Social and occupational functioning

The assessment of role performance has a fairly long history in psychotherapy research. The Social Adjustment Scale (62) was developed over 20 years ago to document the level in functioning in six areas: work as worker, 'housewife', or student; social activities; relationship with family; relationship with spouse; parental responsibilities; member of a family unit. There is much documentation of its psychometric properties and clinical utility, and it has been used with a wide range of adult outpatients. A unique feature of the Longitudinal Interval Follow-up Evaluation (63) is that it was designed to collect information on psychosocial functioning (as well as on diagnosis and symptoms) over longer periods of time. In the hands of trained evaluators, it is a structured interview that has been shown to have good reliability.

The concern among both scientists and health-care managers about the cost-effectiveness of specific treatments has generated interest in more comprehensive assessments of work functioning and productivity. Mintz et al.(64) reviewed 4000 articles in the psychiatric literature and discovered that what little is known about work functioning is based on patient responses to a very small number work-related questionnaire items. To address this problem, Endicott and Nee developed the Endicott Work Productivity Scale,(65) a self-report instrument containing 25 items designed to be sensitive to more subtle differences among patients in work attitudes and behaviour. Initial testing of this instrument in a patient and community sample provided evidence of its reliability, validity (concurrent and discriminant), and ability to detect change. Wider use of this new scale is required to draw conclusions about its clinical utility.

The interpersonal domain has been considered a secondary outcome in most treatment studies of Axis I disorders, its measurement restricted to a few items embedded in instruments that have broader coverage, such as the LIFE and the SAS. However, psychotherapy studies which specifically target interpersonal problems have advanced scale development in this area, and there is a fair amount of data on two self-report instruments appropriate for adult outpatients: The Inventory of Interpersonal Problems(66) and the Dyadic Adjustment Scale.*6!) The Inventory of Interpersonal Problems is a 127-item self-report measure with high internal consistency and test-retest reliability of each of the six subscales: assertive, social, intimate, submissive, responsible, and controlling. The Dyadic Adjustment Scale is a 32-item scale designed to assess the severity of relationship discord in married and unmarried cohabiting couples, with higher scores indicating better adjustment. Responses on the Dyadic Adjustment Scale discriminate between distressed and non-distressed couples and yield a total score based on the factors of dyadic consensus, dyadic cohesion, dyadic satisfaction, and affectional expression.

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