Reliability and validity of the Work and Social Adjustment Scale in phobic disorders

doi:10.1016/j.comppsych.2004.08.007

Comprehensive Psychiatry

Volume 46, Issue 3, May–June 2005, Pages 223-228

https://doi.org/10.1016/j.comppsych.2004.08.007 Get rights and content

Abstract

The Work and Social Adjustment Scale (WSAS) is a simple widely used 5-item measure of disability whose psychometric properties need more analysis in phobic disorders. The reliability, factor structure, validity, and sensitivity to change of the WSAS were studied in 205 phobic patients (73 agoraphobia, 62 social phobia, and 70 specific phobia) who participated in various open and randomized trials of self-exposure therapy. Internal consistency of the WSAS was excellent in all phobics pooled and in agoraphobics and social phobics separately. Principal components analysis extracted a single general factor of disability. Specific phobics gave less consistent ratings across WSAS items, suggesting that some items were less relevant to their problem. Internal consistency was marginally higher for self-ratings than clinician ratings of the WSAS. Self-ratings and clinician ratings correlated highly though patients tended to rate themselves as more disabled than clinicians did. WSAS total scores reflected differences in phobic severity and improvement with treatment. The WSAS is a valid, reliable, and change-sensitive measure of work/social and other adjustment in phobic disorders, especially in agoraphobia and social phobia.

Introduction

The Work and Social Adjustment Scale (WSAS) is a simple 5-item measure of general impairment which grew out of a study of change during psychotherapy [1]. It was adapted as a 4-item scale (work, home, social, and private leisure) to rate disability in psychotherapy studies in phobics [2], [3], [4]. Marks et al [5] adapted it further to measure the outcome of most patients in treatment and later added its fifth item concerning interpersonal relations. Each item has 9 points; a modification by Sheehan [6] has 11-point items. The WSAS is simple for self-ratings and assessor ratings and was sensitive to change in anxious/depressed and other patients in many drug and psychotherapy studies.

In large samples of depressed and obsessive-compulsive patients, the WSAS was reliable, valid, and sensitive to change [7]. In the study of Mundt et al, the WSAS's internal consistency was high and its 5 items formed a single factor of general disability. It is not known, however, if different phobics score less consistently across the 5 WSAS items. For instance, agoraphobics may have impaired work but not home adjustment, specific snake phobics may have no difficulty in either area, whereas social phobics may have impaired social but not private leisure. This study examined the psychometric properties of the WSAS in a large sample of agoraphobics, social phobics, and specific phobics who took part in various controlled and open trials of computer-guided exposure therapy.

Section snippets

Patients

Participants were 205 phobics (73 agoraphobia, 62 social phobia, and 70 specific phobia) who took part in various controlled and open trials of computer-aided self-exposure therapy at the Maudsley and Charing Cross hospitals in London [8], [9], [10], [11]. They were diagnosed by experienced clinicians using checklists of the relevant International Statistical Classification of Diseases, 10th Revision, or Diagnostic and Statistical Manual of Metal Disorders, Fourth Edition, criteria. The

Internal consistency

The WSAS's internal consistency was assessed by Cronbach's α on 3 occasions (pre- and posttreatment and 1-month follow-up) for self-ratings and blind assessor ratings, and for each phobia type (agoraphobia, social phobia, and specific phobia). Using the criteria of Nunnally [15], internal consistency was deemed good on 16/24 data sets (α = .80-.90; Table 1) and acceptable on a further 7/24 data sets (α = .71-.77) across the 3 occasions and 3 phobia types. It was low on just 1 data set

Discussion

This study explored the psychometric properties of the WSAS, a widely used measure of disability, in 205 phobic patients along the lines of earlier analyses in patients with depression and obsessive-compulsive disorder [7].

For phobics in general and for agora- and social phobics in particular, the WSAS appeared to be a highly reliable measure of disability, with Cronbach's α ranging from 0.72 to 0.90. Factor analysis of the WSAS's 5 items yielded a single general disability factor explaining

Acknowledgments

We thank Drs James C. Mundt and John H. Greist for their helpful comments on an earlier version of the manuscript.

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Reliability and validity of the Work and Social Adjustment Scale in phobic disorders

Abstract

Introduction

Section snippets

Patients

Internal consistency

Discussion

Acknowledgments

Behav. Ther.

Evaluation of psychotherapy: with a follow up study of 62 cases of anxiety neurosis

Psychosom. Med.

Severe agoraphobia: a controlled prospective therapeutic trial

Br. J. Psychiatry

Flooding vs. desensitisation in phobic disorders

Br. J. Psychiatry

The psychiatric nurse as therapist

BMJ

The anxiety disease

The Work and Social Adjustment Scale: a simple accurate measure of impairment in functioning

Br. J. Psychiatry

Reducing demands on clinicians by offering computer-aided self-help for phobia/panic: feasibility study

Br. J. Psychiatry

Pragmatic evaluation of computer-aided self-help for anxiety/depression

Br. J. Psychiatry