title: Development of an instrument to measure behavioral health function for work disability: item pool construction and factor analysis.
abstract: OBJECTIVE
  To develop a broad set of claimant-reported items to assess behavioral health functioning relevant to the Social Security disability determination processes, and to evaluate the underlying structure of behavioral health functioning for use in development of a new functional assessment instrument.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Community.
  
  
  METHODS
  Item pools of behavioral health functioning were developed, refined, and field tested in a sample of persons applying for Social Security disability benefits (N=1015) who reported difficulties working because of mental or both mental and physical conditions.
  
  
  METHODS
  None.
  
  
  METHODS
  Social Security Administration Behavioral Health (SSA-BH) measurement instrument.
  
  
  RESULTS
  Confirmatory factor analysis (CFA) specified that a 4-factor model (self-efficacy, mood and emotions, behavioral control, social interactions) had the optimal fit with the data and was also consistent with our hypothesized conceptual framework for characterizing behavioral health functioning. When the items within each of the 4 scales were tested in CFA, the fit statistics indicated adequate support for characterizing behavioral health as a unidimensional construct along these 4 distinct scales of function.
  
  
  CONCLUSIONS
  This work represents a significant advance both conceptually and psychometrically in assessment methodologies for work-related behavioral health. The measurement of behavioral health functioning relevant to the context of work requires the assessment of multiple dimensions of behavioral health functioning. Specifically, we identified a 4-factor model solution that represented key domains of work-related behavioral health functioning. These results guided the development and scale formation of a new SSA-BH instrument.
authors.affiliation: Boston University School of Public Health, Health & Disability Research Institute, Boston, MA, USA. emarfeo@bu.edu
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Marfeo
authors.forename: Pengsheng
authors.initials: P
authors.lastname: Ni
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Haley
authors.forename: Alan M
authors.initials: AM
authors.lastname: Jette
authors.forename: Kara
authors.initials: K
authors.lastname: Bogusz
authors.forename: Mark
authors.initials: M
authors.lastname: Meterko
authors.forename: Christine M
authors.initials: CM
authors.lastname: McDonough
authors.forename: Leighton
authors.initials: L
authors.lastname: Chan
authors.forename: Diane E
authors.initials: DE
authors.lastname: Brandt
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Rasch
mesh_terms: D000328:Adult; D000339:Affect; D001519:Behavior; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities; D006304:Health Status; D006801:Humans; D007223:Infant; D007398:Interpersonal Relations; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011594:Psychometrics; D020377:Self Efficacy; D012943:Social Security; D012959:Socioeconomic Factors; D014481:United States; D014938:Work Capacity Evaluation
keywords: CAT; CFA; CFI; Disability evaluation; EFA; IRT; Mental health; Neuro-QOL; Outcome assessment (health care); PROMIS; Patient-Reported Outcomes Measurement Instrument System; Psychometrics; Quality of Life Outcomes in Neurological Disorders; RMSEA; Rehabilitation; SSA; SSA-BH; SSDI; Social Security Administration; Social Security Administration Behavioral Health measurement instrument; Social Security Disability Insurance; TLI; Tucker-Lewis Index; comparative fit index; computer adaptive testing; confirmatory factor analysis; exploratory factor analysis; item response theory; root mean square error of approximation
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