title: Disability in bipolar I disorder: the 36-item World Health Organization Disability Assessment Schedule 2.0.
abstract: BACKGROUND
  The WHODAS 2.0 is an ICF-based multidimensional instrument developed for measuring disability. The present study analyzes the utility of the 36-item interviewer-administered version in a sample of patients with bipolar disorder. There is no study to date that analyses how the scale works in a sample that only comprises such patients.
  
  
  METHODS
  A total of 291 patients with bipolar disorder (42.6% males) according to DSM-IV-TR criteria from a cross-sectional study conducted in outpatient psychiatric clinics were enrolled. In addition to the WHODAS 2.0, patients completed a comprehensive assessment battery including measures on psychopathology, functionality and quality of life. Analyses were centered on providing evidence on the validity and utility of the Spanish version of the WHODAS 2.0 in bipolar patients.
  
  
  RESULTS
  Participation domain had the highest percentage of missing data (2.7%). Confirmatory factorial analysis was used to test three models formulated in the literature: six primary correlated factors, six primary factors with a single second-order factor, and six primary factors with two second-order factors. The three models were plausible, although the one formed by six correlated factors produced the best fit. Cronbach's alpha values ranged between .73 for the Self-care domain and .92 for Life activities, and the internal consistency of the total score was .96. Relationships between the WHODAS 2.0 and measures of psychopathology, functionality and quality of life were in the expected direction, and the scale was found to be able to differentiate among patients with different intensity of clinical symptoms and work situation.
  
  
  CONCLUSIONS
  The percentage of euthymic patients was considerable. However, the assessment of euthymic patients is less influenced by mood. Some psychometric properties have not been studied, such as score stability and sensitivity to change.
  
  
  CONCLUSIONS
  The Spanish version of the 36-item WHODAS 2.0 has suitable psychometric properties in terms of reliability and validity when applied to patients with bipolar disorder. Disability in bipolar patients is especially prominent in Cognition, Getting along, Life activities, and Participation domains, so functional remediation interventions should emphasize these areas in order to improve the daily living activities of these patients.
authors.affiliation: Department of Methodology, Faculty of Psychology, University of Barcelona, Barcelona, Spain; Institute for Brain, Cognition, and Behavior (IR3C), Granollers Hospital General, Granollers, Barcelona, Spain.
authors.forename: Georgina
authors.initials: G
authors.lastname: Guilera
authors.affiliation: Department of Methodology, Faculty of Psychology, University of Barcelona, Barcelona, Spain; Institute for Brain, Cognition, and Behavior (IR3C), Granollers Hospital General, Granollers, Barcelona, Spain. Electronic address: juanagomez@ub.edu.
authors.forename: Juana
authors.initials: J
authors.lastname: Gómez-Benito
authors.affiliation: Department of Methodology, Faculty of Psychology, University of Barcelona, Barcelona, Spain; Department of Psychiatry, Benito Menni CASM, Granollers Hospital General, Granollers, Barcelona, Spain.
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Pino
authors.affiliation: Department of Psychiatry, Benito Menni CASM, Granollers Hospital General, Granollers, Barcelona, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Rojo
authors.affiliation: Bipolar Disorders Program, Institute of Neuroscience, Hospital Clinic i Provincial, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
authors.affiliation: Psychiatric Hospitalization Unit, Hospital Virgen del Camino, Pamplona-Iruña, Spain.
authors.forename: Manuel J
authors.initials: MJ
authors.lastname: Cuesta
authors.affiliation: Department of Psychiatry, Bebensee Schizophrenia Research Unit, University of Alberta, Edmonton, AB, Canada.
authors.forename: Scot E
authors.initials: SE
authors.lastname: Purdon
authors.affiliation: Barcelona Clinic Schizophrenia Unit, Institute of Neuroscience, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Bernardo
authors.affiliation: University Hospital Marqués de Valdecilla, IDIVAL, School of Medicine, University of Cantabria, Spain and CIBERSAM, Santander, Spain.
authors.forename: Benedicto
authors.initials: B
authors.lastname: Crespo-Facorro
authors.affiliation: Department of Psychiatry, Hospital Provincial Rodríguez Chamorro, Zamora, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Franco
authors.affiliation: Department of Psychiatry, Bebensee Schizophrenia Research Unit, University of Alberta, Edmonton, AB, Canada.
authors.forename: Anabel
authors.initials: A
authors.lastname: Martínez-Arán
authors.affiliation: Psychiatry Unit, Hospital Universitari Mútua Terrassa, Terrassa, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Safont
authors.affiliation: Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Tabarés-Seisdedos
authors.affiliation: Health Outcomes Research Department, Medical Unit, Pfizer Spain, Alcobendas, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Rejas
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology*; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D011788:Quality of Life; D015203:Reproducibility of Results; D012648:Self Care; D014944:World Health Organization
keywords: Bipolar I disorder; Disability; Functioning; Health status; ICF; WHODAS 2.0