Affiliations: [a] Health and Disability Research Institute, Boston University School of Public Health, Boston, MA, USA | [b] Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA | [c] Rehabilitation Medicine Department, Mark O. Hatfield Clinical Research Center, National Institutes of Health, Bethesda, MD, USA | [d] Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
Correspondence:
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Corresponding author: Elizabeth E. Marfeo, Health and Disability Research Institute, Boston University School of Public Health, 715 Albany St. T5W, Boston, MA 02118-2526, USA. Tel.: +1 617 638 1990; Fax: +1 617 638 1999; E-mail:[email protected]
Abstract:
BACKGROND: 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.
Keywords: Work disability, behavioral health, disability evaluation
