The 12-item WHO Disability Assessment Schedule II as an outcome measure for treatment of common mental disorders. (18th April 2016)

• Record Type: Journal Article
• Authors: Thomas, C.C.; Rathod, S.D.; De Silva, M.J.; Weiss, H.A.; Patel, V.
• Is Part Of: Global mental health. Volume 3(2016)
• Publication Date: 2016-04-18
• Subjects: 12-item WHODAS, -- anxiety, -- depression, -- disability, -- etiology, -- validity; Mental health -- Periodicals; Mental health care -- Periodicals; Mental health policy -- Periodicals; World health -- Periodicals; 362.19689
• DOI: 10.1017/gmh.2016.7
• Languages: English
• ISSNs: 2054-4251

Abstract

Abstract : Background: Common mental disorders (CMD) are among the most significant contributors to disability worldwide. Patient-reported disability outcomes should be included as a key metric in the comparative assessment of value across global mental health interventions. This study aims to evaluate the validity of a widely used, cross-cultural tool – the 12-item World Health Organization Disability Assessment Schedule II (WHODAS) – as a functional outcome measure for CMD treatment. Methods: The study population includes 1024 participants with CMD enrolled in the MANAS trial in India. CMD was assessed using the Revised Clinical Interview Schedule (CIS-R). Disability was assessed using the 12-item WHODAS II plus a measure of disability days. This analysis presents the correlations between these disability items and CMD symptom severity at 2 months after enrollment (convergent validity) and the items' associations with CMD recovery 4 months later (external responsiveness). Results: All items showed a positive correlation of disability with CMD symptom severity ( p < 0.001). The WHODAS items of 'standing, ' 'household responsibilities, ' and 'emotional disturbance' explained the most variance in CMD symptom severity. Improvements in 'disability days, ' 'emotional disturbance, ' 'standing, ' 'household responsibilities, ' 'day-to-day work, ' and 'concentrating' were significantly associated with CMD recovery over follow-up. Conclusions: Further research is recommended on a CMD-specific WHODAS subscale comprised of the six WHODAS items found to be most strongly associated with CMD severity and recovery. This shorter, CMD-specific disability subscale would critically serve as a common metric to compare intervention impact on patient-centered outcomes and, in turn, to allocate global mental health resources efficiently.