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Proxy reliability of the 12-item world health organization disability assessment schedule II among adult patients with mental disorders

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Abstract

Purpose

Despite the wide usage of World Health Organization Disability Assessment Schedule II (WHODAS 2.0) in psychiatry research and clinical practice, there was limited knowledge on its proxy reliability among people with mental disorders. This paper aimed to compare the 12-item WHODAS 2.0 responses of adult patients with mental disorders to their family caregivers.

Methods

In this study, 205 pairs of patients with mental disorders and primary family caregivers were consecutively recruited from one inpatient mental health department in a large hospital in China. All participants completed the 12-item version WHODAS 2.0 to assess patients’ functioning in the 30 days prior to the hospitalization. Measurement invariance, including configural, metric and scalar invariance, was tested across patient and proxy groups, using multi-group confirmatory factor analysis. Agreement between patients and proxies was examined by paired Wilcoxon tests and intraclass correlation coefficients (ICC). Subgroup analyses for proxy reliability were conducted within strata of proxy kinship and patient psychiatric diagnosis.

Results

The 12-item WHODAS 2.0 achieved configural, metric and partial scalar invariance across patient and proxy groups. Unsatisfactory consistency was found for most items (ICC < 0.75, P < 0.05), especially for items on Cognition, Getting along, Life activities, and Participation in society (ICC < 0.4, P < 0.05). Spouses agreed with patients more often than parents (ICC ≥ 0.4, P < 0.05). The paired Wilcoxon tests found that impairment of patients with psychotic disorders tended to be overestimated by proxies while proxies tended to underestimate impairment of patients with mood disorders.

Conclusion

Our study reveals inconsistency between self and proxy reports in the 12-item WHODAS 2.0 among adult patients with mental disorders. When proxy reports is needed, spouses are preferred than parents. We should be aware of proxies’ impairment overestimation among patients with psychotic disorders and underestimation among patients with mood disorders.

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Acknowledgements

We would like to thank the Mental Health Department in Second Xiangya Hospital, Central South University, for their assistance in data collection.

Funding

This study was supported by the National Social Science Foundation of China (17CGL050) to Wei Zhou.

Author information

Authors and Affiliations

  1. Hospital Administration Institute, Xiangya Hospital, Central South University, Changsha, Hunan, China

    Wei Zhou

  2. Xiangya School of Public Health, Central South University, Changsha, Hunan, China

    Qian Liu, Shuiyuan Xiao & Lizhang Chen

  3. Division of Prevention and Community Research & The Consultation Center, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA

    Yu Yu

  4. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA

    Kaveh Khoshnood

  5. Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA

    Shimin Zheng

Authors
  1. Wei Zhou
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  2. Qian Liu
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  3. Yu Yu
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  4. Shuiyuan Xiao
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  5. Lizhang Chen
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Correspondence to Wei Zhou.

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All authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by Institutional Review Board of the Xiangya School of Public Health, Central South University (XYGW-2018-01).

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Informed consent was obtained from all individual participants included in the study.

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Zhou, W., Liu, Q., Yu, Y. et al. Proxy reliability of the 12-item world health organization disability assessment schedule II among adult patients with mental disorders. Qual Life Res 29, 2219–2229 (2020). https://doi.org/10.1007/s11136-020-02474-w

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