Utility of the Work and Social Adjustment Scale (WSAS) in predicting long-term sick-leave in Danish patients with emotional disorders

Abstract

Background

The Work and Social Adjustment Scale (WSAS) is a self-administered measure designed to assess the level of inability to function socially as a consequence of a defined problem or disorder.

Methods

A total of 230 patients with emotional disorders completed the Danish translation of the WSAS, measures of anxiety and depression, the Level of Personality Functioning Brief Form, the Personality Inventory for DSM-5 Short Form, and the World Health Organization Five-Item Well-Being Index (WHO-5). We conducted a confirmatory factor analysis of the previously suggested factor structure of the instrument. We furthermore evaluated the construct validity of the WSAS by means of its relationship with depression, anxiety, personality functioning, and overall well-being. Finally, we evaluated the utility of the WSAS to identify those on long-term sick-leave by conducting receiver operating characteristic (ROC) curves.

Results

The instrument had a poor to average fit with the previously reported single-factor structure, but a better fit to a modified single-factor structure. Cronbach’s alpha and McDonald’s omega showed good internal scale reliability (α = .79, ωtotal = .85). WSAS was positively correlated with measures of anxiety (r = .33), depression (r = .44), and personality functioning (r = .23 and r = .20), and negatively correlated with WHO-5 wellbeing (r = –.57). The optimal cut-off point in the ROC-analyses was 23, which yielded a sensitivity of 74% and a specificity of 55% in the prediction of sick-leave status.

Discussion

The Danish WSAS shows promising psychometric properties, but has limited external validity insofar as predicting long-term sick leave in psychiatric patients with emotional disorders.

Keywords:

• WSAS
• personality disorders
• emotional disorders
• assessment

Author contributions

SA, MA, MH, SP and NR conceived the project. ABC, AE, MH and NR collected data. ORH carried out statistical calculations and was responsible for writing the first draft of the manuscript. SA, BB and NR contributed with significant analysis comments and guidance. All authors have discussed, reviewed and approved the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

By reasonable request from the last author.

Additional information

Funding

The mother study was funded by grant ID 114241 from TrygFonden; grant 5577 and 6215 from Jascha Fonden; grant RSSF2017-000667, RSSF2016-000342, and RSSF2015-000342 from Region Zealand Research Foundation; PhD scholarship (Bryde Christensen) from Region Zealand Mental Health Services; PhD scholarship (Reinholt) from Mental Health Services Capital Region of Denmark.

Notes on contributors

Oliver Rumle Hovmand

Oliver Rumle Hovmand, Psychiatric Research Unit, Region Zealand Mental Health Service, Slagelse, Faelledvej 6, Slagelse, Denmark and Department of Clinical Medicine, Faculty of Health, University of Copenhagen.

Nina Reinholt

Nina Reinholt, Psychiatric Research Unit, Region Zealand Mental Health Service, Slagelse, Faelledvej 6, Slagelse, Denmark.

Anne Bryde Christensen

Anne Bryde Christensen, Eating Disorders Research Unit, Mental Health Services Capital Region of Denmark. Maglevænget 30, Ballerup, Denmark.

Bo Bach

Bo Bach, Psychiatric Research Unit, Region Zealand Mental Health Service.

Anita Eskildsen

Anita Eskildsen, Department of Affective Disorders, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, Bygning K, Aarhus N.

Mikkel Arendt

Mikkel Arendt, Institute for Clinical Medicine, Aarhus University.

Morten Hvenegaard

Morten Hvenegaard, Neurocentre, Rigshospitalet, Copenhagen University Hospital, Denmark.

Stig Poulsen

Stig Poulsen, Department of Psychology, University of Copenhagen, Denmark.

Sidse M. Arnfred

Sidse M. Arnfred, Psychiatric Research Unit, Region Zealand Mental Health Service West and Psychiatric Research Unit, Region Zealand Mental Health Service, Copenhagen University Hospital – Psychiatry Region Zealand, Slagelse, Denmark & Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.