Attitudes towards evaluation of psychiatric disability claims: a survey of Swiss stakeholders.

QUESTIONS: In Switzerland, evaluation of work capacity in individuals with mental disorders has come under criticism. We surveyed stakeholders about their concerns and expectations of the current claim process. METHODS: We conducted a nationwide online survey among five stakeholder groups. We asked 37 questions addressing the claim process and the evaluation of work capacity, the maximum acceptable disagreement in judgments on work capacity, and its documentation. RESULTS: Response rate among 704 stakeholders (95 plaintiff lawyers, 285 treating psychiatrists, 129 expert psychiatrists evaluating work capacity, 64 social judges, 131 insurers) varied between 71% and 29%. Of the lawyers, 92% were dissatisfied with the current claim process, as were psychiatrists (73%) and experts (64%), whereas the majority of judges (72%) and insurers (81%) were satisfied. Stakeholders agreed in their concerns, such as the lack of a transparent relationship between the experts' findings and their conclusions regarding work capacity, medical evaluations inappropriately addressing legal issues, and the experts' delay in finalising the report. Findings mirror the characteristics that stakeholders consider important for an optimal work capacity evaluation. For a scenario where two experts evaluate the same claimant, stakeholders considered an inter-rater difference of 10%‒20% in work capacity at maximum acceptable. CONCLUSIONS: Plaintiff lawyers, treating psychiatrists and experts perceive major problems in work capacity evaluation of psychiatric claims whereas judges and insurers see the process more positively. Efforts to improve the process should include clarifying the basis on which judgments are made, restricting judgments to areas of expertise, and ensuring prompt submission of evaluations.

[Development of a screening instrument for rumination and suppression RS-8]. / Entwicklung eines Screening-Instruments zu Rumination und Suppression RS-8.

Rumination and suppression are 2 maladaptive emotion regulation strategies known to be involved in pathological behaviors such as overeating and uncontrolled drinking. Until now, no short screening scale has been available focusing on both strategies. The RS-8 questionnaire includes 8 items assessing both dimensions: rumination and suppression. Psychometric properties were investigated in 2 clinical (alcohol-dependent [n = 79] and obese patients [n = 53]), and one non-clinical population (n = 133). Findings reveal the RS-8 to be a reliable and valid instrument. Both dimensions (rumination and suppression) showed good internal consistency and excellent factorial validity. The RS-8 is a short instrument, which can be used as a screening instrument in clinical and non-clinical samples.