title: Do claimants over-report behavioral health dysfunction when filing for work disability benefits?
abstract: BACKGROUND
  Questions exist related to the best way to use medical evidence relative to self-report as part of the SSA disability determination process.
  
  
  OBJECTIVE
  To examine concordance between provider and claimant responses along the four dimensions of work related behavioral health functioning: Social Interactions, Mood and Emotions, Behavioral Control, and Self-Efficacy.
  
  
  METHODS
  Using secondary data from a larger study, which collected data on individuals reporting difficulties with work (claimants) due to mental conditions, 39 items were completed by claimants and their healthcare provider. Inter-rater agreement was assessed using three techniques: Cohen's kappa, percent absolute agreement, and folded mountain plots.
  
  
  RESULTS
  A sample of 65 dyads was obtained. Inter-rater agreement was low for most items (k=0.0-0.20) with a minority of items having fair agreement (k=0.21-0.40) Percent agreement was fair: Mood and Emotions (46%), Self-Efficacy (44%), Behavioral Control (39%) and Social Interactions (38%). Overall, providers reported lower functioning compared to claimants for the Behavioral Control and Self-Efficacy scales; the reverse trend held for the Mood and Emotions scale.
  
  
  CONCLUSIONS
  Results indicate discordance between provider and claimant report of behavioral health functioning. Understanding reasons for and approaches to reconciling the inconsistencies between claimant and provider perspectives is a complex task. These findings have implications for how best to assess mental and behavioral-health related work disability in the absence of an established gold standard measure.
authors.affiliation: Health and Disability Research Institute, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Marfeo
authors.affiliation: Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.
authors.forename: Sue
authors.initials: S
authors.lastname: Eisen
authors.affiliation: Health and Disability Research Institute, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Pengsheng
authors.initials: P
authors.lastname: Ni
authors.affiliation: Rehabilitation Medicine Department, Mark O. Hatfield Clinical Research Center, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Rasch
authors.affiliation: Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA.
authors.forename: E Sally
authors.initials: ES
authors.lastname: Rogers
authors.affiliation: Health and Disability Research Institute, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Jette
mesh_terms: D000339:Affect; D001519:Behavior; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005260:Female; D006282:Health Personnel; D006801:Humans; D007342:Insurance Benefits; D007344:Insurance Claim Reporting; D018868:Insurance, Disability; D007398:Interpersonal Relations; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D015588:Observer Variation; D020377:Self Efficacy; D057566:Self Report; D012943:Social Security; D014481:United States
keywords: Work disability; behavioral health; disability evaluation