Team . R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2016. [2017-11-23].
    1. Rosseel Y. lavaan: an R package for structural equation modeling. J Stat Softw. 2012;48(2):1–36. doi: 10.18637/jss.v048.i02.
    1. Li C. Confirmatory factor analysis with ordinal data: comparing robust maximum likelihood and diagonally weighted least squares. Behav Res Methods. 2016 Sep;48(3):936–949. doi: 10.3758/s13428-015-0619-7.
    1. Byrne BM. Structural Equation Modeling with AMOS: Basic Concepts, Applications and Programming. Mahwah, NJ: Lawrence Erlbaum Associates; 2001.
    1. Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991 Feb;59(1):12–19. doi: 10.1037/0022-006x.59.1.12.
    1. Revicki D, Hays RD, Cella D, Sloan J. Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol. 2008 Feb;61(2):102–109. doi: 10.1016/j.jclinepi.2007.03.012.
    1. Saltychev M, Mattie R, McCormick Z, Laimi K. Confirmatory factor analysis of 12-Item World Health Organization Disability Assessment Schedule in patients with musculoskeletal pain conditions. Clin Rehabil. 2017 May;31(5):702–709. doi: 10.1177/0269215516652930.
    1. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, de Vet HC. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007 Jan;60(1):34–42. doi: 10.1016/j.jclinepi.2006.03.012.
    1. Kreuter F, Presser S, Tourangeau R. Social desirability bias in CATI, IVR, and web surveys: the effects of mode and question sensitivity. Public Opinion Quarterly. 2009 Jan 26;72(5):847–865. doi: 10.1093/poq/nfn063.
    1. Eklund M, Bäckström M, Tuvesson H. Psychometric properties and factor structure of the Swedish version of the Perceived Stress Scale. Nord J Psychiatry. 2014 Oct;68(7):494–499. doi: 10.3109/08039488.2013.877072.
    1. Seivewright H, Salkovskis P, Green J, Mullan N, Behr G, Carlin E, Young S, Goldmeier D, Tyrer P. Prevalence and service implications of health anxiety in genitourinary medicine clinics. Int J STD AIDS. 2004 Aug;15(8):519–522. doi: 10.1258/0956462041558122.
    1. Ericsson M, Poston II WS, Linder J, Taylor JE, Haddock CK, Foreyt JP. Depression predicts disability in long-term chronic pain patients. Disabil Rehabil. 2002 Apr 15;24(6):334–340. doi: 10.1080/09638280110096241.
    1. Kroenke K, Spitzer RL, Williams JB, Löwe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010;32(4):345–359. doi: 10.1016/j.genhosppsych.2010.03.006.
    1. van Den Berg TI, Elders LA, de Zwart BC, Burdorf A. The effects of work-related and individual factors on the Work Ability Index: a systematic review. Occup Environ Med. 2009 Apr;66(4):211–220. doi: 10.1136/oem.2008.039883.
    1. Allen AR, Newby JM, Mackenzie A, Smith J, Boulton M, Loughnan SA, Andrews G. Internet cognitive-behavioural treatment for panic disorder: randomised controlled trial and evidence of effectiveness in primary care. BJPsych Open. 2016 Mar;2(2):154–162. doi: 10.1192/bjpo.bp.115.001826.
    1. Andrews G, Davies M, Titov N. Effectiveness randomized controlled trial of face to face versus Internet cognitive behaviour therapy for social phobia. Aust N Z J Psychiatry. 2011 Apr;45(4):337–340. doi: 10.3109/00048674.2010.538840.
    1. Mason EC, Andrews G. The use of automated assessments in internet-based CBT: the computer will be with you shortly. Internet Interv. 2014 Oct;1(4):216–224. doi: 10.1016/j.invent.2014.10.003.
    1. Mewton L, Wong N, Andrews G. The effectiveness of internet cognitive behavioural therapy for generalized anxiety disorder in clinical practice. Depress Anxiety. 2012 Oct;29(10):843–849. doi: 10.1002/da.21995.
    1. Newby JM, Mewton L, Andrews G. Transdiagnostic versus disorder-specific internet-delivered cognitive behaviour therapy for anxiety and depression in primary care. J Anxiety Disord. 2017 Mar;46:25–34. doi: 10.1016/j.janxdis.2016.06.002.
    1. Newby JM, Mahoney AE, Mason EC, Smith J, Uppal S, Andrews G. Pilot trial of a therapist-supported internet-delivered cognitive behavioural therapy program for health anxiety. Internet Interv. 2016 Nov;6:71–79. doi: 10.1016/j.invent.2016.09.007.
    1. Perini S, Titov N, Andrews G. The Climate Sadness program of Internet-based treatment for depression: a pilot study. EJAP. 2008 Dec 23;4(2):18–24. doi: 10.7790/ejap.v4i2.135.
    1. Spence J, Titov N, Solley K, Dear BF, Johnston L, Wootton B, Kemp A, Andrews G, Zou J, Lorian C, Choi I. Characteristics and treatment preferences of people with symptoms of posttraumatic stress disorder: an internet survey. PLoS One. 2011;6(7):e21864. doi: 10.1371/journal.pone.0021864.
    1. Titov N, Andrews G, Schwencke G, Drobny J, Einstein D. Shyness 1: distance treatment of social phobia over the Internet. Aust N Z J Psychiatry. 2008 Jul;42(7):585–594. doi: 10.1080/00048670802119762.
    1. Titov N, Andrews G, Schwencke G. Shyness 2: treating social phobia online: replication and extension. Aust N Z J Psychiatry. 2008 Jul;42(7):595–605. doi: 10.1080/00048670802119820.
    1. Williams AD, Blackwell SE, Mackenzie A, Holmes EA, Andrews G. Combining imagination and reason in the treatment of depression: a randomized controlled trial of internet-based cognitive-bias modification and internet-CBT for depression. J Consult Clin Psychol. 2013 Oct;81(5):793–799. doi: 10.1037/a0033247.
    1. Williams AD, O'Moore K, Mason E, Andrews G. The effectiveness of internet cognitive behaviour therapy (iCBT) for social anxiety disorder across two routine practice pathways. Internet Interv. 2014 Oct;1(4):225–229. doi: 10.1016/j.invent.2014.11.001.
    1. Williams AD, O'Moore K, Blackwell SE, Smith J, Holmes EA, Andrews G. Positive imagery cognitive bias modification (CBM) and internet-based cognitive behavioral therapy (iCBT): a randomized controlled trial. J Affect Disord. 2015 Jun 01;178:131–141. doi: 10.1016/j.jad.2015.02.026.
    1. Wootton BM, Titov N, Dear BF, Spence J, Kemp A. The acceptability of Internet-based treatment and characteristics of an adult sample with obsessive compulsive disorder: an Internet survey. PLoS One. 2011;6(6):e20548. doi: 10.1371/journal.pone.0020548.

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