4Dirección General, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad El WHODAS y la escala de evaluación del funcionamiento social y In the s, the use of the Global Assessment of Functioning (GAF) scale was. GAF (1).pdf. Uploaded by Gabritxy. Save .. – Instrucciones escala de depresion de Uploaded by psiquiatria perinatal Uploaded by. escala CANFOR se desarrolló en el , para evaluar las necesidades la escala CANFOR a una muestra de 90 usuarios con patología psiquiátrica concurrent validity a negative correlation was found between GAF (p<0,01); LSP.
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WHODAS and the evaluation of disability among people with mental disorders with and without psychotic symptoms. It could be used as a complementary measure of disability in those with psychotic symptoms.
Thus, disability is a key indicator of health status, since it not only combines the consequences of the physical deterioration caused by illness or injury, but also the impact of social and environmental barriers that can be modified through particular interventions.
Hence the relevance of their proper measurement to determine the most heavily compromised areas in specific patient populations. Disability is on the rise.
This increase may be due to the attention given to assessing the loss of functionality, and even to gauging the world burden of disease. In fact, this was how mental disorders were shown to constitute significant public health problems worldwide Murray et al. In the s, the use of the Global Assessment of Functioning GAF scale was proposed to evaluate treatment outcomes and the level of improvement or deterioration in the functioning of patients with mental disorders, one of its greatest advantages being sensitivity to changes over time.
However, since it is only a cross-sectional evaluation, it does not take into account the time of evolution of the disorder —as, for example, the Personal and Social Performance PSP does Apiquian et al. However, sscala is still psiquiateia to compare the adequacy of this measure to evaluate populations with different mental disorders.
In addition psiquiatrix variations in the severity of the disability depending on the mental disorder that is suffered, there may be differences in the areas of functioning affected. According to Lara, Medina-Mora, Borges, and Zambranosocial relations is the psiquiatrix most severely compromised in patients with affective disorders, with depression causing the greatest impact on the average number of days with disability.
Anxiety disorders are also among the main causes of years lost through disability worldwide Vos et al. In the study by Olfson et al. People with psychotic disorders tend to have significant impairment in cognitive functioning, commonly associated not only with disability in social and occupational activities, but also those of a more basic order or involving survival Velligan et al.
WHODAS is the instrument that allows the evaluation of the greatest number of operating dimensions in people with very diverse health problems.
Children’s Global Assessment Scale – Wikipedia
It has already been evaluated in different groups of mental disorders, showing adequate indexes of validity and reliability Garin et al. However, there are few studies on its differential functioning in Mexican patients with and without psychotic symptoms. This information is relevant for decision-making as to whether or not to use a self-report disability measure such as WHODAS in both general peiquiatria groups. It could be hypothesized that individuals with psychotic symptoms would provide less reliable reports given the cognitive deficit they frequently present Alptekin et al.
Accordingly, the main objective of this study was to determine and compare the convergent and construct validity as well as the internal consistency of the total and the dimensions of the second Spanish version of WHODAS 2.
In all cases, they were men or eescala of legal age who had agreed to participate in the study and signed the corresponding informed consent form. Patients with physical or neurological problems that affected their ability to communicate, those with mental disorders following medical conditions or trauma, and those who turned up for the evaluation in a state of intoxication, agitation, or suicide ideation were excluded. It provides an objective profile of functioning and the subjective perception of the patient on the impact his or her illness produces in each one of escwla areas, with a higher score indicating greater disability.
It consists of 38 items with 5-point Likert responses, where 1 refers to no disability in performing the activity and 5 to a total inability to perform the activity. Two types of scores were obtained, referring to each sub-scale and a global score. To facilitate the interpretation of the subscale and total scores, these are converted into scores from 0 to It is therefore a measure specifically designed to evaluate the functionality of people with mental disorders, where deterioration is evident in the loss of skills for proper performance in four areas: The highest levels in the SOFAS assessment describe individuals who do not present significant psychopathology and exhibit many positive mental health traits or components Romera et al.
The scale should be applied by a clinician, using information from any source such as psiquiatrka history and interviews. Lastly, the evaluation of symptomatic severity was carried out by two psychiatrists after a diagnostic interview with the patient lasting approximately one hour. To confirm the usefulness of this evaluation in the present study, the correlations between two raters and the SOFAS were calculated.
The results are given in the corresponding section of this text. In general, it achieves adequate inter-rater reliability and convergent validity, so it was decided to use it as a method of evaluation of this variable in the study. Patients were subsequently evaluated by two psychiatrists, one of whom acted as an escalaa and the other as an observer. At the end of the diagnostic interview, both clinicians independently completed the evaluation of the functionality of each patient based on SOFAS, and their symptomatic severity through the ad hoc Likert scale for the study.
Data were analyzed using the SPSS-X version 21 spiquiatria, for Windows, PC The descriptive analyses were conducted on the basis of means, standard deviations and range for the continuous variables, and with frequencies and percentages for the categorical variables.
Chi square or T-Student tests of independent samples were used to determine whether there were differences in sociodemographic variables, symptom severity, and WHODAS and SOFAS scores among groups of patients with and without psychotic symptoms. Pearson and Spearman correlations were used to evaluate the associations between the different study variables according to their measurement levels. Lastly, in order to compare WHODAS scores between the different levels of symptomatic severity of the patients, they were divided into three groups according to the rating given by the evaluating clinician: Psiquiatgia, the final sample consisted of a total of patients: Two study groups were then formed: Table 2 shows the sociodemographic characteristics of the total sample and by diagnostic groups with or without psychotic symptoms.
Socio-demographic variables of the total sample and study groups. In the internal consistency analysis of the WHODAS scales and subscales, high coefficients were recorded for the total sample.
Assessment of psychoanalytic psychotherapy outcomes
The disability scores reported by patients with psychotic symptoms in the WHODAS-based interview were lower than those recorded by patients without psychotic symptoms—except for the area of interpersonal relationships. Conversely, according to clinician-rated functionality SOFASpatients with psychotic symptoms showed greater impairment of functioning than those without psychotic symptoms Table 3.
Moreover, although the WHODAS total score was statistically significantly associated with that of the SOFAS in the group of patients without psychotic symptoms, this was not the case for patients with psychotic symptoms Table 4.
Disability, functionality and symptomatic severity: Description and comparison between groups of patients with and without psychotic symptoms. Figure 1 shows the average total scores of WHODAS according to the level of symptomatic severity mild, moderate, or severe for the two groups of patients with and without psychotic symptoms. Total scores for each level of symptomatic severity by patient group with and without psychotic symptoms. As one can see, only statistically significant differences were found in the disability scores of mild and severe patients with no psychotic symptoms.
Sociodemographic variables, symptomatic severity, and perception of disability. In the total study sample, partnered patients whether married or living together reported higher total disability scores than those without a partner single, divorced, separated, and widowed WHODAS with partner: Being partnered or otherwise was significantly related to gender The remaining demographic variables were not significantly related to the perceived disability of the total sample, or to the group of patients without psychotic symptoms.
The analysis restricted to patients with psychotic symptoms showed that self perception of disability was greater in those who were not engaged in paid employment WHODAS without paid employment: Lastly, in relation to the symptomatic severity of the patient according to the evaluation of the two participating cliniciansfor the total of the sample, a positive, statistically significant correlation was found with the degree of disability perceived by patients through WHODAS relationship between WHODAS and severity according to the evaluating clinician: The same was true of the analysis by diagnostic groups with or without psychotic symptoms.
These findings are consistent with those obtained in other countries where very high rates of internal consistency of WHODAS have been obtained in patients with schizophrenia Guilera et al. In addition, coefficients hovered around.
This may be because they are also among the scales with fewest items, which explains why the coefficients are similar in both groups of patients Cervantes, Moreover, for the group of patients without psychotic symptoms, a significant correlation was found between the evaluation using this tool and that performed by clinicians based on SOFAS.
Global Assessment of Functioning
This association was, however, of a low magnitude approximately. These data coincide with those previously observed in the Spanish population Guilera et al. As in the Spanish sample of patients with bipolar disorder, in the participants of our study with affective, anxiety, or stress-related disorders, the areas of greatest disability were the activities involving everyday living basically at home and social participation.
As might be hypothesized, given the nature of the symptomatology characteristic of these conditions, patients with affective, anxiety, or stress-related disorders will find it more difficult to function socially because of the lack of desire to undertake activities involving interpersonal relationships. Regarding the construct validity of WHODAS, it was observed that among patients with no psychotic symptoms, the total WHODAS score was higher for those with mild symptomatology compared to those with moderate and severe symptomatology.
At the same time, it is striking that the patients with psychotic symptoms included in this study perceived themselves as having less disability in almost all areas of functioning compared to patients without psychotic symptoms. In fact, in the group of patients with psychotic symptoms, there was no relationship between their assessment of disability with WHODAS 2. These results are consistent with the study by Chopra, Couper, and Herrman which showed that patients with psychotic disorders minimized their problems in the areas of everyday living and self-care compared to clinical evaluations.
It is probable that these patients, given the cognitive impairment that their symptoms imply, lacked clarity regarding the impact of their disease on their everyday functioning, as opposed to patients without psychotic symptoms Guilera et al. Furthermore, in this study, there were no significant differences in WHODAS scores among patients with mild, moderate, or severe symptoms.
This data could be interpreted in two ways: For example, since patients with psychotic symptoms perceived themselves to be more disabled if they did not have a paid job, functional rehabilitation programs targeting this population would have to devote special efforts to their job training. In the case of those with psychotic symptoms, it also functions consistently and makes it possible to determine their subjective perception of disability, which, although it may not always coincide with that of a specialist clinician, may be useful for complementing the evaluation of this construct by taking into account both perspectives, that of the clinician and the patient.
Although the sample size is adequate for the central objective of the study in relation to the WHODAS psychometric evaluationthe descriptions of the disability level by area or functioning domain presented for each group of patients constitutes additional information which should be generalized with caution, in view of the fact that it is drawn from a sample of people seeking specialized care services in an urban area, who have higher average educational attainment than the general population.
Lucia Munch for her participation in applying the interviews to patients in the study as part of her role as research assistant in the overall project from which this study is derived. Clinical correlates and prediction over 1-year follow-up.
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