The DOI matches its Crossref record; 22 of the 22 references it cites were found in a registry or an index.
The work and social adjustment scale: Reliability, sensitivity and value
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.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“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).”
Citations
Cites
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910
A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765
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
Evaluating patient-based outcome measures for use in clinical trials.
Fitzpatrick, Davey, Buxton, & Jones (1998) · Health Technology Assessment · doi:10.3310/hta2140 · Cited by 1,715
Löwe, B., Kroenke, K., Herzog, W., & Gräfe, K. (2004) · Journal of Affective Disorders · doi:10.1016/s0165-0327(03)00198-8 · Cited by 1,558 · cited 3×
“However, using Löwe et al. (2004b) criteria with the current sample results in a minimal clinically significant change for the GAD-7 of 3-points.”
MethodThe English indices of deprivation 2004
Noble, M., Wright, G., Dibben, C., Smith, G., McLennan, D., Anttila, C., Barnes, H., Mokhtar, C., Noble, S., & Gardner, J. (2004) · Cited by 1,494
Monitoring Depression Treatment Outcomes With the Patient Health Questionnaire-9
L??we, B., Un??tzer, J., Callahan, C. M., Perkins, A. J., & Kroenke, K. (2004) · Medical Care · doi:10.1097/00005650-200412000-00006 · Cited by 1,354
Fitzpatrick, R. M., Shortall, Sculpher, Murray, Morris, Lodge, Dawson, Carr, Britton, & Briggs, A. H. (1998) · Health Technology Assessment · doi:10.3310/hta2200 · Cited by 969
Health and quality of life outcomes
Jolly, M., Sequeira, W., & Block, J. A. (2014) · Health and Quality of Life Outcomes · doi:10.1186/s12955-014-0173-5 · Cited by 722
The English Indices of Deprivation 2010
McLennan, D., Barnes, H., Noble, M., Davies, J., Garrett, E., & Dibben, C. J. L. (2011) · Cited by 591
Flagged first, then by citations
Research works printed but not linked: 5
- Arbuckle JL, 2010, AMOS, v19.0.0 build 1376
- Fitzpatrick R, 1998, Health Technol Assess, 2, 1
- Department of Health, 2008, Improving access to psychological therapis implementaion plan: National guidlines for regional delivery
- Marks I, 1986, Behavioural psychotherapy Bristol: John Wright, now published by I
- SPSS, 2010, IBM SPSS Statistics, v19.0.0
Cited by
Sorted by citations
Items 101–142 of 142
Koc, G., Dinç, G. Ş., & Elhan, A. H. (2025) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2025.89.1.27 · Cited by 2
Heißel, A., Bollmann, J., Kangas, M., Abula, K., Rapp, M. A., & Sánchez, A. (2021) · Research Square · doi:10.21203/rs.3.rs-151437/v1 · Cited by 2
Lalk, C., Väth, T., Hanraths, S., Pruessner, L., Timm, C., Hartmann, S. F., Barnow, S., & Rubel, J. A. (2023) · doi:10.31234/osf.io/w9f4s · Cited by 2
Meredith, F., Banting, R., Wilcox, D., & Paskell, R. (2023) · Journal of EMDR Practice and Research · doi:10.1891/emdr-2022-0058 · Cited by 2
Caetano, A. S., Marques, M., de Melo, A. C., Ferreira, A., Xavier, S., Queirós, A., & Martins, M. J. (2024) · The Psychologist Practice & Research Journal · doi:10.33525/pprj.v7i1.136 · Cited by 1
“Although one study found that the WSAS measures a distinct social functioning component when compared to PHQ-9 and GAD-7 (Zahra et al., 2014), future studies should further corroborate the unique contribution of the WSAS in addition to psychopathology measures.”
BackgroundMethodResultInfluentialBarnett, P., Buckman, J. E. J., Delamain, H., Suh, J. W., Pilling, S., & Saunders, R. (2025) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2025.100608 · Cited by 1
“This measure has good psychometric properties, including high internal reliability and sensitivity to change when used in NHS TTad services (Zahra et al., 2014).”
Cognitive analytic therapy‐guided self‐help for depression: A mixed methods evaluation
Kelly, R. E., Kellett, S., Simmonds‐Buckley, M., & Power, N. (2025) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.70008 · Cited by 1
“It has a clinical cut-off of >10, is sensitive to treatment effects and has good internal reliability ( α = .82; Zahra et al., 2014).”
Assmann, N., Kaiser, T., Herzog, P., Arntz, A. R., Klein, J. P., Faßbinder, E., & Schaich, A. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104899 · Cited by 1
“The WSAS has shown to be reliable, valid, and change-sensitive in different patient samples (Thandi et al., 2017; Zahra et al., 2014).”
Williams, M. G., Horowitz, M. A., Davies, J., & Moncrieff, J. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.121069 · Cited by 1
Smith, O. R. F., Aarø, L. E., & Knapstad, M. (2026) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2026.101078 · Cited by 1
Tahrekhani, M., Rasouli, A., Rasouli, S. A., & Saed, O. (2026) · International Journal of Mental Health Nursing · doi:10.1111/inm.70308 · Cited by 1
Dimensions of Growth: Examining the Five Factors of the Posttraumatic Growth Inventory
Silverstein, M. W. (2015)
Taheri, A. A., Foroughi, A., Davoudi, M., Heshmati, K., Mohammdpour, M., & Khoramnia, S. (2021) · Shenakht Journal of Psychology and Psychiatry · doi:10.32598/shenakht.8.2.143
Shenberger, E., Funkhouser, C. J., Boley, R. A., Zalta, A. K., & Shankman, S. A. (2021) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2021.100193
“Participants also completed the Work and Social Adjustment Scale (WSAS; Zahra et al. 2014), a five-item self-report scale measuring functional impairment.”
MethodSelf‐reassurance moderated by identity dysfunction: Associations with distress and impairment
Kealy, D., Ben‐David, S., Spidel, A., Wadsley‐Rose, S., & Kim, D. (2021) · Journal of Counseling & Development · doi:10.1002/jcad.12411
Lenhard, F., de la Cruz, L. F., Wahlund, T., Andersson, E., Åhlén, J., Nerini, F. F., Akay, H., & Mataix‐Cols, D. (2023) · doi:10.31234/osf.io/wmhsn
Pampoulov, P., Mander, H., & Monro, S. (2022) · Clinical Psychology Forum · doi:10.53841/bpscpf.2022.1.360.41
Skelton, M., Catarino, A., Brown, S. A. T., Carr, E., Davies, M. R., Peel, A. J., Rayner, C., Breen, G. D., & Eley, T. C. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104386
The genetic overlap between functional impairment and severity of depression and anxiety symptomsPreprint
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. (2023) · PsyArXiv (OSF Preprints) · doi:10.31234/osf.io/4d6ju · Cited by 1
Khodashenas, M., & Vieskarami, H. (2023) · Nursing and Midwifery Journal · doi:10.61186/unmf.21.3.218
Flóvenz, S. Ó., Salkovskis, P. M., Gregory, J. D., Valdimarsdottir, H. B., Sigurðsson, E., & Sigurðsson, J. F. (2024) · Nordic Psychology · doi:10.1080/19012276.2024.2342345
“The scale has been shown to have good psychometric properties (Mundt et al., 2002; Zahra et al., 2014) and in our sample it had a Cronbach ’ s alpha of 0.84.”
InfluentialDagnan, D., Saunders, R., Stott, J. C. H., Thwaites, R., & Hatton, C. (2025) · Journal of Intellectual Disability Research · doi:10.1111/jir.13231
“The GAD-7 and the PHQ-9 have an additional interest in that Kroenke et al. (2009) provided evidence for a brief screening scale, the PHQ-4, which was based on the first two items from each of the PHQ-9 and GAD-7; from the PHQ-9 (‘Feeling down, depressed or hopeless’ and ‘Little interest or pleasure in doing things’) a…”
InfluentialFatt, C. C., Foster, J. A., Mayes, T. L., Vasu, S., Sethuram, S., Trombello, J. M., Hughes, J. L., Greer, T. L., Cooper, C. M., Carmody, T. J., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120149
Arendt, I. T. P., Gondan, M., Juul, S., Hastrup, L. H., Hjorthøj, C. R., & Møeller, S. B. (2025) · Trials · doi:10.1186/s13063-025-09012-4
Stewart, C. S., Baudinet, J., Munuve, A., Bell, A., Konstantellou, A., Eisler, I., & Simic, M. (2022) · Figshare · doi:10.6084/m9.figshare.19128958
Holgersen, K. H., Brønstad, I., Jensen, M., Brattland, H., Reitan, S. K., Hassel, A. M., Arentz, M., Lara-Cabrera, M., & Skjervold, A. E. (2020) · Figshare · doi:10.6084/m9.figshare.12380900
Harty, S., Enrique, Á., Akkol‐Solakoglu, S., Adegoke, A., Farrell, H., Connon, G., Ward, F., Kennedy, C., Chambers, D., & Richards, D. (2023) · Figshare · doi:10.6084/m9.figshare.24286561
Harty, S., Enrique, Á., Akkol‐Solakoglu, S., Adegoke, A., Farrell, H., Connon, G., Ward, F., Kennedy, C., Chambers, D., & Richards, D. (2024) · Figshare · doi:10.6084/m9.figshare.24286649
Stewart, C. S., Baudinet, J., Munuve, A., Bell, A., Konstantellou, A., Eisler, I., & Simic, M. (2022) · Figshare · doi:10.6084/m9.figshare.19128955
Andersen, L. H., Fallesen, P., & Bruckner, T. A. (2021) · Figshare · doi:10.6084/m9.figshare.14685033
Andersen, L. H., Fallesen, P., & Bruckner, T. A. (2021) · Figshare · doi:10.6084/m9.figshare.14685030
Serpeloni, F., Narrog, J. A., Gonçalves de Assis, S., Quintes Avanci, J., Carleial, S., & Koebach, A. (2021) · Figshare · doi:10.6084/m9.figshare.14129132
Kumar, M. T., & Kar, N. (2026) · Indian Journal of Psychological Medicine · doi:10.1177/02537176251415360
Lewis, C., Thomas, B. J., Yun, J. W. S., Cloître, M., Karatzias, T., Roberts, N. P., Kitchiner, N., & Bisson, J. I. (2026) · European Journal of Psychotraumatology · doi:10.1080/20008066.2025.2605806
“However, no significant changes were observed in insomnia (ISI), functioning (WSAS), alcohol use (AUDIT), global health (EQ5D), or progress towards self-identified goals (GBO).”
InfluentialCarey, T. A. (2026) · Frontiers in Health Services · doi:10.3389/frhs.2026.1753567
“In a study of the WSAS’s psychometric properties involving comparisons with the PHQ-9 ( 23) and the GAD-7 (18) using data from 4,835 patients, the WSAS was demonstrated to have high internal reliability and sensitivity to treatment effects (32).”
Eyles, E., Farr, M., Dunn, B. D., Redaniel, M. T., Warbrick, L. A., Kessler, D. S., Cooper, R., & Moran, P. (2026) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x25100482
“(3) Social functioning (the Work and Social Adjustment Scale, WSAS) (Mundt et al ., 2002; Zahra et al ., 2014); higher scores (ranging between 0 and 40) indicate higher levels of impairment to functioning due to a specified condition.”
The Association of Perceived Stress with Anxiety-related Symptoms during Use of the MindShift app
Jerome, E., McLean, C. P., Ameringen, M. V., Whittal, M. L., & Rappaport, L. M. (2026) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-026-00616-4
Briley, P. M., Webster, L., Hall, B., Davison, L., Gallagher, P., Pszczółkowski, S., Lankappa, S. T., Auer, D. P., Liddle, P. F., McAllister-Williams, H., et al. (2026) · Psychological Medicine · doi:10.1017/s0033291726104899
“There is evidence for a unidimensional factor structure for the WSAS, including in mental health conditions (Lundqvist et al., 2024; Zahra et al., 2014).”
Maksic, E., Klæth, J. R., Nordahl, H. M., & Hjemdal, O. (2026) · International Journal of Cognitive Behavioral Therapy · doi:10.1007/s41811-026-00290-7
“Cronbach’s alpha was α = 0.68 in the current study, supporting earlier findings (Zahra et al., 2014).”
InfluentialIntensive trauma-focused treatment for PTSD and Complex PTSD in a public clinic: a feasibility study
Evensen, J. H., Engeset, J., Jakobsen, M., Malkomsen, A., & Vaage-Kowalzik, V. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1869412
Kadri, K., Keating, C., Anderson, M., Novelli, D., McBride, E., & Scott, W. (2026) · British Journal of Pain · doi:10.1177/20494637261497966
“31 Depression.”
Metadata
- 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
- 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
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review