Disability assessment in the persons with schizophrenia: Inter-rater agreement and correlation between self-, proxy-, and interviewer-rated versions of the World Health Organization Disability Assessment Schedule 2.0

Abstract

Schizophrenia has been described as the most disabling mental disorder, and patients with schizophrenia have been said to be disabled mostly in occupation, sexual relation, self-care, and social relationship domains. The present study aimed at assessing disability through self-, proxy-, and interviewer-rated versions of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 among persons with schizophrenia. The study was cross-sectional. Thirty samples of patients with schizophrenia as per the International Classification of Diseases-10 criteria were selected using a consecutive sampling technique. Patients above 18 years of age with a total duration of illness of at least more than 2 years were included in the study. The study was conducted at the Outpatient Department of Mental Health Institute and Department of Psychiatry, Government Medical College and Hospital Sector 32, Chandigarh, India. The overall inter-rater reliability in schizophrenia was 0.599 (0.395–0.767), indicative of moderate reliability. Domains, namely, getting along with people (0.803) and life activities of household (0.854) had a good reliability, whereas domains such as cognition (0.681), mobility (0.616), self-care (0.636), life activities at school/work (0.664), and participation in the society (0.753) indicated a moderate reliability. There was no significant difference among the self, proxy, and interviewer assessments for most items. This study highlighted the fact that service users can also carry out an objective self-assessment of disability, thus upholding the principles of advanced directives as envisaged under the Mental Health Care Act, 2017.