The work and social adjustment scale: Reliability, sensitivity and value

Zahra, Daniel; Qureshi, Adam; Henley, William; Taylor, Rod; Quinn, Cath; Pooler, Jill; Hardy, Gillian; Newbold, Alexandra; Byng, Richard

doi:10.3109/13651501.2014.894072

Cited by 142Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychometric Methodologies and TestingHealth Systems, Economic Evaluations, Quality of Life

The work and social adjustment scale: Reliability, sensitivity and value

Zahra, Daniel, Qureshi, Adam, Henley, William, Taylor, Rod, Quinn, Cath, Pooler, Jill, Hardy, Gillian, Newbold, Alexandra +1 more·2014·International Journal of Psychiatry in Clinical Practice

DOI 10.3109/13651501.2014.894072

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Abstract

OBJECTIVE: To investigate the psychometric properties of the Work and Social Adjustment Scale (WSAS) as an outcome measure for the Improving Access to Psychological Therapy programme, assessing its value as an addition to the Patient Health (PHQ-9) and Generalised Anxiety Disorder questionnaires (GAD-7). Little research has investigated these properties to date. METHODS: Reliability and responsiveness to change were assessed using data from 4,835 patients. Principal components analysis was used to determine whether the WSAS measures a factor distinct from the PHQ-9 and GAD-7. RESULTS: The WSAS measures a distinct social functioning factor, has high internal reliability, and is sensitive to treatment effects. CONCLUSIONS: The WSAS, PHQ-9 and GAD-7 perform comparably on measures of reliability and sensitivity. The WSAS also measures a distinct social functioning component suggesting it has potential as an additional outcome measure.

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The WSAS is a 5-item self-report questionnaire that assesses disability in daily life.
“The WSAS [84, 85] is a 5-item self-report questionnaire to assess disability in daily life (e.g., work, home management, social activities) on a 9-point Likert scale (0 = no disability, 8 = severe disability).”
From Eye movement desensitization and reprocessing (EMDR) therapy or supportive counseling prior to exposure therapy in patients with panic disorder: study protocol for a multicenter randomized controlled trial (IMPROVE) (2023) · cites this paper as [85]

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“age (years), mean (sD) 67 (13) 67 (13) Female, n (%) 62 (34) 55 (33) employment status, n (%) continued no employment 109 (59) 96 (58) Gave up employment 31 (17) 26 (16) continued employment 40 (22) 39 (23) started employment 5 (3) 5 (3) engaged in therapy, n (%) 86 (46) 29 (17) mrs (0–6), median (iQr) 1.”
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Background
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Method
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Method
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Background
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Result
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Background
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Background
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“The WSAS demonstrated high internal reliability, with a Cronbach’s alpha of 0.82, and a sensitivity to treatment effects comparable to widely used measures like the PHQ-9 and GAD-7 [39].”
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“The WSAS has been demonstrated to have good psychometric properties, to identify constructs related to functioning rather than general impairment [35], and has been used with adults with eating disorders [36].”
Method
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Arnfred, B. T., Bang, P., Hjorthøj, C. R., Winding, C., Moeller, K. S., Hvenegaard, M., Agerskov, L., Gausbøl, U. K., Soe, D., Wiborg, P., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-051147 · Cited by 17 · see citing works
Clinical effectiveness of active Alpha-Stim AID versus sham Alpha-Stim AID in major depression in primary care in England (Alpha-Stim-D): a multicentre, parallel group, double-blind, randomised controlled trial
Morriss, R. K., Patel, S., Boutry, C., Patel, P., Guo, B., Briley, P. M., Butler, D. A., Craven, M. P., Duncan, A., Griffiths, C., et al. (2023) · The Lancet Psychiatry · doi:10.1016/s2215-0366(23)00007-x · Cited by 17 · see citing works
Efficacy of an Unguided, Digital Single-Session Intervention for Internalizing Symptoms in Web-Based Workers: Randomized Controlled Trial
Lorenzo‐Luaces, L., & Howard, J. (2023) · Journal of Medical Internet Research · doi:10.2196/45411 · Cited by 16 · see citing works
“Prior work supports the reliability and validity of the WSAS across various patient populations [42].”
Preventing relapse with personalized smart‐messaging after cognitive behavioural therapy: A proof‐of‐concept evaluation
Malins, S., Biswas, S., Patel, S., Levene, J., Moghaddam, N. G., & Morriss, R. K. (2020) · British Journal of Clinical Psychology · doi:10.1111/bjc.12244 · Cited by 15 · see citing works
“…criteria for minimal clinically significant difference from 2 All beta values reported are non-standardized. non-users in quality of life (EQ-5D, 0.135), general health (VAS, 13.14), and generalized anxiety (GAD-7, 3.04) (Pickard, Neary, & Cella, 2007; Walters & Brazier, 2005; Zahra et al., 2014).”
BackgroundInfluential
“I wanted to do more of the homework!”—Feasibility and acceptability of blending app‐based homework with group therapy for social cognition in psychosis
Sedgwick, O., Hardy, A., Greer, B., Newbery, K., & Cella, M. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23193 · Cited by 15 · see citing works
Efficacy of acupuncture in refractory irritable bowel syndrome patients: a randomized controlled trial
Zhao, J., Zheng, H., Wang, X., Wang, X., Shi, Y., Xie, C.-R., Tao, Q., Li, D., Sun, J., Tian, J., et al. (2024) · Frontiers of Medicine · doi:10.1007/s11684-024-1073-7 · Cited by 14 · see citing works
The Effectiveness of Low-Intensity Psychological Interventions for Comorbid Depression and Anxiety in Patients with Long-Term Conditions: A Real-World Naturalistic Observational Study in IAPT Integrated Care
Lee, C. T., Harty, S., Adegoke, A., Palacios, J. E., Gillan, C. M., & Richards, D. (2023) · International Journal of Behavioral Medicine · doi:10.1007/s12529-023-10215-9 · Cited by 15 · see citing works
“The measure has also demonstrated good reliability and sensitivity [26].”
Background
An Empirical Study of Personality Disorders Among Treatment-Seeking Problem Gamblers
Brown, M., Oldenhof, E., Allen, J. S., & Dowling, N. A. (2016) · Journal of Gambling Studies · doi:10.1007/s10899-016-9600-3 · Cited by 14 · see citing works
“The WSAS has good psychometric properties, with internal consistency ranging from satisfactory to excellent (0.79–0.89) and a test–retest correlation of 0.84 (Cella et al. 2011; Mundt et al. 2002; Zahra et al. 2014).”
Influential
Trajectories of functional limitations, health-related quality of life and societal costs in individuals with long COVID: a population-based longitudinal cohort study
Wang, J., Goodfellow, H., Walker, S., BLANDFORD, A. E., Pfeffer, P., Hurst, J. R., Sunkersing, D., Bradbury, K. J., Robson, C., Henley, W., et al. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-088538 · Cited by 15 · see citing works
Self-citation
Comparative effectiveness of short-term psychodynamic psychotherapy and cognitive behavioral therapy for major depression in psychiatric outpatient clinics: a randomized controlled trial
Malkomsen, A., Wilberg, T., Bull-Hansen, B., Dammen, T., Evensen, J. H., Hummelen, B., Løvgren, A., Osnes, K., Ulberg, R., & Røssberg, J. I. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06544-6 · Cited by 13 · see citing works
“WSAS has been shown to have high internal reliability, and is sensitive to treatment effects [49].”
Prompt Mental Health Care (PMHC): work participation and functional status at 12 months post-treatment
Knapstad, M., Sæther, S. M. M., Hensing, G. K. E., & Smith, O. R. F. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-4932-1 · Cited by 13 · see citing works
The clinical effectiveness and cost-effectiveness of a ‘stepping into day treatment’ approach versus inpatient treatment as usual for anorexia nervosa in adult specialist eating disorder services (DAISIES trial): a study protocol of a randomised controlled multi-centre open-label parallel group non-inferiority trial
Irish, M., Dalton, B., Potts, L. C., McCombie, C., Shearer, J., Au, K., Kern, N., Clark-Stone, S., Connan, F., Johnston, A. L., et al. (2022) · Trials · doi:10.1186/s13063-022-06386-7 · Cited by 13 · see citing works
Acceptability and Outcomes of Transdiagnostic Guided Self-help Bibliotherapy for Internalizing Disorder Symptoms in Adults: A Fully Remote Nationwide Open Trial
Lorenzo‐Luaces, L., Howard, J., Jesús-Romero, R. D., Peipert, A., Buss, J., Lind, C. M., Botts, K., & Starvaggi, I. (2022) · Cognitive Therapy and Research · doi:10.1007/s10608-022-10338-5 · Cited by 13 · see citing works
“Prior work supports the reliability and validity of the WSAS across various patient populations (Zahra et al., 2014).”
Method
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders compared with diagnosis-specific protocols for anxiety disorders: A three-year follow-up
Bullis, J. R., Eustis, E. H., Curreri, A. J., Cardona, N. D., Woods, B. K., Rosellini, A. J., Barlow, D. H., & Farchione, T. J. (2023) · Journal of Mood and Anxiety Disorders · doi:10.1016/j.xjmad.2023.100024 · Cited by 11 · see citing works
“The WSAS has demonstrated high reliability and sensitivity [44].”
Exploring the mental health of individuals who play fantasy football
Wilkins, L., Dowsett, R., Zaborski, Z., Scoles, L. H., & Allen, P. M. (2021) · Human Behavior and Emerging Technologies · doi:10.1002/hbe2.316 · Cited by 12 · see citing works
Feasibility and acceptability of brief cognitive remediation targeting metacognition in acute inpatients with psychosis: a case series
Tsapekos, D., Taylor, R., & Cella, M. (2017) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2017.1301263 · Cited by 13 · see citing works
“Participants’ functioning was assessed with the Work and Social Adjustment Scale–Revised (WSAS-R; Zahra et al., 2014).”
MethodSelf-citation
Brief psychological interventions for anxiety and depression in a secondary care adult mental health service: an evaluation
Roberts, K., Travers-Hill, E., Coker, S., Troup, J., Casey, S., Parkin, K., & Kim, Y. (2021) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x21000258 · Cited by 11 · see citing works
Long-term outcomes at 24- and 36-month follow-up in the intervention arm of the randomized controlled trial of Prompt Mental Health Care
Smith, O. R. F., Sæther, S. M. M., Haug, E., & Knapstad, M. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04227-0 · Cited by 11 · see citing works
“A client was defined as reliably recovered when scoring below threshold on both measures at follow-up and showing reliable improvement on either PHQ-9 or GAD-7.”
MethodInfluential
A pilot randomized controlled trial of online written exposure therapy delivered by peer coaches to veterans with posttraumatic stress disorder
McLean, C. P., Malek, N., & Straud, C. L. (2024) · Journal of Traumatic Stress · doi:10.1002/jts.23020 · Cited by 11 · see citing works
Transcutaneous Auricular Vagus Nerve Stimulation Treatment for Erythematotelangiectatic Rosacea
Li, J., Wei, J., Zhang, M., Kong, M., Xie, L., Wan, M., Pan, Z., Tian, J., Ou, Z., Chen, S., et al. (2025) · JAMA Dermatology · doi:10.1001/jamadermatol.2025.3796 · Cited by 13 · see citing works
Internet-delivered CBT intervention (Space for Sleep) for insomnia in a routine care setting: Results from an open pilot study
Wogan, R., Enrique, Á., Adegoke, A., Earley, C., Sollesse, S., Gale, S., Chellingsworth, M., & Richards, D. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100443 · Cited by 11 · see citing works
Long-term outcomes of Prompt Mental Health Care: A randomized controlled trial
Sæther, S. M. M., Knapstad, M., Grey, N., Rognerud, M. A., & Smith, O. R. F. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103758 · Cited by 11 · see citing works
Initial evaluation of the Optimal Health Program for people with diabetes: 12-month outcomes of a randomised controlled trial
O’Brien, C. L., Apputhurai, P., Knowles, S. R., Jenkins, Z., Ski, C. F., Thompson, D. R., Moore, G., Ward, G. M., Loh, M., & Castle, D. J. (2022) · Psychology and Health · doi:10.1080/08870446.2022.2060507 · Cited by 10 · see citing works
“The WSAS has demonstrated reliability and validity (Zahra et al., 2014).”
Background
Group intervention for sexual minority adults with common mental health problems: preliminary evaluation
Hambrook, D. G., Aries, D., Benjamin, L., & Rimes, K. A. (2022) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465822000297 · Cited by 10 · see citing works
“1PHQ-9; 2GAD-7; 3WSAS.”
MethodInfluential
Functional impairment: The role of posttraumatic stress disorder symptoms, negative mood regulation, and interpersonal problems.
Silverstein, M. W., Lee, D. J., Seligowski, A. V., & Worley, C. B. (2018) · Traumatology An International Journal · doi:10.1037/trm0000164 · Cited by 9 · see citing works
“The WSAS has demonstrated strong reliability, validity, and responsiveness to treatment across a number of populations (Mataix-Cols et al., 2005; Mundt et al., 2002; Zahra et al., 2014).”
Background
The significance of anxiety symptoms in predicting psychosocial functioning across borderline personality traits
Howard, J., Jesús-Romero, R. D., Peipert, A., Riley, T. N., Rutter, L. A., & Lorenzo‐Luaces, L. (2021) · PLoS ONE · doi:10.1371/journal.pone.0245099 · Cited by 9 · see citing works
“Prior work supports the reliability and validity of WSAS ratings across various patient populations [33, 34].”
Background
Anxiety and functional impairment affects undergraduate psychology students’ learning in remote emergency teaching during the COVID-19 pandemic
de Sá, V. R., Gulá, P. V. S. S., Prizon, T., Falcoski, R. M., Ruggiero, R. N., & Padovan‐Neto, F. E. (2023) · Scientific Reports · doi:10.1038/s41598-023-27845-4 · Cited by 9 · see citing works
The Work and Social Adjustment Scale (WSAS): An investigation of reliability, validity, and associations with clinical characteristics in psychiatric outpatients
Lundqvist, J., Lindberg, M. S., Brattmyr, M., Havnen, A., Hjemdal, O., & Solem, S. (2024) · PLoS ONE · doi:10.1371/journal.pone.0311420 · Cited by 8 · see citing works
Assessing functioning in adolescents with chronic fatigue syndrome: psychometric properties and factor structure of the School and Social Adjustment Scale and the Physical Functioning Subscale of the SF36
Loades, M. E., Vitoratou, S., Rimes, K. A., & Chalder, T. (2020) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465820000193 · Cited by 8 · see citing works
“In adults, the WSAS, from which the SSAS was developed, a distinct social functioning factor has been found (i.e. a 2-factor solution) (Zahra et al., 2014), but this did not appear to be the case for adolescents with CFS in the current study.”
Background
Narrative Exposure Therapy versus treatment as usual in a sample of trauma survivors who live under ongoing threat of violence in Rio de Janeiro, Brazil: study protocol for a randomised controlled trial
Serpeloni, F., Narrog, J. A., de Assis, S. G., Avanci, J. Q., Carleial, S., & Koebach, A. (2021) · Trials · doi:10.1186/s13063-021-05082-2 · Cited by 8 · see citing works
Psychometric Properties of Chinese Version of Work and Social Adjustment Scale for Outpatients With Common Mental Disorders: Classical Test Theory and Rasch Analysis
Shih, S., Chan, A. S. M., Yeung, E. Y. Y., Tsang, A. M., Chiu, R. L. P., Chu, M. H.-W., & Poon, M. (2021) · East Asian Archives of Psychiatry · doi:10.12809/eaap20101 · Cited by 8 · see citing works
Effectiveness of low-dose amitriptyline and mirtazapine in patients with insomnia disorder and sleep maintenance problems: a randomised, double-blind, placebo-controlled trial in general practice (DREAMING)
Bakker, M. H., Hugtenburg, J. G., Bet, P. M., Twisk, J. W. R., van der Horst, H. E., & Slottje, P. (2025) · British Journal of General Practice · doi:10.3399/bjgp.2024.0173 · Cited by 7 · see citing works
“…and 6 36 ], anxiety and depression [Hospital Anxiety and Depression Scale {HADS}], 37–39 and functioning [Work and Social Adjustment Scale {WSAS} 40,41 and Glasgow Sleep Impact Index {GSII} parts 1, 2, and 3 42 ]); • treatment satisfaction; • treatment sufficiency (additional sleep treatments…”
North American open-label 16-week trial of the MindShift smartphone app for adult anxiety
Rappaport, L. M., Jerome, E., Van Ameringen, M., Whittal, M., & McLean, C. P. (2023) · Journal of Mood & Anxiety Disorders · doi:10.1016/j.xjmad.2023.100036 · Cited by 7 · see citing works
Utility of the Work and Social Adjustment Scale (WSAS) in predicting long-term sick-leave in Danish patients with emotional disorders
Hovmand, O. R., Reinholt, N., Christensen, A. B., Bach, B., Eskildsen, A., Arendt, M. C. B. B., Hvenegaard, M., Poulsen, S., & Arnfred, S. (2023) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2023.2226123 · Cited by 7 · see citing works
“Similar results were observed in other British patients with emotional disorders (alpha = .82) [14], German patients with depression (alpha= .89) [18], and Norwegian outpatients with personality disorders (alpha = .79) [16].”
BackgroundMethodResult
The relationship between posttherapeutic Cognitive Behavior Therapy skills usage and follow‐up outcomes of internet‐delivered Cognitive Behavior Therapy
Eilert, N., Wogan, R., Adegoke, A., Earley, C., Duffy, D. J., Enrique, Á., Palacios, J. E., Timulák, L., & Richards, D. (2022) · Journal of Clinical Psychology · doi:10.1002/jclp.23403 · Cited by 7 · see citing works
“The Work and Social Adjustment Scale (WSAS) is a valid measure of impaired functioning with sensitivity to treatment change and good reliability (Mundt et al., 2002; Zahra et al., 2014).”
Background
Effectiveness of attexis , a digital intervention based on cognitive behavioral therapy for adults with ADHD: a randomized controlled trial
D’Amelio, R., Betz, L. T., Jow, S. M., Retz, W., Philipsen, A., Klein, J. P., Faßbinder, E., Jacob, G. A., & Retz‐Junginger, P. (2026) · Psychological Medicine · doi:10.1017/s0033291726103390 · Cited by 7 · see citing works
“…more participants in the intervention group showed meaningful improvements in work and social functioning (based on an MCID of 8 points [Zahra et al., 2014]; 26.2% vs. 11.6%; χ 2 = 11.9, p < .001; OR = 2.7, 95% CI = [1.5, 4.9]), depression levels (based on an MCID of 5 points [Löwe et…”
Influential
A Pragmatic Randomized Controlled Trial of Stepped Care Cognitive-behavioral Therapy for Internalizing Distress in Adults
Lorenzo‐Luaces, L., Dierckman, C., Lind, C. M., Peipert, A., Jesús-Romero, R. D., Buss, J., Ramírez, I., Starvaggi, I., Adams, S. M., Howard, J., et al. (2024) · Cognitive Therapy and Research · doi:10.1007/s10608-024-10489-7 · Cited by 7 · see citing works
“Prior work supports the reliability and validity of the WSAS across various patient populations (Zahra et al., 2014 ).”
Acceptability, feasibility and preliminary efficacy of a compassion‐based cognitive behavioural intervention for low self‐esteem in sexual minority young adults
Bridge, L., Langford, K., McMullen, K., Rai, L., Smith, P. A., & Rimes, K. A. (2023) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2911 · Cited by 6 · see citing works
Is Mild Really Mild?: Generating Longitudinal Profiles of Stroke Survivor Impairment and Impact Using Unsupervised Machine Learning
Adikari, A., Nawaratne, R., Silva, D. D., Carey, D. L., Walsh, A., Baum, C. M., Davis, S. M., Donnan, G. A., Alahakoon, D., & Carey, L. M. (2024) · Applied Sciences · doi:10.3390/app14156800 · Cited by 6 · see citing works
Changes in Posttraumatic Stress Disorder Symptoms With Integrative Psychotherapy for Functional Neurological Symptom Disorder
Calderbank, A., Gray, C., Morgan-Boon, A., & Reuber, M. (2023) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.21070184 · Cited by 5 · see citing works
Emotion Regulation and Mentalization in Patients With Depression and Anxiety
Christensen, A. B., Poulsen, S., Højberg, T. M., Jessen, S. B., Reinholt, N., Hvenegaard, M., Eskildsen, A., Arendt, M. C. B. B., & Arnfred, S. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2995 · Cited by 5 · see citing works
Protocol for the Work Engagement and Well-being Study (SWELL): a randomised controlled feasibility trial evaluating the effects of mindfulness versus light physical exercise at work
Vainre, M., Galante, J., Watson, P., Dalgleish, T., & Hitchcock, C. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-050951 · Cited by 4 · see citing works
Patient-reported outcome measures in depression
Steig, D. H. Á., Reinholt, N., Christensen, A. B., Pedersen, M. H., & Arnfred, S. (2022) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2022.2074136 · Cited by 5 · see citing works
“It is validated for use across the full spectrum of psychiatric disorders and is used in epidemiological research as well as clinically [18,19].”
Background
A combined individual and group-based stabilization and skill training intervention versus treatment as usual for patients with long lasting posttraumatic reactions receiving outpatient treatment in specialized mental health care – a study protocol for a randomized controlled trial
Holgersen, K. H., Brønstad, I., Jensen, M. P., Brattland, H., Reitan, S. K., Hassel, A. M., Arentz, M., Lara‐Cabrera, M. L., & Skjervold, A. E. (2020) · Trials · doi:10.1186/s13063-020-04297-z · Cited by 5 · see citing works
Eye movement desensitization and reprocessing (EMDR) therapy or supportive counseling prior to exposure therapy in patients with panic disorder: study protocol for a multicenter randomized controlled trial (IMPROVE)
Endhoven, B., De Cort, K., Matthijssen, S. J. M. A., de Jongh, A., van Minnen, A., Duits, P., Schruers, K. R. J., van Dis, E. A. M., Krypotos, A. M., Gerritsen, L., et al. (2023) · BMC Psychiatry · doi:10.1186/s12888-022-04320-4 · Cited by 4 · see citing works
“ASI Anxiety Sensitivity Index ATPTM Attitudes Toward Psychotherapy Treatment Manuals BSQ Bodily Sensation Questionnaire CBT Cognitive behavioral therapy CEQ Dutch credibility and expectancy scale CS Credibility Scale CSQ-8 Client Satisfaction Questionnaire EBPAS Evidence-Based Practice Attitude Scale EMDR Eye movement…”
Background
Contributions of the posterior cerebellum to mentalizing and social functioning: A transdiagnostic investigation
Moe, A. M., Blain, S. D., Kalathil, A., Peltier, S., Colombi, C., Thakkar, K. N., Burton, C. Z., & Tso, I. F. (2025) · Psychological Medicine · doi:10.1017/s003329172500039x · Cited by 4 · see citing works
“Work and Social Adjustment Scale (WSAS; Zahra et al., 2014).”
Clinical effectiveness and cost-effectiveness of Structured Psychological Support for people with probable personality disorder in mental health services in England: study protocol for a randomised controlled trial
Crawford, M., Leeson, V. C., Evans, R., Goulden, N., Weaver, T. D., Trumm, A., Barrett, B. M., Khun-Thompson, F., Pandya, S. P., Saunders, K. E. A., et al. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-086593 · Cited by 4 · see citing works
Genetic overlap between functional impairment and depression and anxiety symptom severity: evidence from the GLAD Study
Skelton, M., Mundy, J., ter Kuile, A., Adey, B. N., Armour, C., Buckman, J. E. J., Coleman, J. R. I., Davies, M. R., Hirsch, C. R., Hotopf, M. H., et al. (2025) · Psychological Medicine · doi:10.1017/s0033291725101037 · Cited by 3 · see citing works
“Phenotypic correlations were consistent in size and pattern with previous estimates (Kroenke et al., 2001; Spitzer et al., 2006; Zahra et al., 2014) and existing evidence that symptom severity and functional impairment are partially independent.”
Influential
Brief individual psychological intervention for people with probable personality disorder: a multicentre, researcher-masked, randomised, controlled superiority trial in England
Crawford, M. J., Leeson, V. C., Evans, R., Goulden, N., Kuhn-Thompson, F., Pandya, S. P., Trumm, A., Weaver, T. D., Barrett, B. M., Saunders, K., et al. (2026) · The Lancet Psychiatry · doi:10.1016/s2215-0366(25)00372-4 · Cited by 3 · see citing works
Can clinician’s risk assessments distinguish those who disclose suicidal ideation from those who attempt suicide?
Barker, J., Oakes-Rogers, S., Lince, K., Taylor, A., Keddie, R., Bruce, H., Selvarajah, S., Fish, D., Aspen, C., & Leddy, A. (2023) · Death Studies · doi:10.1080/07481187.2023.2192532 · Cited by 3 · see citing works
“The Work and Social Adjustment Scale (WASAS) is evidenced to measure difficulties in daily functioning with excellent psychometric properties (Zahra et al., 2014).”
Background
Perspective taking as a transdiagnostic risk factor for interpersonal dysfunction
Hudson, C. C., Bowers, E. M., Björgvinsson, Þ., & Beard, C. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.05.007 · Cited by 3 · see citing works
The Emotional Resources Group: A Mixed Methods Practice-Based Study of a Transdiagnostic Emotion Regulation Group Intervention
Moore, R., Gillanders, D. T., & Stuart, S. (2022) · Psychiatry International · doi:10.3390/psychiatryint3040024 · Cited by 3 · see citing works
Self-Guided Smartphone App (Vimbo) for the Reduction of Symptoms of Depression and Anxiety in South African Adults: Pilot Quantitative Single-Arm Study
Steyn, S., & Slabbert, M. (2024) · JMIR Formative Research · doi:10.2196/54216 · Cited by 4 · see citing works
“The WSAS, on the other hand, has proven to be a reliable and valid measure of impaired functioning, offering enough sensitivity to be an effective outcome measure [36,37].”
What interventions or best practice are there to support people with Long COVID, or similar post-viral conditions or conditions characterised by fatigue, to return to normal activities: a rapid reviewPreprint
Spencer, L. H., Hendry, A., Makanjuola, A., Anthony, B. F., Davies, J. R., Pisavadia, K., Hughes, D. A., Fitzsimmons, D., Wilkinson, C., Edwards, R. T., et al. (2023) · medRxiv · doi:10.1101/2023.01.24.23284947 · Cited by 3 · see citing works
“Functional impairment was assessed using the Work and Social Adjustment Scale (WSAS), a reliable and valid tool (Zahra et al., 2014).”
Method
Efficacy of a Brief Blended Cognitive Behavioral Therapy Program for the Treatment of Depression and Anxiety in University Students: Uncontrolled Intervention Study (Preprint)
Atik, E., Stricker, J., Schückes, M., & Pittig, A. (2022) · doi:10.2196/preprints.44742 · Cited by 23 · see citing works
Cognitive behavioural therapy augmented with virtual reality exposure for treatment of social anxiety: A randomised clinical trial
Arnfred, B., Bang, P., Hjorthøj, C., Winding, C., Møller, K., Hvenegaard, M., Gausbøl, U. K., Sø, D., Rosenberg, N., & Nordentoft, M. (2019) · doi:10.21203/rs.2.504/v1 · Cited by 2 · see citing works
“Self-report questionnaires (FNE, CSQ, WAI, WSAS, WHO-5) will be answered by following a link send to the patients email address, which the patients can access either on a personal device or on one of the clinics computers.”
Method
Longitudinal trajectories of psychosocial functioning in patients with pre-existing mental disorders after one year of COVID-19 pandemic
Luciano, M., Carmassi, C., Sampogna, G., Bertelloni, C. A., Daga, G. A., Albert, U., Castellini, G., Rocca, B. D., Fantasia, S., Menchetti, M., et al. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.02.016 · Cited by 3 · see citing works
“It is currently considered one of the most reliable self-reported questionnaires to assess psychosocial functioning, compared to the Social Functioning Questionnaire, WHO-Disability Assessment Schedule (WHODAS) and Short-Form 12-Item Health Survey (Zahra et al., 2014).”
BackgroundMethod
Effectiveness of a guided digital self-help intervention to improve sleep and the biological clock in university students – Study protocol for a randomized controlled trial
Pape, L. M., van Straten, A., Struijs, S. Y., Spinhoven, P., & Antypa, N. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100763 · Cited by 2 · see citing works
“The WSAS shows high internal reliability and sensitivity to treatment effects (Zahra et al., 2014).”
Background
An evaluation of a pilot high-intensity treatment pathway for prolonged grief reactions in a Devon NHS Talking Therapies service
Goff, S., Carson, J., Ladwa, A., Colletta, M., Topciu, R. A., Shear, K. M., & Dunn, B. D. (2025) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x25000030 · Cited by 2 · see citing works

ความเชอถอไดและความแมนตรงของแบบวดการปรบตวทางสงคมและการทำงานฉบบภาษาไทยในผปวยนอกแผนกจตเวชทไมมอาการโรคจต
Chamchuen, S., Manatsathit, M., Chittaropas, P., Saipanish, R., Waleeprakhon, P., & Prachason, T. (2026) · Journal of the Psychiatric Association of Thailand
The Work and Social Adjustment Scale: a simple measure of impairment in functioning
Mundt, J. C., Marks, I. M., Shear, M. K., & Greist, J. M. (2002) · British Journal of Psychiatry · doi:10.1192/bjp.180.5.461 · Cited by 2,515 · see citing works
Work and Social Adjustment Scale (WSAS): psychometric characteristics of a Spanish adaptation in a clinical population
Morejón, A. J. V., Vázquez-Morejón, R., & Álvarez, P. C. (2021) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465821000308 · Cited by 11 · see citing works
Psychometric properties of the Icelandic version of the work and social adjustment scale
Elíasson, I. T. (2021) · Skemman
Reliability and validity of the Work and Social Adjustment Scale in phobic disorders
Mataix-Cols, D., Cowley, A. J., Hankins, M., Schneider, A., Bachofen, M., Kenwright, M., Gega, L., Cameron, R., & Marks, I. M. (2005) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2004.08.007 · Cited by 135 · see citing works

Authors: Zahra, D., Qureshi, A., Henley, W., Taylor, R., Quinn, C., Pooler, J., Hardy, G., Newbold, A., & Byng, R.
Affiliations: University of Plymouth (GB)
Edge Hill University (GB)
University of Exeter (GB)
University of Sheffield (GB)
Corresponding author: Zahra, Daniel
ORCID: Zahra, Daniel
Qureshi, Adam
Henley, William
Taylor, Rod
Quinn, Cath
Hardy, Gillian
Newbold, Alexandra
Byng, Richard
Venue: International Journal of Psychiatry in Clinical Practice
Publisher: Informa UK Limited
Published: 2014-03-16
Volume: 18
Issue: 2
Pages: 131-138
ISSN: 1365-1501 (ISSN-L)
1471-1788
DOI: 10.3109/13651501.2014.894072
OpenAlex: W2152311889
Cited by: 141
References: 22
Citations by year: 2026: 14 · 2025: 14 · 2024: 15 · 2023: 25 · 2022: 16 · 2021: 18 · 2020: 9 · 2019: 7 · 2018: 6 · 2017: 8 · 2016: 6 · 2015: 3
FWCI: 7.88
Type: journal article
Language: en
Open access: closed
Locations: International Journal of Psychiatry in Clinical Practice (publishedVersion)
PubMed (publishedVersion)
ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
Edge Hill University Research Information Repository (Edge Hill University) (submittedVersion)
Funders: National Institute for Health and Care Research
National Institutes of Health
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Keywords: Work and Social Adjustment Scale, psychometric properties, reliability statistics, responsiveness to change, social functioning, PHQ-9, GAD-7, Improving Access to Psychological Therapies, outcome measures, depression, generalized anxiety disorder, factor structure
MeSH terms: Adolescent, Adult, Aged, Aged, 80 and over, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Psychometrics, Social Adjustment, Work, Young Adult, Patient Outcome Assessment

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The work and social adjustment scale: Reliability, sensitivity and value

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