Reliability and validity of the Work and Social Adjustment Scale in phobic disorders
Introduction
The Work and Social Adjustment Scale (WSAS) is a simple 5-item measure of general impairment which grew out of a study of change during psychotherapy [1]. It was adapted as a 4-item scale (work, home, social, and private leisure) to rate disability in psychotherapy studies in phobics [2], [3], [4]. Marks et al [5] adapted it further to measure the outcome of most patients in treatment and later added its fifth item concerning interpersonal relations. Each item has 9 points; a modification by Sheehan [6] has 11-point items. The WSAS is simple for self-ratings and assessor ratings and was sensitive to change in anxious/depressed and other patients in many drug and psychotherapy studies.
In large samples of depressed and obsessive-compulsive patients, the WSAS was reliable, valid, and sensitive to change [7]. In the study of Mundt et al, the WSAS's internal consistency was high and its 5 items formed a single factor of general disability. It is not known, however, if different phobics score less consistently across the 5 WSAS items. For instance, agoraphobics may have impaired work but not home adjustment, specific snake phobics may have no difficulty in either area, whereas social phobics may have impaired social but not private leisure. This study examined the psychometric properties of the WSAS in a large sample of agoraphobics, social phobics, and specific phobics who took part in various controlled and open trials of computer-guided exposure therapy.
Section snippets
Patients
Participants were 205 phobics (73 agoraphobia, 62 social phobia, and 70 specific phobia) who took part in various controlled and open trials of computer-aided self-exposure therapy at the Maudsley and Charing Cross hospitals in London [8], [9], [10], [11]. They were diagnosed by experienced clinicians using checklists of the relevant International Statistical Classification of Diseases, 10th Revision, or Diagnostic and Statistical Manual of Metal Disorders, Fourth Edition, criteria. The
Internal consistency
The WSAS's internal consistency was assessed by Cronbach's α on 3 occasions (pre- and posttreatment and 1-month follow-up) for self-ratings and blind assessor ratings, and for each phobia type (agoraphobia, social phobia, and specific phobia). Using the criteria of Nunnally [15], internal consistency was deemed good on 16/24 data sets (α = .80-.90; Table 1) and acceptable on a further 7/24 data sets (α = .71-.77) across the 3 occasions and 3 phobia types. It was low on just 1 data set
Discussion
This study explored the psychometric properties of the WSAS, a widely used measure of disability, in 205 phobic patients along the lines of earlier analyses in patients with depression and obsessive-compulsive disorder [7].
For phobics in general and for agora- and social phobics in particular, the WSAS appeared to be a highly reliable measure of disability, with Cronbach's α ranging from 0.72 to 0.90. Factor analysis of the WSAS's 5 items yielded a single general disability factor explaining
Acknowledgments
We thank Drs James C. Mundt and John H. Greist for their helpful comments on an earlier version of the manuscript.
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