Using the WHODAS 2.0 to Assess Functioning Among Veterans Seeking Compensation for Posttraumatic Stress Disorder.
OBJECTIVE
One of the major changes in DSM-5 was removal of the Global Assessment of Functioning (GAF). To determine whether the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a suitable replacement for the GAF, this study compared how well the WHODAS 2.0 and the GAF measured functional impairment and other phenomena related to posttraumatic stress disorder (PTSD) among veterans applying for financial compensation (service connection) for PTSD.


METHODS
Clinicians evaluating veteran claimants administered the Clinician Administered PTSD Scale (CAPS) and the WHODAS 2.0 to 177 veterans during their evaluations. Veterans also completed the Inventory of Psychosocial Functioning (IPF), a self-report measure of functional impairment, and received a GAF rating from the examiner. Actual benefit determinations and ratings were obtained.


RESULTS
Confirmatory factor analyses demonstrated that the WHODAS 2.0 and the IPF were stronger indicators of a latent variable reflecting functioning compared with the GAF. In receiver operating characteristic curve analyses, the WHODAS 2.0, IPF, and GAF all displayed similar ability to identify veterans with PTSD-related impairment assessed by the CAPS. Compared with the GAF, the WHODAS 2.0 and IPF were less strongly related to PTSD symptom severity and disability ratings by the U.S. Department of Veterans Affairs, but these variables are typically influenced by GAF scores.


CONCLUSIONS
The WHODAS 2.0 and IPF are acceptable replacements for the GAF and can be used to assess functional impairment among veterans seeking compensation for PTSD.
Dr. Marx, Dr. Wolf, and Dr. Keane are with the National Center for PTSD, VA Boston Healthcare System, Boston (e-mail: brian.marx@va.gov ). They are also with the Department of Psychiatry, Boston University School of Medicine, Boston. Dr. Cornette is with the Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Dr. Schnurr and Dr. Friedman are with the Executive Division, National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont, and the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Rosen is with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, and with the Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut. Dr. Speroff is with the Center for Health Services Research, Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, and the Vanderbilt University School of Medicine, Nashville, Tennessee.
Brian P
BP
Marx
Dr. Marx, Dr. Wolf, and Dr. Keane are with the National Center for PTSD, VA Boston Healthcare System, Boston (e-mail: brian.marx@va.gov ). They are also with the Department of Psychiatry, Boston University School of Medicine, Boston. Dr. Cornette is with the Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Dr. Schnurr and Dr. Friedman are with the Executive Division, National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont, and the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Rosen is with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, and with the Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut. Dr. Speroff is with the Center for Health Services Research, Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, and the Vanderbilt University School of Medicine, Nashville, Tennessee.
Erika J
EJ
Wolf
Dr. Marx, Dr. Wolf, and Dr. Keane are with the National Center for PTSD, VA Boston Healthcare System, Boston (e-mail: brian.marx@va.gov ). They are also with the Department of Psychiatry, Boston University School of Medicine, Boston. Dr. Cornette is with the Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Dr. Schnurr and Dr. Friedman are with the Executive Division, National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont, and the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Rosen is with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, and with the Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut. Dr. Speroff is with the Center for Health Services Research, Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, and the Vanderbilt University School of Medicine, Nashville, Tennessee.
Michelle M
MM
Cornette
Dr. Marx, Dr. Wolf, and Dr. Keane are with the National Center for PTSD, VA Boston Healthcare System, Boston (e-mail: brian.marx@va.gov ). They are also with the Department of Psychiatry, Boston University School of Medicine, Boston. Dr. Cornette is with the Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Dr. Schnurr and Dr. Friedman are with the Executive Division, National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont, and the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Rosen is with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, and with the Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut. Dr. Speroff is with the Center for Health Services Research, Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, and the Vanderbilt University School of Medicine, Nashville, Tennessee.
Paula P
PP
Schnurr
Dr. Marx, Dr. Wolf, and Dr. Keane are with the National Center for PTSD, VA Boston Healthcare System, Boston (e-mail: brian.marx@va.gov ). They are also with the Department of Psychiatry, Boston University School of Medicine, Boston. Dr. Cornette is with the Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Dr. Schnurr and Dr. Friedman are with the Executive Division, National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont, and the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Rosen is with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, and with the Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut. Dr. Speroff is with the Center for Health Services Research, Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, and the Vanderbilt University School of Medicine, Nashville, Tennessee.
Marc I
MI
Rosen
Dr. Marx, Dr. Wolf, and Dr. Keane are with the National Center for PTSD, VA Boston Healthcare System, Boston (e-mail: brian.marx@va.gov ). They are also with the Department of Psychiatry, Boston University School of Medicine, Boston. Dr. Cornette is with the Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Dr. Schnurr and Dr. Friedman are with the Executive Division, National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont, and the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Rosen is with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, and with the Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut. Dr. Speroff is with the Center for Health Services Research, Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, and the Vanderbilt University School of Medicine, Nashville, Tennessee.
Matthew J
MJ
Friedman
Dr. Marx, Dr. Wolf, and Dr. Keane are with the National Center for PTSD, VA Boston Healthcare System, Boston (e-mail: brian.marx@va.gov ). They are also with the Department of Psychiatry, Boston University School of Medicine, Boston. Dr. Cornette is with the Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Dr. Schnurr and Dr. Friedman are with the Executive Division, National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont, and the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Rosen is with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, and with the Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut. Dr. Speroff is with the Center for Health Services Research, Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, and the Vanderbilt University School of Medicine, Nashville, Tennessee.
Terence M
TM
Keane
Dr. Marx, Dr. Wolf, and Dr. Keane are with the National Center for PTSD, VA Boston Healthcare System, Boston (e-mail: brian.marx@va.gov ). They are also with the Department of Psychiatry, Boston University School of Medicine, Boston. Dr. Cornette is with the Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Dr. Schnurr and Dr. Friedman are with the Executive Division, National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont, and the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Rosen is with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, and with the Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut. Dr. Speroff is with the Center for Health Services Research, Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, and the Vanderbilt University School of Medicine, Nashville, Tennessee.
Theodore
T
Speroff
D000328:Adult; D016000:Cluster Analysis; D003130:Combat Disorders / Q000175:diagnosis*; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012680:Sensitivity and Specificity; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis*; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*; D014729:Veterans Disability Claims; D014944:World Health Organization; D055815:Young Adult