The 12-item Self-Report World Health Organization Disability Assessment Schedule (WHODAS) 2.0 Administered Via the Internet to Individuals With Anxiety and Stress Disorders: A Psychometric Investigation Based on Data From Two Clinical Trials

Axelsson, Erland; Lindsäter, Elin; Ljótsson, Brjánn; Andersson, Erik; Hedman-Lagerlöf, Erik

doi:10.2196/mental.7497

Cited by 79Psychometric Methodologies and TestingAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesHealth Systems, Economic Evaluations, Quality of Life

The 12-item Self-Report World Health Organization Disability Assessment Schedule (WHODAS) 2.0 Administered Via the Internet to Individuals With Anxiety and Stress Disorders: A Psychometric Investigation Based on Data From Two Clinical Trials

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Axelsson, Erland, Lindsäter, Elin, Ljótsson, Brjánn, Andersson, Erik, Hedman-Lagerlöf, Erik·2017·JMIR Mental Health

DOI 10.2196/mental.7497PMC PMC5741825

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Abstract

Background: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a widespread measure of disability and functional impairment, which is bundled with the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) for use in psychiatry. Administering psychometric scales via the Internet is an effective way to reach respondents and allow for convenient handling of data. Objective: The aim was to study the psychometric properties of the 12-item self-report WHODAS 2.0 when administered online to individuals with anxiety and stress disorders. The WHODAS 2.0 was hypothesized to exhibit high internal consistency and be unidimensional. We also expected the WHODAS 2.0 to show high 2-week test-retest reliability, convergent validity (correlations approximately .50 to .90 with other self-report measures of functional impairment), that it would differentiate between patients with and without exhaustion disorder, and that it would respond to change in primary symptom domain. Methods: We administered the 12-item self-report WHODAS 2.0 online to patients with anxiety and stress disorders (N=160) enrolled in clinical trials of cognitive behavior therapy, and analyzed psychometric properties within a classical test theory framework. Scores were compared with well-established symptom and disability measures, and sensitivity to change was studied from pretreatment to posttreatment assessment. Results: The 12-item self-report WHODAS 2.0 showed high internal consistency (Cronbach alpha=.83-.92), high 2-week test-retest reliability (intraclass correlation coefficient=.83), adequate construct validity, and was sensitive to change. We found preliminary evidence for a three-factorial structure, but one strong factor accounted for a clear majority of the variance. Conclusions: We conclude that the 12-item self-report WHODAS 2.0 is a psychometrically sound instrument when administered online to individuals with anxiety and stress disorders, but that it is probably fruitful to also report the three subfactors to facilitate comparisons between studies. Trial Registration: Clinicaltrials.gov NCT02540317; https://clinicaltrials.gov/ct2/show/NCT02540317 (Archived by WebCite at http://www.webcitation.org/6vQEdYAem); Clinicaltrials.gov NCT02314065; https://clinicaltrials.gov/ct2/show/NCT02314065 (Archived by WebCite at http://www.webcitation.org/6vQEjlUU8)

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Physical functioning may not be substantially affected in anxiety disorders.
“physical functioning may not be substantially affected in anxiety disorders [48].”
From Cost Effectiveness of Internet-Delivered Acceptance and Commitment Therapy for Patients with Severe Health Anxiety: A Randomised Controlled Trial (2022) · cites this paper as [48]
The Discussion (Score Distribution; page unavailable) suggests that people with severe health anxiety or a stress disorder are typically not much impaired in everyday self-care. The Results (Table 3; page unavailable) also show low difficulty scores for standing and walking. These findings support the hedged claim, but the paper studied those specific clinical samples rather than anxiety disorders generally. (LLM, conf=0.83)
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Authors: Axelsson, E., Lindsäter, E., Ljótsson, B., Andersson, E., & Hedman-Lagerlöf, E.
Affiliations: Karolinska Institutet (SE)
Corresponding author: Axelsson, Erland
ORCID: Axelsson, Erland
Lindsäter, Elin
Ljótsson, Brjánn
Andersson, Erik
Hedman-Lagerlöf, Erik
Venue: JMIR Mental Health
Publisher: JMIR Publications Inc.
Published: 2017-12-08
Volume: 4
Issue: 4
Pages: e58
ISSN: 2368-7959 (ISSN-L)
DOI: 10.2196/mental.7497
PMC: PMC5741825
OpenAlex: W2773856859
Cited by: 79
References: 53
Citations by year: 2026: 13 · 2025: 18 · 2024: 4 · 2023: 6 · 2022: 12 · 2021: 14 · 2020: 7 · 2019: 5
FWCI: 2.90
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: JMIR Mental Health (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Funders: Karolinska Institutet
Stockholms Läns Landsting
Topics: Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Keywords: WHODAS 2.0, disability assessment, functional disability, anxiety disorders, stress disorders, online administration, psychometric properties, internal consistency, test-retest reliability, convergent validity, sensitivity to change, cognitive behavioral therapy, burnout, exhaustion disorder, factor structure, self-report questionnaire, unidimensionality

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The 12-item Self-Report World Health Organization Disability Assessment Schedule (WHODAS) 2.0 Administered Via the Internet to Individuals With Anxiety and Stress Disorders: A Psychometric Investigation Based on Data From Two Clinical Trials

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