Digitally Assisted Standard Diagnostics in Insurance Medicine (DASDIM): psychometric data in psychiatric work disability evaluations.

PURPOSE: Insurers often commission psychiatric experts to evaluate the eligibility of workers with mental disorders for disability benefits, by estimating their residual work capacity (RWC). We investigated the validity of a standardized, computer-based battery of established diagnostic instruments, for evaluating the personality, cognition, performance, symptom burden, and symptom validity of claimants. METHODS: One hundred and fifty-three claimants for benefits were assessed by the assembled test battery, which was applied in addition to a conventional clinical work disability evaluation. RESULTS: A principal component analysis of the test and questionnaire battery data revealed six factors (Negative Affectivity, Self-Perceived Work Ability, Behavioral Dysfunction, Working Memory, Cognitive Processing Speed, and Excessive Work Commitment). Claimants with low, medium, and high RWC exclusively varied in the factor Negative Affectivity. Importantly, this factor also showed a strong association to psychiatric ratings of capacity limitations in psychosocial functioning. CONCLUSIONS: The findings demonstrate that the used test battery allows a substantiation of RWC estimates and of psychiatric ratings by objective and standardized data. If routinely incorporated in work disability evaluations, the test battery could increase their transparency for all stakeholders (insurers, claimants, medical experts, expert case-coordinators, and legal practitioners) and would open new avenues for research in the field of insurance medicine.Implications for rehabilitationThe residual work capacity (RWC) estimation by medical experts is internationally good practice, but plagued by a relatively low interrater agreement.The current study shows that psychiatric RWC estimates and capacity limitation ratings can be substantiated by data from objective, standardized psychometric instruments.Systematically using such instruments might help to improve the poor interrater agreement for RWC estimates in work disability evaluations.Such data could also be used for adopting vocational trainings and return-to-work programs to the individual needs of workers with mental health problems.

Utility and validity of the Brief Psychiatric Rating Scale (BPRS) as a transdiagnostic scale.

The Brief Psychiatric Rating Scale (BPRS) was originally conceived to assess psychopathology in several psychiatric disorders, making it an appropriate candidate to be used as a transdiagnostic instrument. We analyzed the utility and validity of the BPRS in a diagnostically heterogeneous sample of 600 psychiatric inpatients. As a comparator, we chose the mini-ICF-APP, a scale used to measure functioning and impairment across the diagnostic spectrum. Both scales had good internal consistency. The BPRS and the mini-ICF-APP showed a moderate correlation, with good levels of agreement. We were able to identify general symptoms present across the diagnostic spectrum, influencing severity and a cluster of symptoms specific for each diagnosis. Our results show the utility and validity of the BPRS as a transdiagnostic assessment tool that could easily be introduced in routine clinical work.

Online Survey of Medical and Psychological Professionals on Structured Instruments for the Assessment of Work Ability in Psychiatric Patients.

Objective: To evaluate perceived needs and difficulties related to instruments for assessing work ability in individuals with mental disorders. Method: We conducted an online survey of 104 German-speaking medico-legal experts (forensic psychiatric and psychology experts, insurance physicians) and therapists. Results: The large majority of respondents reported they would welcome a standardized, structured instrument for the assessment of work ability. High predictiveness, inter-rater agreement, comprehensibility for laymen, and symptom validity were desired in roughly equal measure as the main characteristic of such an instrument. More women than men, and more medico-legal experts than therapists, considered symptom validation as always necessary. Pain, personality, and affective disorders were perceived to be the most difficult disorders in the context of work ability assessments. Conclusion: Our survey documents professionals' wish for a structured assessment of work ability in both medico-legal and therapeutic settings.