Disability determinations for adults with mental disorders: Social Security Administration vs independent judgments.
OBJECTIVE
Disability determinations made by the Disability Determination Service for Social Security Administration (SSA) disability claims due to mental impairment were compared with the independent judgments of a team of mental health workers. The decisions of the Service and the team's agreement with those decisions were predicted from a set of explanatory variables.


METHODS
One hundred fifty-eight adult applicants for or beneficiaries of SSA benefit programs participated. The team used SSA disability criteria to judge disability based on in-depth interviews.


RESULTS
Team members voted yes, no, or maybe regarding approval for disability. Of the cases approved by the team, 89% were actually allowed by the Disability Determination Service. However, the team could not reach a yes or no decision for almost half of the subjects, contributing to a total agreement with the Service on only 40% of the cases.


CONCLUSIONS
Sufficient evidence exists to question the reliability of SSA disability determinations for mental disorders. Although the Disability Determination Service decision for mental impairments can be predicted above chance, a direct test of the reliability of such determinations should be conducted, with particular attention to the effect of the quality of the medical information.
Department of Psychiatry, Vanderbilt University, Nashville, TN.
S O
SO
Okpaku
A E
AE
Sibulkin
C
C
Schenzler
D000293:Adolescent; D000328:Adult; D003659:Decision Making, Organizational; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D007600:Judgment; D008297:Male; D008329:Managed Care Programs; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D011237:Predictive Value of Tests; D012050:Rehabilitation, Vocational; D015203:Reproducibility of Results; D012943:Social Security / Q000458:organization & administration*; D014481:United States