Digitally Assisted Standard Diagnostics in Insurance Medicine (DASDIM): psychometric data in psychiatric work disability evaluations

Figures & data

Table 1. Demographic sample characteristics.

	All			Disability insurer^a			Pension fund			z^b	p	r^c
	N	Mdn	IQR	N	Mdn	IQR	N	Mdn	IQR
Age (years)	153	47	17.5	102	47	19.5	51	47	14	0.372	0.710	0.03
Educational years	153	13	4	102	12	3.3	51	15	4	4.572	<0.001	0.37
Premorbid IQ	153	100	50	102	99	11.3	51	110	18	4.846	<0.001	0.39
Highest annual income (k CHF)	117	72	55	73	62	49	44	96	51	4.629	<0.001	0.43

Mdn: median; IQR: inter-quartile range.

The sample characteristics of the total sample (“all”) and the two sub-samples defined by the commissioning body (“disability insurer” and “pension fund”).

^a Includes five SUVA cases.

^b z-value extracted from the Wilcoxon rank sum test.

^c Pearson’s correlation coefficient as effect size.

Table 2. Number of the participants’ main primary ICD-10 F-diagnoses.

Diagnosis	All	Disability insurer	Pension fund
F3x: mood/affective disorders	56 (36.6%)	29 (28.4%)	27 (52.9%)
F4x: neurotic, stress-related, and somatoform disorders	38 (24.8%)	25 (24.5%)	13 (25.5%)
F6x: disorders of adult personality and behavior	28 (18.3%)	23 (22.5%)	5 (9.8%)
Other F diagnosesa	21 (13.7%)	17 (16.7%)	4 (7.8%)
No F diagnosis	10 (6.5%)	8 (7.8%)	2 (3.9%)

The number and relative frequency of the primary ICD-10 F diagnoses in the total sample and two sub-samples. The distribution of the diagnoses varied between the two sub-samples (χ²=11.340, p = 0.023).

^a Two patients, one in each group, had an F2x diagnosis (schizophrenia, schizotypal, and delusional disorders).

Table 3. Factor loadings and communalities (h²) for the test and questionnaire data.

Scale	Factor
	Fa1	Fa2	Fa3	Fa4	Fa5	Fa6	h^2
Fa1: Negative Affectivity
MMPI – Emotional/Internalizing Dysfunction	0.904	–0.240	0.092	–0.013	–0.040	–0.066	0.890
MMPI – Demoralization	0.859	–0.228	0.183	–0.028	–0.044	0.003	0.826
MMPI – Dysfunctional Negative Emotions	0.798	–0.047	0.382	–0.016	–0.120	0.136	0.817
MMPI – Negative Emotionality/Neuroticism	0.780	–0.135	0.362	–0.011	–0.164	0.163	0.811
MMPI – Stress/Worry	0.766	–0.143	0.212	–0.026	–0.058	0.149	0.678
Fa2: Self-Perceived Work Ability
WAI – WAI Total Score	–0.219	0.878	–0.033	–0.058	0.006	0.094	0.833
WAI – Demand-related Physical Work Ability	–0.126	0.860	–0.101	0.074	0.079	0.018	0.779
WAI – Demand-related Work Ability	–0.289	0.829	–0.029	0.041	0.049	0.049	0.778
SF36 – Bodily Pain	0.063	0.698	–0.180	0.130	0.199	–0.088	0.588
SF36 – Role Physical	–0.016	0.697	–0.139	0.079	0.158	–0.042	0.539
Fa3: Behavioral Dysfunction
MMPI – Behavioral/Externalizing Dysfunction	0.091	–0.066	0.882	–0.032	0.073	–0.191	0.834
MMPI – Hypomanic Activation	–0.009	–0.070	0.862	–0.046	0.056	0.052	0.757
MMPI – Disconstraint	0.074	–0.015	0.763	0.056	0.145	–0.226	0.664
MMPI – Antisocial Behavior	0.302	–0.035	0.746	–0.022	0.064	–0.253	0.719
MMPI – Thought Dysfunction	0.258	–0.127	0.742	–0.107	–0.201	0.159	0.710
Fa4: Working Memory
Digit Span – Reliable Digit Span	–0.018	0.071	–0.051	0.937	0.091	0.018	0.894
Digit Span – Digit Span Good Trials Backward	–0.065	0.031	0.044	0.852	0.090	–0.031	0.742
Digit Span – Digit Span Good Trials Forward	–0.058	–0.006	–0.023	0.819	–0.015	–0.078	0.681
Digit Span – Reliable Digit Span Forward	0.000	0.036	–0.061	0.815	0.017	0.026	0.670
Digit Span – Digit Span Forward	–0.037	0.079	–0.016	0.776	0.143	–0.003	0.631
Fa5: Cognitive Processing Speed
TAP – Alertness w/o Warning Signal	–0.157	0.125	0.125	0.203	0.757	0.169	0.699
TAP – Alertness SD w/o Warning Signal	–0.193	0.199	0.109	0.098	0.697	0.141	0.604
TAP – Alertness w. Warning Signal	–0.170	0.131	0.136	0.215	0.680	0.171	0.602
TAP – Alertness SD w. Warning Signal	–0.255	0.203	0.062	0.163	0.627	0.175	0.560
Behavioral Eval. – Working Speed	0.082	0.112	0.009	0.172	0.594	–0.122	0.417
Fa6: Excessive Work Commitment
MPT – Rigidity	0.159	0.053	–0.088	–0.151	–0.033	0.688	0.533
AVEM – Work-related Ambition	–0.169	0.115	0.149	0.026	0.078	0.682	0.537
AVEM – Willingness to Work Until Exhausted	0.089	–0.122	–0.003	0.045	0.140	0.676	0.501
AVEM – Striving for Perfection	0.214	–0.025	–0.119	0.031	–0.003	0.643	0.475
AVEM – Subjective Importance of Work	–0.023	–0.010	–0.003	–0.102	–0.141	0.603	0.394
Total variance explained (%)	15.7	11.0	9.8	6.1	5.6	4.6

The factor loadings and communalities (h²) for the five test and questionnaire scales with highest loadings on each of the six factors (Fa1–Fa6). Factor loadings >|0.5| are marked by bold type. For the complete list, we refer to supplementary Table S2.

Figure 1. Factor score profile of claimants for disability benefits and applicants for early retirement. Claimants for disability benefits (blue bars) exhibited higher scores in the factor FaPsy Limitations in Psychosocial Capacity, as obtained from the psychiatric ratings, and in Behavioral Dysfunction (Fa3), as well as lower scores in the factors Self-Perceived Work Ability (Fa2), Working Memory (Fa4), and Cognitive Processing Speed (Fa5), as compared to applicants for early retirement (red bars). The two groups did not vary in Negative Affectivity (Fa1) and Excessive Work Commitment (Fa6). Significant group differences are marked by the dashed boxes.

The graph displays the differences between claimants for disability benefits and applicants for early retirement in their factor scores. The two profiles considerably vary. Among others, claimants for disability benefits showed more Limitations in Psychosocial Capacity and Behavioral Dysfunctions.

Figure 2. Factor score profile of claimants with different psychiatric diagnoses. Participants with F6x diagnoses (brown bars) exhibited higher scores FaPsy Limitations in Psychosocial Capacity, Negative Affectivity (Fa1), and Behavioral Dysfunction (Fa3), as compared to participants with F3x and F4x diagnoses (green and yellow bars, respectively). The groups did not vary in Self-Perceived Work Ability (Fa2), Working Memory (Fa4), Cognitive Processing Speed (Fa5), and Excessive Work Commitment (Fa6).

The graph displays the factor score differences between participants with three different ICD-F diagnoses. The profiles of the groups show some variation. Most noteworthy, participants with F6x diagnoses exhibited higher scores for Limitations in Psychosocial Capacity, Negative Affectivity, and Behavioral Dysfunction, as compared to participants with F3x and F4x diagnoses.

Figure 3. Factor score profile of claimants for disability benefits with different levels of RWC. Claimants with different levels of RWC showed significant differences in the factor FaPsy Limitations in Psychosocial Capacity, as obtained from the psychiatric ratings, and the factor 1 (Fa1) Negative Affectivity. They did not vary in the factors Self-Perceived Work Ability (Fa2), Behavioral Dysfunction (Fa3), Working Memory (Fa4), Cognitive Processing Speed (Fa5), and Excessive Work Commitment (Fa6).

The graph displays the factor score differences between claimants with low, medium, and high residual work capacity. The scores vary for two factors and show few differences for the others. Claimants with good residual work capacity showed fewest Limitations in Psychosocial Capacity and lowest Negative Affectivity.

Data availability statement

The datasets generated and analyzed during the current study are not publicly available due to data protection reasons. Coded data might be selectively available from the senior author (RM) upon reasonable request.